Lab Matters Spring 2025 | Page 24

Mercury Testing continued from page 18

That effort provides an exemplary framework for a public health mercury response . As shown in Figure 1 , policies and protocols in place for lead are lacking for mercury . Most public health laboratories currently lack the funding and response infrastructure to collect and test samples , provide environmental interventions or conduct enforcement around mercury . For example , SLPs can contaminate entire homes , from furniture to washing machines and require a complex , coordinated effort to mitigate . Further , medical knowledge and protocols are lacking for treatment of and follow-up care for mercury exposed individuals .

Behavioral change efforts can reduce personal mercury exposure , as seen in New Jersey where varying fish size consumption led to more than 90 % reductions in individual exposure levels .

Encouragingly , there are short- and long-term steps that can immediately reduce mercury exposure levels . Level 1 and 2 Laboratory Response Network for Chemical Threats ( LRN-C ) public health laboratories can conduct mercury testing and initiate small-scale biomonitoring studies . Individuals can switch from eating large to small fish , from using CFL to LED lightbulbs , and from dental amalgam to resin . Such individual actions entail minor cost differences and lower risk and mercury levels within months . Note : SLPs present a challenge as they are targeted at minorities and there are documented societal and occupational costs associated with cessation . Public health laboratories can leverage existing programs ( e . g ., LRN-C , childhood lead , communications , product enforcement ) to address mercury exposures and sources . Public health laboratories and health departments can assume a role in improving health outcomes in populations exposed to mercury . g

LRN-B Protocol continued from page 19

participation will further LRN ’ s mission of ensuring emergency readiness by validating an important method that may be used in response to a variety of water contamination events . APHL hopes to support these state laboratories ’ diligent work in addressing critical gaps in environmental microbiology testing and will continue to support similar professional opportunities for laboratory scientists .

Scientists from CDPHE commented that their experience in the MCE study has been a very good learning experience . “ It has been a great experience learning new lab techniques and being a part of something big and important . This MCE study has definitely strengthened not only my confidence in myself and my lab abilities , but also my feeling of the importance of what we do as an LRN lab .”

The work benchtop laboratory scientists do every day is a critical — but sometimes removed — element of public health protection . Hands-on training and professional development opportunities such as the MCE study help to connect laboratory scientist ’ s work to tangible public health impact , retain skilled workers and strengthen the laboratory workforce . g

Kakuma Laboratory continued from page 21

Key Outcomes

² Kakuma Ammusait became the first laboratory in a refugee setting globally to attain international accreditation status .

² Kakuma Laboratory achieved its accreditation within 15 months of active QMS implementation , significantly improving services .

² The laboratory workload increased from 56,000 patients served in 2023 to 103,000 in 2024 .

² The laboratory test on accreditation scope at the time of accreditation was 75 %, which is the highest among the laboratories in Kenya .

² Capacity developed for SARS-CoV-2 is currently put into use for mpox PCR testing .

² Wastages due to supply expiration have significantly dropped from 30 % to less than 5 %.

Lessons Learned

² It is possible to implement QMS in a hard-to-reach , refugee setting with limited infrastructure and still be able to offer quality-assured services .

² Providing quality services is essential in vulnerable states . Improving patient management and reducing the cost of operation associated with wastage laboratory improvement resulted in an increase in workload over time as seen in the previous results shared , with patients and other laboratory users showing trust and reliability in the results issues .

² Strong support and collaborative teamwork from IRC field management , Senior Management Team , and APHL teams enhanced the efforts toward accreditation .

² Regular QMS and risk management training empowered staff , ensuring they were well-prepared and engaged in the ISO 15189:2022 transition .

² Utilizing the WHO / AFRO SLIPTA checklist provided clear benchmarks , allowing for the systematic identification of gaps and monitoring of improvements .

² Leadership ’ s active engagement fostered ownership and accountability among staff , contributing to a seamless accreditation process .

Implementation of the ISO 15189 ; 2022 at Kakuma Laboratory resulted in improvement in service delivery and efficiency in service provision . APHL continues to support workforce development , specifically in training the IRC staff , most of whom are typically refugees themselves working in this laboratory . g

22 LAB MATTERS Spring 2025

PublicHealthLabs @ APHL . org APHL . org