Designing diagnostic labs that are safe, specific and sustainable

To detect an outbreak early -- whether Ebola, Zika or influenza -- healthcare workers must have a local, trustworthy diagnostic lab. For the past five years Sandia's International Biological and Chemical Threat Reduction group has served as a trusted adviser for design of diagnostic labs around the world that are safe, secure, sustainable, specific and flexible.

Now Bill Arndt, a systems analyst at Sandia, has developed a new method to speed up the critical initial stages of the lab design process used by Sandia, without sacrificing results. Arndt and his team used his Prototype Lab tool in Iraq to support the initial design of the central veterinary lab.

"We have all these laboratory and support space modules, and the idea is like going back to when you were a kid with Lego bricks. We work with the in-country partners to actually put the pieces together to build a functional lab," said Arndt.

The Prototype Lab tool, funded by the Defense Threat Reduction Agency's Cooperative Biological Engagement Program, greatly speeds up Sandia's lab design process. It was first used to design a foot-and-mouth disease diagnostic lab in Kenya.

Since details within each module generate drawings that are nearly a third construction-ready, the international partners can have blueprints for builders in about half the time, said Arndt.

The modules are all the same dimensions -- for ease and speed of design and construction -- with designs of secure entryways, loading docks, restrooms, office spaces and many different types of laboratories. The labs include seven different molecular diagnostic modules for testing patient samples for telltale DNA or RNA signatures of various diseases and four clinical collection modules for sample collection, sorting and processing.

Each lab design process Sandia participates in expands the catalogue of modules. For instance, the Iraqi central veterinary lab required large animal diagnostic modules, which will be available for subsequent design processes. The handover of the final lab design conceptual drawing for the Iraqi central veterinary lab occurred last summer.

Laboratory modules with biosafety and biosecurity best practices built in

The primary goal of biosafety is to make sure infectious pathogens stay contained and "the staff only go home with their salary and nothing else," said Halkjaer-Knudsen.

Personal protective equipment, standard operating procedures, administrative controls and engineering controls all help reduce the risks of working with pathogens. And by building in these controls during the lab design process, the work performed in the lab will be safer.

Sandia's lab design experts and their partner HDR Inc. of Omaha, Nebraska, an international architecture and engineering company, have designed biosafety and biosecurity best practices into each module. This includes putting sinks near the exits so staff can wash their hands as they exit the lab, placing key laboratory equipment away from high traffic areas so that they function properly and pre-selecting easy-to-clean floors and benchtop surfaces.

Careful placement of modules is another way to make certain biosafety best practices are being followed. Two examples include placing breakrooms away from labs with hazardous or infectious materials and ensuring that labs that generate a lot of infectious waste are located close to sterilization facilities.

Another important aspect of lab design is biosecurity, including physical security. Sandia's process supports secure access to the building and between public space and laboratory space, though it's not expressly built into the prototype modules themselves.

Building labs that are specific yet flexible to adapt to future needs

In addition to being safe and secure, a new lab must meet the needs of international partners and be flexible enough to adapt to evolving diagnostics over the next several decades of operation.

The design process brings all the stakeholders to the table -- the end-users, lab design experts, biosafety experts, sponsors and architects -- and determines the activities and needs of the facilities, and how best to achieve them. The end-users know the most about the diagnostics and services their labs provide, but often they're limited by preconceived ideas influenced by their old lab. The external experts have a comprehensive understanding of lab design, but they don't know what does and does not work in the specific country and environment.

All of the stakeholders meet for three or four intense sessions that last several days each, spread over about six months, and plan everything from defining the general mission of the new building all the way to developing a detailed conceptual layout. Sandia doesn't advance the designs to full construction-ready blueprints; instead the conceptual designs are turned over to architects for completion.

To guarantee that the final lab is going to actually meet the needs of the users and conform to international best practices, Sandia continues to play an advisory role by reviewing and providing comments on the construction-ready blueprints. Also, this support builds local design and construction capacities and helps ensure biosafety and biosecurity best practices are taken into consideration in future design projects, even if Sandia isn't involved, said Arndt.

The tool "is a very tangible, hands-on, visual tool to help understand and sharpen the dialogue, because very few facilities are actually identical when you begin to grind down, but they all consist of the same blocks in different permutations," said Halkjaer-Knudsen. Each module comes with a 3-D rendering of what the space will look like, which helps the end-users and sponsors envision the final product.

Beyond meeting the basic facility needs, Sandia's lab design process focuses on adaptability. Using open labs for activities that are not endangered by cross-contamination or need for specialized ventilation is one way to build in flexibility. Another is to use mobile instead of fixed casework such as benches and cabinets. An open lab with sections for three different bacterial diseases can adapt to a cholera outbreak by scooting equipment over a bit, whereas three small, specialized bacteriology labs lack that surge capacity, Halkjaer-Knudsen explained.

Establishing sustainable labs for the local environment

Making sure a lab lasts 30 or 40 years in the relatively harsh climates of Iraq, Kenya or Cambodia and other tropical locales demands attention to hazards and environment. In many developing countries, frequent blackouts and brownouts turn biosafety cabinets and other critical equipment into nothing more than "modern art," said Halkjaer-Knudsen. Backup generators, uninterrupted power supplies for vital equipment, even solar panels are potential solutions, but only if fuel for the generator is readily available and the solar panels can withstand local sandstorms.

"You cannot take something we have in the U.S. and just plop it down as copy-paste," said Halkjaer-Knudsen. "Asia is extraordinarily humid, everything grows mold and fungus. In the Middle East everything is dusty and dry."

That is why Sandia's process and prototype tool promotes the use of local architects and engineers. They know the finishes that can mitigate mold growth and air filters that can survive a sandstorm. They know the materials and construction methods that locals can use, repair and maintain, explained Arndt.

The prototype design tool also helps ensure that the lab is an affordable and sustainable size. Each module has its own entry in a cost estimation spreadsheet that includes the cost to build and equip it. Very early in the design process, well before the lab is laid out, the spreadsheet can generate a quote for a lab built with those modules. The estimation tool can even be adjusted using local construction costs to improve the accuracy of the quote. This gives the sponsors and the end-users a benchmark figure early in the design process, so they can consolidate or adjust the plan as needed.

During outbreaks, foreign donors sometimes fund temporary labs. These labs can be deployed quickly to critical situations, but are often only a short-term solution. They are typically designed and built in a foreign country, under radically different environmental conditions. Thus, they can meet short-term needs but are not as durable. Local contractors may not know how to repair the labs or have the right parts.