The National System of Transport of specimens on track in Cambodia

Cambodia

June 13, 2023
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The National System of Transport of specimens on track in Cambodia

An initial survey involving 37 laboratories from human and animal health sectors has documented the flow of samples and the current ad hoc system that relied on untrained transport means. The results were presented in July 2022 to the key stakeholders who brainstormed on the structure of the pilot phase for a sustainable National Transportation System of specimens (NTS).

The 3-month pilot phase started on October 15, 2022 and ended on January 15, 2023 and included an intervention component of 3 provincial laboratories participating in the SEALAB program, and 8 district hospitals. and a control component of 3 provincial hospitals and 5 district hospitals. All laboratories completed forms to to assess the efficiency of the system and impact on the quality of specimens, particularly on sample rejection. A total of 2,640 specimens were transported during the pilot-phase, resulting in a large quantity of data that has been analyzed by the epidemiology unit of the Institut Pasteur in Cambodia for documented recommendations.

A national workshop held on June 12, 2023, brought together health authorities from human and veterinary sectors, and representatives of organizations involved in laboratory strengthening programs. The main objective of the workshop was to present the pilot phase results and to issue a consensual proposal to guide a realistic and sustainable National Transportation System of specimens.

Dr. Sorn San, Deputy Director General of GDAHP and Dr. Hoy Serey Vathanak, Deputy Director General of MoH provided opening statements, reminding that transportation of samples is a major part of the preanalytical pathway and that there exists a likelihood of exposure for the people and the environment, which could be critical during a disease outbreak. It was acknowledged that Specimen Transport Systems are an under-recognized component of a country’s laboratory capacity.

A preliminary presentation repeated the methodology of the pilot phase, followed by a presentation by Dr. Ly Sowath, Deputy Director of IPC, on data, analysis and consequent recommendations for the participants. Dr. Sek Mardy presented the findings of a satisfaction survey conducted by interviewing  each “intervention laboratory” with a questionnaire on technical data and an overall appreciation of laboratory managers.

During the discussions between participants it was clear that information provided by data analysis and survey results must be enriched by practical considerations. For example, laboratory managers noted that a national system requires a large courier company to cover the entire laboratory network. However there is a large turn-over of drivers who are rarely familiar with the locations for picking-up and delivering samples, resulting in delays and incorrect deliveries. It was proposed to ask the courier company to geolocalize all laboratories. Presentations made by laboratory managers from the intervention laboratories comparing previous and experimental system  were very informative.

The laboratory managers were more concerned by lessons learnt during the COVID-19 crisis, especially the challenge a laboratory network faces when tackling high-risk global health security threats and the safe transportation of potentially bio-hazardous specimens.

Further discussions between the participants showed that  a National System of Transport of biological specimens is a priority, BS&S is critical, the best service should be provided by a national courier company and there is a need of a policy for NTS.

An online questionnaire was sent to all participants in order to better define:

  • The goals of a standardized transportation system
  • The biosecurity challenges (risks of spillover)
  • The criteria of selection of a courier company
  • The main articles of a NTS policy

The real time analysis was shared with the participants for comments and suggestions and the data analysis and report issued by IPC and the results of the survey will be transmitted to the GDAHP and MOH. Both Ministries recently set up a One Health Technical Working Group and the documents will be presented to the working group by the NAHPRI/GDAHP.

The process to finalize this initial phase of setting up a sustainable NTS has been complex but it is now on track. Health Authorities from both sectors have formally recognized this priority for Laboratory System strengthening.

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