As National Laboratory Professionals Week comes to a close, APHL is proud to honor all of the public health laboratory professionals who work tirelessly to protect the health and safety of the public. You are each to be commended for the high quality work you deliver day after day-- despite budget cuts, furloughs, staff down-sizing, antiquated facilities and all the other challenges that confront laboratorians in 2010.
So today, raise a purple-gloved hand high in a salute to you and your colleagues. Few people can say that their work saves lives, but you can. I extend my sincere thanks on behalf of the people you serve and the association that is fortunate to represent you.
Scott Becker
Executive Director, APHL
Friday, April 23, 2010
Thursday, April 22, 2010
Celebrating Earth Day and Lab Week
Happy Earth Day! This year marks the 40th anniversary of this celebration, a day designed to inspire awareness and appreciation for the Earth's environment. While we have come a long way in improving our environment – no more rivers so contaminated that they regularly are consumed in flame, for example – we still have a long way to go, as evidenced by recent findings of contaminants in dog food, baby bottles, and children’s toys.
Did you know that laboratories are vital to protecting us from harmful contaminants in our environment?
Public health laboratories measure contaminants once they get into our bodies, while environmental laboratories measure contaminants in the environment itself (in the air, water or soil).
To better illustrate the importance of the lab’s role in protecting us from environmental contamination, here is a fictional but realistic scenario:
A group of six young men, all apparently friends, arrive at a local emergency room with similar symptoms: nausea, vomiting, headache, fatigue and weakness. The ER immediately takes blood and urine specimens, sending them to the hospital labs for screening while simultaneously contacting the state Poison Control Center for advice.
Tests indicate cell and tissue decomposition and the Poison Control Center suspects radiation sickness. They recommend calling the state public health lab for guidance. Meanwhile, all of the patients and medical staff who came into contact with these men (receptionists, nurses, and physicians) enter quarantine. The men’s clothing is secured.
The public health lab contacts the local FBI field office, which immediately sends agents, while the Department of Defense’s Civil Support Team begins processing the men’s townhome. A suspicious white powder is found along with documentation on a laptop linking the men to a recent theft totaling over $75M in radiopharmaceuticals. Following confirmation of radioactivity, the scene is evacuated and cordoned off.
Meanwhile, the FBI locates a storage unit rented by one of the men under an assumed name. Upon search of the unit they find more of the white powdery substance as well as containers of paint remover, concentrated sulfuric acid and hydrogen peroxide. In addition, the unit contains laboratory equipment (glassware, distillers, mixers, an ice bath and filters).
Ultimately, the white powder is determined to be Triacetone Triperoxide (TATP), a powerful, highly unstable homemade explosive. Apparently, the men were trying to build a dirty bomb and were exposed to the radioactive pharmaceutical they had stolen.
People who came into contact with these men remain concerned about their potential exposure, so the state public health lab tests their urine. The results reassure the medical staff and the men’s neighbors that they need not worry. The state environmental laboratory tests soil and water samples from around the storage unit and the men’s townhome; much to local policymakers’ relief the results show no reason for concern.*
Thanks to the coordinated response between the hospital, the Poison Control Center, the Civil Support Team, the public health laboratory, the environmental laboratory and the FBI, the terrorist plot was foiled. Public health and safety were protected!
* Note that there is no national program for radioanalytical laboratory preparedness and response. Some states are better able to test for radioactivity than others, some not at all.
For more information on environmental health and laboratories see www.aphl.org/eh
For more information on Earth Day see:
Did you know that laboratories are vital to protecting us from harmful contaminants in our environment?
Public health laboratories measure contaminants once they get into our bodies, while environmental laboratories measure contaminants in the environment itself (in the air, water or soil).
To better illustrate the importance of the lab’s role in protecting us from environmental contamination, here is a fictional but realistic scenario:
Tests indicate cell and tissue decomposition and the Poison Control Center suspects radiation sickness. They recommend calling the state public health lab for guidance. Meanwhile, all of the patients and medical staff who came into contact with these men (receptionists, nurses, and physicians) enter quarantine. The men’s clothing is secured.
The public health lab contacts the local FBI field office, which immediately sends agents, while the Department of Defense’s Civil Support Team begins processing the men’s townhome. A suspicious white powder is found along with documentation on a laptop linking the men to a recent theft totaling over $75M in radiopharmaceuticals. Following confirmation of radioactivity, the scene is evacuated and cordoned off.
Meanwhile, the FBI locates a storage unit rented by one of the men under an assumed name. Upon search of the unit they find more of the white powdery substance as well as containers of paint remover, concentrated sulfuric acid and hydrogen peroxide. In addition, the unit contains laboratory equipment (glassware, distillers, mixers, an ice bath and filters).
Ultimately, the white powder is determined to be Triacetone Triperoxide (TATP), a powerful, highly unstable homemade explosive. Apparently, the men were trying to build a dirty bomb and were exposed to the radioactive pharmaceutical they had stolen.
People who came into contact with these men remain concerned about their potential exposure, so the state public health lab tests their urine. The results reassure the medical staff and the men’s neighbors that they need not worry. The state environmental laboratory tests soil and water samples from around the storage unit and the men’s townhome; much to local policymakers’ relief the results show no reason for concern.*
Thanks to the coordinated response between the hospital, the Poison Control Center, the Civil Support Team, the public health laboratory, the environmental laboratory and the FBI, the terrorist plot was foiled. Public health and safety were protected!
* Note that there is no national program for radioanalytical laboratory preparedness and response. Some states are better able to test for radioactivity than others, some not at all.
For more information on environmental health and laboratories see www.aphl.org/eh
For more information on Earth Day see:
- Top Ten Actions Individuals, Organizations, and Businesses can Take in Reducing Their Contribution to Global Warming
- Commit to taking action or sign up for daily green tips
Wednesday, April 21, 2010
Laboratory Systems & Standards: Building the Foundation for Quality Testing
In honor of Laboratory Professional Week, APHL would like to highlight some of the activities that it conducts on behalf of members. The Laboratory Systems and Standards (LSS) program works with public health and laboratory partners to build the foundation for quality testing: comprehensive standards and integrated public health laboratory systems.
Vaccine-Preventable Disease Project
As the incidence of Vaccine-Preventable Diseases (VPD) decreases in the US, the capacity and capability of state and local public health laboratories to perform VPD testing has declined, becoming increasingly inconsistent. While some labs are quite proficient in VPD testing, others are eliminating testing altogether. However, timely and accurate diagnosis of VPDs is essential to identify and control outbreaks and to provide the information needed to improve vaccines and vaccination programs. To address gaps in testing capacity for VPDs, APHL was recently awarded funding through the American Recovery and Reinvestment Act of 2009 (ARRA) to provide training programs and quality improvement activities for VPD testing in public health laboratories. The association is partnering with CDC to develop and present these programs.
The first initiative is a series of teleconferences targeted to public health laboratorians. To date, CDC subject matter experts have presented new diagnostic testing methods for several VPDs, including Bordetella pertussis (whooping cough), Streptococcus pneumoniae, measles virus and mumps virus. The mumps educational teleconferences have been especially timely in light of the ongoing mumps outbreak in the northeastern United States. State public health lab staff are being trained in the new mumps assay developed at CDC. Access to this assay will enhance patient diagnosis and epidemiological investigations in participating states.
In response to a recent survey of public health labs’ training needs for VPDs, more trainings and quality improvement activities are planned, including hands-on workshops, proficiency testing exercises and assay comparison studies. By working together on these activities, APHL and CDC look forward to helping public health laboratories to improve their capability to quickly and accurately detect cases of VPDs.
Voluntary Accreditation Program
“Continuous quality improvement” is part of the laboratorian’s credo. Assays and equipment must meet precise quality standard before they can be utilized in the laboratory. Now APHL is developing voluntary standards specific to public health laboratories that will be used to assess the quality of the laboratory itself and specifically its operations and functions. These new standards will not supplant CLIA, but be used as a complement to the federal regulation.
The accreditation program will be voluntary, and will integrate standards from existing domestic and international sources as well as those outlined in the Core Functions of Public Health Laboratories.
Incorporation of the public health laboratory standards will be proposed to the Public Health Accreditation Board (PHAB) for incorporation into their accreditation process. Accreditation will signify that the laboratory has met agreed-upon standards of quality and that it ascribes to them as a measure of its services.
APHL is convening a Think Tank with PHAB at the end of April to discuss how the program should look, be structured, and what elements should be included in such a partnership. Information from the Think Tank will be shared with membership on the APHL web site and through reports in Lab Matters.
Laboratory System Improvement Program (L-SIP) Assessment
To make it easier for labs to find quality improvement and performance-related materials, APHL provides a one-stop-shop for resources to improve the quality of state public health laboratory systems. One of those tools is the Laboratory System Improvement Program (L-SIP) assessment tool. During an L-SIP assessment, representatives of the state public health laboratory system and partners convene to assess the performance of state public health laboratory system. This program provides a user-friendly process, including a performance assessment tool for assessing and establishing a baseline measure of performance.
Most recently, South Dakota has scheduled our Laboratory System Improvement Assessment for April 29th. We have closely followed the recommendations of the APHL L-SIP Assessment Tool User's Guide, a document that walks the coordinators through the assessment preparation process and includes sample materials such as letters to participants and agendas. For this lab and the others who utilize the L-SIP assessment tool, they find that it offers a means for strengthening relationships with public health, clinical and other laboratories and partners that comprise the broader laboratory system, as well as a framework for continuous improvement of public health laboratory systems.
We are looking forward to convening our system partners later this month to discuss our state public health laboratory system and what we can do to improve it.
Vaccine-Preventable Disease Project
As the incidence of Vaccine-Preventable Diseases (VPD) decreases in the US, the capacity and capability of state and local public health laboratories to perform VPD testing has declined, becoming increasingly inconsistent. While some labs are quite proficient in VPD testing, others are eliminating testing altogether. However, timely and accurate diagnosis of VPDs is essential to identify and control outbreaks and to provide the information needed to improve vaccines and vaccination programs. To address gaps in testing capacity for VPDs, APHL was recently awarded funding through the American Recovery and Reinvestment Act of 2009 (ARRA) to provide training programs and quality improvement activities for VPD testing in public health laboratories. The association is partnering with CDC to develop and present these programs.
The first initiative is a series of teleconferences targeted to public health laboratorians. To date, CDC subject matter experts have presented new diagnostic testing methods for several VPDs, including Bordetella pertussis (whooping cough), Streptococcus pneumoniae, measles virus and mumps virus. The mumps educational teleconferences have been especially timely in light of the ongoing mumps outbreak in the northeastern United States. State public health lab staff are being trained in the new mumps assay developed at CDC. Access to this assay will enhance patient diagnosis and epidemiological investigations in participating states.
In response to a recent survey of public health labs’ training needs for VPDs, more trainings and quality improvement activities are planned, including hands-on workshops, proficiency testing exercises and assay comparison studies. By working together on these activities, APHL and CDC look forward to helping public health laboratories to improve their capability to quickly and accurately detect cases of VPDs.
Voluntary Accreditation Program
“Continuous quality improvement” is part of the laboratorian’s credo. Assays and equipment must meet precise quality standard before they can be utilized in the laboratory. Now APHL is developing voluntary standards specific to public health laboratories that will be used to assess the quality of the laboratory itself and specifically its operations and functions. These new standards will not supplant CLIA, but be used as a complement to the federal regulation.
The accreditation program will be voluntary, and will integrate standards from existing domestic and international sources as well as those outlined in the Core Functions of Public Health Laboratories.
Incorporation of the public health laboratory standards will be proposed to the Public Health Accreditation Board (PHAB) for incorporation into their accreditation process. Accreditation will signify that the laboratory has met agreed-upon standards of quality and that it ascribes to them as a measure of its services.
APHL is convening a Think Tank with PHAB at the end of April to discuss how the program should look, be structured, and what elements should be included in such a partnership. Information from the Think Tank will be shared with membership on the APHL web site and through reports in Lab Matters.
Laboratory System Improvement Program (L-SIP) Assessment
To make it easier for labs to find quality improvement and performance-related materials, APHL provides a one-stop-shop for resources to improve the quality of state public health laboratory systems. One of those tools is the Laboratory System Improvement Program (L-SIP) assessment tool. During an L-SIP assessment, representatives of the state public health laboratory system and partners convene to assess the performance of state public health laboratory system. This program provides a user-friendly process, including a performance assessment tool for assessing and establishing a baseline measure of performance.
Most recently, South Dakota has scheduled our Laboratory System Improvement Assessment for April 29th. We have closely followed the recommendations of the APHL L-SIP Assessment Tool User's Guide, a document that walks the coordinators through the assessment preparation process and includes sample materials such as letters to participants and agendas. For this lab and the others who utilize the L-SIP assessment tool, they find that it offers a means for strengthening relationships with public health, clinical and other laboratories and partners that comprise the broader laboratory system, as well as a framework for continuous improvement of public health laboratory systems.
We are looking forward to convening our system partners later this month to discuss our state public health laboratory system and what we can do to improve it.
Tuesday, April 20, 2010
Rebuilding Haiti’s Labs: Governance, Policies and Systems Before Bricks and Mortar
At a March 31 United Nations special session on rebuilding Haiti, countries responded with pledges of significant funding for the decimated nation; however, funding alone will not rebuild Haiti, and certainly not its battered laboratories.
Photo: A typical lab in Port-au-Prince, Haiti
Second, the international donor community must adopt new operational models that are less dependent on the services of ex-patriots. Good models are available. Paul Farmer at Partners in Health and Jean William Pape at GHESKIO/ Weill Cornell Medical College, for example, have shown that impoverished communities with few resources can combat diseases and improve health care. Their approach—like that of APHL's project in Haiti—is to build long-term partnerships with local groups and to help train their doctors and healthcare professionals.
Third, Haiti’s laboratories need to be reconceived and rebuilt as part of an integrated national laboratory network operated under a strong quality management system. A precursor to this is development and implementation of a revised national laboratory policy and strategic plan to guide the orchestration of the necessary resources, including a trained and competent workforce.
Yet the reality at the moment is that there isn’t a comprehensive and forceful Haitian laboratory policy, strategic plan or network, only the commitment of the country’s national laboratory to forge a true laboratory system and support from some non-governmental organizations. How can APHL best support development of a nationwide laboratory system that will serve all of Haiti’s people? We look forward to your comments.
First, Haitian leaders must find the courage and commitment to confront corruption and inefficiency within their government. Without a fundamental shift from opportunism to public service, donors will not be willing to sustain the long—and costly—process of recovery.
Second, the international donor community must adopt new operational models that are less dependent on the services of ex-patriots. Good models are available. Paul Farmer at Partners in Health and Jean William Pape at GHESKIO/ Weill Cornell Medical College, for example, have shown that impoverished communities with few resources can combat diseases and improve health care. Their approach—like that of APHL's project in Haiti—is to build long-term partnerships with local groups and to help train their doctors and healthcare professionals.
Third, Haiti’s laboratories need to be reconceived and rebuilt as part of an integrated national laboratory network operated under a strong quality management system. A precursor to this is development and implementation of a revised national laboratory policy and strategic plan to guide the orchestration of the necessary resources, including a trained and competent workforce.
Yet the reality at the moment is that there isn’t a comprehensive and forceful Haitian laboratory policy, strategic plan or network, only the commitment of the country’s national laboratory to forge a true laboratory system and support from some non-governmental organizations. How can APHL best support development of a nationwide laboratory system that will serve all of Haiti’s people? We look forward to your comments.
Monday, April 19, 2010
Case Study 1 -- The Response
To follow up on our previous post about Mr Fudd and his family's mysterious illness...
Response:
If the specimen was initially tested in a sentinel clinical laboratory where analyses are unable to rule out a possible Bioterrorism agent (in this case, Yersinia pestis) using standard methods they would immediately refer suspicious isolates and specimens to their collaborating LRN reference laboratory.
Case Investigation:
Upon investigation the Fudd family was attending a family and friends reunion in New Mexico. One of the Fudd family traditions is to organize a wascially wabbit hunt the morning of the reunion, and dine on rabbit stew and other assorted rabbit dishes at that evening’s party.
In humans, Yersina pestis is most often acquired from the bite of infected fleas that feed from animal reservoir such as squirrels, rabbits, and prairie dogs. Although rare, there have been several documented reports of Y. pestis infection from the direct contact of contaminated meat products either through ingestion or inhalation.
Response:
If the specimen was initially tested in a sentinel clinical laboratory where analyses are unable to rule out a possible Bioterrorism agent (in this case, Yersinia pestis) using standard methods they would immediately refer suspicious isolates and specimens to their collaborating LRN reference laboratory.
Case Investigation:
Upon investigation the Fudd family was attending a family and friends reunion in New Mexico. One of the Fudd family traditions is to organize a wascially wabbit hunt the morning of the reunion, and dine on rabbit stew and other assorted rabbit dishes at that evening’s party.
In humans, Yersina pestis is most often acquired from the bite of infected fleas that feed from animal reservoir such as squirrels, rabbits, and prairie dogs. Although rare, there have been several documented reports of Y. pestis infection from the direct contact of contaminated meat products either through ingestion or inhalation.
Celebrating Lab Week -- Case Study 1
Happy National Medical Laboratory Professionals Week!
As a fun activity during the week several programs at APHL will be posting fun case studies related to the work being done in public health laboratories across the country. Today’s case study comes from Infectious Disease, Food Safety, and Emergency Preparedness.
Case Study
Mr. Fudd presents in the emergency room in Chicago with fever, lethargy, severe pharyngitis, tonsillitis and a striking swelling of his neck. The ER Physician ordered Rapid Streptococcus A Dtesting, gram stain, and respiratory cultures.
Two days following the first patient presentation, three additional Fudd family members present to the same emergency room with similar symptoms.
Laboratory Tests --
(Photo: Blood Agar Plate Growth at 48 hours)
Biochemicals --
(Photo: Gram Stain of Culture Isolate)
Please include your comments/answers below. APHL is excited to hear what your laboratory would do next! The response and case investigation will be posted this afternoon. Stay tuned...
As a fun activity during the week several programs at APHL will be posting fun case studies related to the work being done in public health laboratories across the country. Today’s case study comes from Infectious Disease, Food Safety, and Emergency Preparedness.
Case Study
Mr. Fudd presents in the emergency room in Chicago with fever, lethargy, severe pharyngitis, tonsillitis and a striking swelling of his neck. The ER Physician ordered Rapid Streptococcus A Dtesting, gram stain, and respiratory cultures.
Two days following the first patient presentation, three additional Fudd family members present to the same emergency room with similar symptoms. All patient specimens were sent to the laboratory for ordered laboratory testing. The lab results included the following:
Laboratory Tests --
(Photo: Blood Agar Plate Growth at 48 hours)
- Rapid Streptococcus A: Negative
- Gram Stain: Gram Negative Rods
- Culture incubated at 37C for(24 hours): Pin point colonies on Blood agar Plate and Chocolate agar
- Culture incubated at 37C for (48 hours): Grey, white, translucent colonies on Blood agar Plate and Chocolate agar; Clear White Non Lactose Fermenting colonies on MacConkey agar
(Photo: Gram Stain of Culture Isolate)
- Catalase: Positive
- Oxidase: Negative
- Urease: Negative
- Indole: Negative
Please include your comments/answers below. APHL is excited to hear what your laboratory would do next! The response and case investigation will be posted this afternoon. Stay tuned...
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