member spotlight
Hospital of Pittsburgh, where I became
director of the hospital’s microbiology
lab.” He stayed at Children’s Hospital for
30 years, working for much of that time
with his third mentor, Richard Michaels,
MD. Toward the end of his tenure at
the hospital, after being “pigeon-holed”
in a pediatric molecular diagnostic
laboratory, Wadowsky was ready for
a new challenge: “I wanted to see if I
could do something on a larger scale.”
Fortunately, Allegheny County was just
then opening its new PHL facility and
needed a director. Wadowsky got the job. Within the past few years, PHL
scientists have confirmed the source
of at least three such outbreaks:
Staff In addition to testing clinical and
environmental samples, the main
laboratory provides analytical support
to the medical examiner’s office in the
City of Pittsburgh. “The biggest concern
for autopsy cases,” said Wadowsky, “is
meningitis, which has potential for spread
in the community.” Over the past three
years, scientists confirmed about three
cases of Neisseria meningitidis in deceased
young adults. Another recent autopsy
case identified Streptococcus viridans as
the cause of death in a five-year-old
child, who apparently contracted strep
infection through a mouth wound.
• Yersinia enterocolitica contaminated
milk products sold by a local dairy.
• E. coli O157 tainted ground beef
traced to a restaurant where
staff were undercooking the beef.
This outbreak involved at least a
dozen confirmed cases, including
a number of college students.
• Bacillus cereus tainted food
served at the county jail.
The laboratory employs 21 staff members,
including eight microbiologists, four
supervisors, five laboratory technicians,
two clerks, an assistant laboratory
manager and director. There is currently
one vacancy for a microbiologist in the
laboratory’s BSL-3 virology program.
Revenue
The laboratory’s annual budget runs to
about $1.3 million, plus an additional
$700,000/year for drug screening to
support the criminal and family courts
in Pittsburgh and McKeesport. Most of
this revenue comes from the county,
with supplemental funding from the
Pennsylvania Department of Health
for emergency preparedness and
HIV and STD testing. The laboratory
collects no fees for any of its services.
Testing
Altogether, the PHL performs about
90,000 tests per year, ranging from
high-volume STD testing to specialized
analyses. The stand-alone STD laboratory
performs direct microscopy testing (gram
stains for gonorrhea, wet mounts for
Trichomonas and KOH preparations for
yeasts) on samples from county clinic
patients, while the main laboratory
conducts a range of tests on samples
from the same population to detect
HIV (serology), syphilis (serology),
Hepatitis A, B and C (serology),
Neisseria gonorrhea (culture, nucleic
acid amplification testing), Chlamydia
(culture, NAAT), Herpes simplex virus
(culture) and Trichomonas (culture).
The laboratory’s food testing program
supports county epidemiologists and
food safety officials investigating
possible foodborne disease outbreaks.
PublicHealthLabs
@APHL
Success Stories
• Not long ago, all of the laboratories’
STD reports were generated on
hand-written forms with multi-part
copies—“the types of reports I used
at Mercy Hospital 35 years ago.” Not
so anymore. The laboratory recently
implemented a LIMS in its STD clinic,
doing much of the design work
in-house. Today, STD specimens are
accompanied by a computer-generated
“work card” with peel-off bar codes
that can be applied to “tubes and
plates and slides.” Wadowsky credits
the electronic system with “a lot of
time-savings and improved accuracy.”
• Implementing the BioFire FilmArray ®
gastroi ntestinal panel last year. The
new assay detects 22 pathogens
via PCR and delivers results within
an hour. Since implementing the
system in November 2016, the
laboratory has already confirmed
six norovirus outbreaks.
• Replacing the Western blot assay
with the Bio-Rad GeeniusTM HIV-1/
HIV-2 Supplemental Assay.
• Designing the new STD lab.
APHL.org
• Initiating two quality improvement
projects as part of the health
department’s culture of quality. One
project focuses on streamlining the
process through which clients order
swab and urine specimen collection
devices for gonorrhea and chlamydia
nucleic acid amplification testing;
the other focuses on reducing the
incidence of false-positive urine
screens for benzodiazepines.
• Developing a surge capacity staffing
list/protocol and specimen handling
and submission protocols, also to
enhance the culture of quality.
Challenges
• Maintaining the facility: “We have
no physical plant manager, so when
something goes awry, the director
has to figure out what’s wrong and
get someone to come and fix it.” With
the building’s sophisticated BSL-3
laboratory and HVAC and security
systems, this is a big challenge.
• Maintaining accreditations under CLIA,
the Commonwealth of Pennsylvania,
the Environmental Protection Agency
and the CDC Select Agent Program.
• “Making do” with no dedicated staff
for select agent BSL-3 testing.
• Lack of discretionary funds to repair
or replace inoperable equipment
or deal with other emergencies.
• Keeping up with the scientific literature
in PHL diagnostics, given “so many
other demands on our time.”
Goals
• To fully implement the BioPlex ® 2200
multiplex platform to test for fifth-
generation HIV, syphilis, measles,
mumps, rubella and varicella. The
platform was installed in late May
and verification studies are ongoing.
• To develop a LIMS interface with the
BioPlex ® , plus customized LIMS data
entry screens and automated reports
for HIV and syphilis test results.
• To become a reference-level
member of the Laboratory Response
Network for Biological Testing
(LRN-B) by the end of 2018.
• To implement point-of-care lead
testing for capillary blood specimens. n
Summer 2017 LAB MATTERS
39