MEMBERSHIP
and one courier. Part-time staff
include three level-one scientists, one
administrative assistant and two couriers.
Revenue
The laboratory’s annual budget hovers
around $3 million, covering personnel,
operating costs and equipment. About a
third of the budget comes from fee-for-
service revenue (about $600,000) and state
funding ($370,000). The remainder comes
from Fairfax County general funds.
Testing
FCHDL performs over 200,000 analytical
tests per year, with laboratory units
dedicated to bacteriology, clinical
chemistry, toxicology, immunology,
mycobacteriology, parasitology, molecular
biology and rabies. It is certified for high-
complexity testing on-site and holds the
CLIA certificate for moderate complexity
testing at five Fairfax County health
department clinics, where scientists
perform wet preps and gram stains.
The laboratory’s highest volume
services include screening for drugs
of abuse (160,000 tests/year), sexually
transmitted disease testing (12,000/
year), QuantiFERON ® testing (10,000/
year), clinical chemistries (8,000/year), TB
cultures and identification (2,000/year),
vector-borne disease testing (6,000/year)
and environmental drinking water testing
(6,000/year).
Since about a third of Virginia’s positive TB
cases reside in Fairfax County, the FCHDL
maintains a comprehensive, full-service
TB laboratory, processing and culturing
specimens for mycobacteria. Smear-
positive sputa specimens are tested
on the molecular GeneXpert MTB/RIF
platform to rapidly ascertain the presence
of MTB and its rifampin resistance. FCHDL
performs first-line drug susceptibility
testing on all MTB isolates, and resistant
strains are forwarded to the Virginia
Division of Consolidated Laboratories
(DCLS) for second-line drug susceptibility
testing.
As a certified drinking water laboratory,
FCHDL performs inorganic chemistry,
heavy metal and bacteriological testing
on public and private water supplies.
Among its water-testing clients are
Dulles International Airport; assorted
local, state, regional and national
PublicHealthLabs
@APHL
parks; and neighboring jurisdictions.
Scientists also test samples from local
streams to identify trends and changes
in populations of pathogenic bacteria on
behalf of the Fairfax County Stormwater
Planning Division.
In 2017, the FCHDL acquired the Aptima ®
Panther molecular testing platform
for rapid identification of chlamydia,
trichomonas, and gonorrhea pathogens
in clinical specimens. The laboratory
provides 24-hour turnaround time for
rabies testing in animals and is able to
detect Borrelia burgdorferi in ticks, and
West Nile and Zika viruses in mosquito
pools. It is currently evaluating additional
molecular protocols to detect emerging
vector-borne pathogens such as the
protozoan parasite Babesia, the bacterium
Anaplasma phagocytophilum, and the
chikungunya and dengue viruses.
Success Stories
• Under the direction of Severson, who
served on APHL’s Laboratory Systems
and Standards Committee, FCHDL
developed a competency-based
career ladder using APHL’s Laboratory
Competency Implementation Toolbox.
The newly-approved ladder has three
classes—one for bench scientists,
one for “scientists interested in
moving to management” and one for
supervisors. Because there are at least
two non-competitive levels within each
competitive class, staff can advance in
pay and recognition without changing
jobs.
• In 2015, FCHDL underwent an APHL
Laboratory System Improvement
Program assessment, which identified
research as an opportunity for growth.
Since then, FCHDL staff prepared
and presented two posters at the
APHL annual meeting. One describes
the laboratory’s 97% reduction in
indeterminate QuantiFERON ® test
results for maternity clients (achieved
by maintaining tight control over staff
training and collection of virtually
all maternal specimens in the first
trimester of pregnancy). The second
describes implementation of mosquito
pool screening for Zika virus in parallel
with the Virginia DCLS.
• In January 2018, FCHDL partnered
with George Washington University’s
APHL.org
medical laboratory science and
master’s level microbiology programs
to provide a public health laboratory
rotation as part of the required
student internship. The rotation
provides an overview of the public
health laboratory’s role in disease
surveillance, diagnosis of emerging
infectious diseases and assessment of
environmental health hazards.
• FCHDL recently purchased the Qualtrax
compliance management software
package to better manage laboratory
workflow, training and tracking of staff
competencies.
• The laboratory collaborates closely
with other Fairfax County Health
Department units—including the
Communicable Disease Program,
Environmental Health Division,
Disease-Carrying Insects Program,
Patient Care Services, and Community
Health Development and Preparedness
Division—to provide quality laboratory
testing tailored to community needs
and to aid in the prevention, diagnosis,
treatment, and monitoring of diseases
of public health interest.
Challenges
• Attracting and retaining qualified staff
is an ongoing challenge.
• Loss of staff through attrition,
retirement and relocation to higher-
salaried positions elsewhere has
resulted in a significant amount of
time dedicated to on-boarding, training
and competency assessment of new
scientists.
• Limited funding has constrained
staff training opportunities, including
attendance at professional conferences.
Goals
• Cross-train scientists in multiple
laboratory areas to ensure operational
efficiency.
• Develop capability for web-based
electronic test ordering and results
reporting.
• Expand testing services to neighboring
jurisdictions.
• Develop regional collaborations with
local laboratories. n
Fall 2018 LAB MATTERS
33