Meet the lab manager at the centre of saliva testing

​If you've ever wondered how saliva testing works, then keep reading as Joanne Mercer shares all there is to know about the process.

What is your role at NSW Health? What are you doing now as part of the COVID-19 response?

My position is Laboratory Manager in Microbiology at the NSW Health Pathology (NSWHP) laboratory based at Royal Prince Alfred (RPA) Hospital.

Like many other NSWHP laboratories, our laboratory performs nucleic acid testing for the detection of the SARS-CoV-2 virus, the organism that causes COVID-19 infection.

Have you been involved in anything like this before?

No, COVID-19 has presented many new challenges for us all!

What are some of the COVID-19 initiatives you have spearheaded?

Our laboratory performs nucleic acid testing of nose/throat swabs from patients presenting to the RPAH Emergency Department, the numerous COVID-19 clinics in the Sydney Local Health District (SLHD), patients in quarantine, staff working at high risks facilities such as the Special Health Accommodation and international aircrew.

In addition to testing for diagnosis of infection, the laboratory has been involved in assessment and implementation of the use of saliva samples for screening of COVID-19 in an occupational setting. The use of saliva samples in surveillance screening has been implemented for those at increased risk of infection e.g. healthcare staff and staff at quarantine hotels, and it also enables sequential testing.

How is this initiative different to what is being done elsewhere?

Saliva is easier to collect than a nasal and oral swab and the process is less confronting. Saliva is used where sequential testing of an individual is required to monitor for infection. A surveillance program which tests saliva samples from staff at hotels utilised for quarantine of returned travellers has been implemented recently.

How is this work beneficial to staff/the public/the NSW Health pandemic response?

Repeated screening of staff participating in an occupational surveillance program may result in the early identification of infected individuals, enabling them to be isolated rapidly and thereby minimising disease transmission.

What's your biggest learning to date?

I've been reminded of the value of teamwork. There are many obstacles to be overcome before the samples even arrive in the laboratory, for example from provision of collection devices, supervision of collections, sample transport and registration of patient samples.

Once in the laboratory, we perform a series of complex analyses and interpretation steps and the results are then disseminated. These steps require the careful attention of many laboratory and medical staff to ensure the result is correct. The outcome of the entire process is owing to the huge effort and contribution of many people.

What have been some of the challenges you've faced and how have you overcome them?

The main challenge COVID-19 has presented to the laboratory, is the massively increased workload in the logistics, specimen reception, data entry, molecular microbiology and IT areas of NSWHP at RPA.

This has required major reconfiguration to instrumentation, workflow and staffing, however the dedication and hard work of our team has been fantastic.