Paper Title
Charting the Changes in Pre-Analytical Protocols in Covid-19 Testing Clinical Laboratories in Metro Manila, Philippines: Implications to Health Care Workers

Abstract
This non-experimental study aimed to identify the significant changes in pre-analytical protocols in licensed COVID-19 testing clinical laboratories in Metro Manila as well as to determine its implications to health care workers. An electronic survey was deployed, and a total of 84 respondents were included in the study through purposive sampling. The majority of responses came from institutional COVID-19 testing laboratories catering to outpatients. Results revealed that transporting samples by hand was the most common method of specimen transportation in both before and during the COVID-19 pandemic. The use of a plastic bag which is placed in a solid-walled, leak-proof container persisted as the most common practice in packing patient samples. The use of gloves and surgical masks remained a common practice during specimen collection and receipt, but a significant rise in the use of goggles or face shields, N95 face masks, and physical barriers were noted. In specimen processing, a significant increase in the frequency of usage of personal protective equipment was observed, particularly in the use of goggles or face shields and N95 face masks. Most laboratories imposed no testing restrictions but regular temperature monitoring and disinfection of surfaces were implemented. A decrease in the average working hours was noted and staff were not split in teams nor divided into rotations. A common challenge encountered by the respondents was about safety and preparedness. Given the results of the study, the researchers were able to infer that the pre-analytical protocols adopted by clinical laboratories in Metro Manila were consistent with those recommended by international institutions. It may be concluded that there was a significant difference (p-value<0.05) in pre-analytical protocols before and during the COVID-19 pandemic in COVID-19 testing clinical laboratories in Metro Manila, Philippines. Keywords - COVID-19; clinical laboratories; pre-analytical protocols, health care workers