Lab Matters Spring 2019 | Page 31

PUBLIC HEALTH PREPAREDNESS AND RESPONSE Public Health System Recovery in Full Swing: Hurricane Response in Puerto Rico and the US Virgin Islands by Jill Sutton, associate specialist, Crisis Response Following back-to-back hurricanes in 2017, public health laboratories and other programs within the Puerto Rico Department of Health (PRDH) and the US Virgin Islands Department of Health (USVIDOH) entered into response and recovery mode. Nearly 19 months later, both jurisdictions are continuing to restore public health infrastructure that is vital for detecting and responding to health threats. With the help of external partners such as APHL, the US Centers for Disease Control and Prevention (CDC) and other non-governmental organizations, both jurisdictions’ public health laboratories have been able to: The PRDOH Bacteriology Molecular Lab minor repairs completion marks the beginning of genomic sequencing for outbreak identification and for the detection of bacterial special pathogens in Puerto Rico 1. Implement a temporary specimen transport system to restore specimen testing capacity. 2. Address procurement needs to replace or repair equipment, reagents and other supplies needed to ensure public health operations and services have the capacity to support local public health needs. 3. Assess and respond to critical health infrastructure damage. 4. Scale up staffing to support gaps in workforce needed to maintain laboratory operations and services. Repairing the Critical Infrastructure Needed to Support Quality Laboratory Systems PRDH recognized that in order to mitigate the impact of future public health emergencies—especially hurricanes— their laboratory network must scale up their capabilities and capacity to support both immediate and long-term public health testing needs. With coordination and collaboration from external partners, PRDH prioritized implementing whole genome sequencing (WGS) within the bacteriology/molecular laboratory to improve testing capacity for infectious diseases. However, prior to implementing PublicHealthLabs @APHL this technology, structural damage that occurred to the lab in San Juan had to be addressed. Repairs on the molecular laboratory began in January 2019 and are expected to be complete by the end of May 2019. Another priority project to further support catastrophic readiness is the implementation of a laboratory quality management system. This project has been initiated across all PRDH laboratories to harmonize and strengthen key operations such as biosafety and biosecurity, information management, equipment maintenance, procurement tracking and continual workforce training. USVIDOH – Health Information Management and Exchange to Address Data Access and Exchange Ensuring rapid and secure exchange of laboratory data is a priority at the USVIDOH. During a disaster situation, lives depend on the ability to use public health laboratory data to inform public health decisions. With support from APHL and CDC, the USVIDOH public health laboratory plans to enhance their current laboratory information management system (LIMS) and move from off-site hosting to on-site. The purpose of transitioning to an on-site hosting environment is to eliminate potential issues with internet infrastructure should it be interrupted during a natural disaster. With the infrastructure in place to support data storage on-site, access to laboratory data during a public health crisis will not be delayed. After the 2017 hurricanes, patients and healthcare providers had limited access to medical records. In addition to enhancing their existing LIMS system, USVIDOH is prioritizing the development and implementation of a universal repository for health data that not only public health officials and laboratorians will have access to, but also healthcare providers and patients. Access to information such as vaccination records, health screenings, laboratory results and treatment status of a patient’s pre-existing condition can drastically improve the medical response and minimize the operational impact in USVI. n Spring 2019 LAB MATTERS 29