Lateral Flow Testing in schools: An SBM's advice and experience

As I write this, we are two weeks into the new term and the Lateral Flow Testing regime that we were tasked to get up and running is established. When it was first announced on the 18th December, my first thought was panic that we couldn’t do it but yet again, I was wrong. We could and we did, all it took was a bit of organisation, tweaking as we went.

I thought it may be useful to share my findings for those who are not yet operational, hopefully to offer reassurance and advice. I should point out this is from my personal experience and shouldn’t be taken as definitive.

Here are my top tips:

1. Calm down. It’s not as bad as you think.
2. You are not setting up a completely germ-free, forensic lab. You are likely doing this in a school gym/spare room. I have even seen one particularly innovative SBM set this up in a minibus. We aren’t operating as per Silent Witness.
3. You can only do the best that you can do. It won’t be perfect but it will be something.
4. You think it’s going to be really complicated but it really isn’t once you get going.
5. The training is fine. It doesn’t take as long as you think.
6. Use the resources on the DfE Google Drive
7. You don’t need as many people as they lead you to believe.

So first things first, what are you provided with by the Government and what do you need to provide.

You are sent:

• LFT tests
• Masks
• Plastic aprons
• Gloves (many sizes)
• Visors
• Yellow and black stripy bags for clinical waste to dispose of used PPE (deemed hazardous)

They assume that you will have:

• Cleaning products (sanitiser spray, wipes, hand gel, mop)
• Trays (we bought Thai takeaway trays. Cheap and easy to clean)
• Timers (cheap kitchen timers are fine – they need to be small enough to sit in a tray with each test as it processes)
• Test tube holders (we use ice cube trays)
• Sharpies to write time of and result on each test
• Clocks (we bought cheap digital clocks)
• Mirrors (helpful when trying to locate tonsils)
• Bins (we bought 3-foot operated pedal bins for disposal of PPE and the tests. We also bought photography clips to attach bin bags to the testing tables for used tissues and discarded packaging)
• Room with non-porous floor (this just means it can be cleaned easily in case of spillage or vomit (yes … the test does activate gag reflex – for this reason I also purchased vomit bowls). Some schools have just used heavy duty plastic.
• Furniture (we used exam desks, plastic chairs and the PTA folding wipeable tables)
• Clinical waste disposal service. You will need to add to your existing contract. The used PPE is classified as hazardous waste and whilst the tests and swabs are not categorised as such they are not allowed to go to landfill so cannot go with your usual waste.

Roles for staff

A number of roles are specified and each has associated online training. There is no reason that once training has completed that people cannot fulfil multiple roles during one session as long as correct notice is made re: PPE and cross-contamination. For example, you may start a shift as registration officer then once everyone is registered, move to processing tests. At the end of the shift you may then move to log all results. When you are only processing a limited numbers of tests, this realisation is helpful, particularly when you may want to minimise numbers of people on site.

Registering pupils

The registration part of the testing process is the most labour intensive/time-consuming part of it all. However, with a bit of organisation steps can be taken to minimise it. Firstly, it is of utmost importance that you create your own staff/student register alongside registering the tests to the official reporting site. On this register, you must stick one of the test barcodes next to the name of the person doing the test. If you don’t do this and you find you have a positive test you will have no way of establishing who the test was from until they themselves receive notification. Obviously if someone is positive you want them off-site asap!

Secondly, it is easier to pre-register students in bulk, in their bubbles, the day before. This can be done at any desk and away from the testing site. All you need is access to a webcam. I have found that if I redeploy a number of support staff onto this the job gets done really quickly.

Firstly, download a list of all students with consent from MIS by bubble groups. Include notification telephone number, 1st line of address, postcode and Date of Birth. As you register the students online, stick one of the 3 barcodes issued per test to the registration card that you have named for the student. One barcode is stuck next to student name on register. Final barcode stapled onto card for student to hand to tester as they arrive for test. Set testing times for each bubble the next day and away you go.

Registering staff

For staff, it is even easier as they can be issued with a card to pre-register themselves for their next test when they arrive for their first test. From this point on, as they arrive to be tested, they give you one barcode from their pre-registration to stick on the register next to their name and the other handed by them to tester. Simples.

Carrying out tests

Once you get registration nailed, you will note that carrying out the tests can be done swiftly. In the first instance, the time-consuming part is the explanation of how to self-administer the test. Most will be fine. Some will not do it right so you can ask them to repeat and in worst case scenario ask them to swab both nostrils. Given the test isn’t 100% reliable even if completed totally correctly, the best you can do is try.

The process speeds up from test number two as you don’t have to explain again. It isn’t something you forget, how to stick a giant cotton bud to the back of your throat then up your nose. In the interests of speed and hygiene, get the person completing the test to wipe down everything they have touched as they leave the booth. It’s one less thing to be done by you.

As the test processor completes each test, they write down the time on it, pop it into a tray and start the timer in the tray. Once the allotted 30 minutes has passed, they write the result in sharpie on the test, remove the timer and wipe it down, then take the test in the tray to the recorder table and leave it. You can stack up a lot of tests here as the recorder can record the results at any point using the notification on the test itself – even at the end of the session.

The assumption is that if a positive result is noted, the test processor will alert the site manager as soon as it is noted i.e. even before it gets to the recording station, to identify the positive person and start the process to get them off-site.

Testing room

The room itself needs to be cleaned thoroughly at least twice a day. We fog the room with antiviral spray every morning and lunchtime to keep on top of the cleanliness. Windows are open to encourage airflow BUT we also have the heating on full and have bought some cheap electric heaters to ensure the temperature is within guidelines. Yes, we do have a thermometer to verify. I am not thinking about the heating bills.

I have to say that this process would have been completely manic had we had to process 2200+ staff over the past 2 weeks and yes, we would have needed volunteers in abundance. It would have been a mammoth task arranging rotas, ensuring training had been undertaken and the admin alone would have been huge. But lockdown has meant that it was manageable. We were able to start relatively small, testing some staff as our first guinea pigs before moving onto testing all students on site the very next day (approximately 70 with consent). This was with only three members of the testing team working simultaneously.

As a result of what we have done over the last two weeks, we know that we have a robust system. We know what we are doing and when we need to we are 100% confident that we can roll it out. The fear factor has gone. Yes, we will need the requested volunteers to process 4,000 tests when we reopen to all students, but it can absolutely be done within the 3-5 day timeframe.

All it will take is organisation. That, we can do. And you can too.