Lab Matters Fall 2018 | Page 35

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 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