Lab Matters Summer 2018 | Page 33

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Brett Stenberg performs daily extractions. Photo: ND PHL

assurance and CLIA coordinator and then was promoted to assistant director. She became director of the Division of Microbiology when the microbiology laboratory was shifted to the Medical Services Section in July 2017.

Staff

The division employs 14 medical laboratory scientists, three MLTs and one administrative assistant. It also has two temporary employees.

Revenue

The laboratory has a biennial budget of about $ 5.8 million, coming from state( 43 %) and federal funds( 31 %), as well as laboratory fees and other“ special revenue”( 26 %).

Testing

The division performs roughly 79,000 tests per year, focusing on( a) public health surveillance and outbreak testing,( b) reference testing for pathogens of public health significance and( c) testing for novel pathogens—“ whatever’ s trending... Zika, influenza, etc.” The laboratory’ s highest-volume testing, for sexually transmitted infections, aims to improve health equity for rural communities that would otherwise lack access to laboratory services.

Lower volume services include dairy testing for small, local farmers; PFGE and whole genome sequencing of foodborne pathogens( as part of the PulseNet foodborne disease surveillance network); drinking and surface water testing( mostly for coliforms); select agent testing( as part of the LRN-B); and rabies testing.

The state contracts with the Iowa State Hygienic Laboratory for newborn screening.

Success Stories

• Piloted a tick surveillance program that taps veterinarians to submit ticks pulled from animal patients.“ We developed a multiplex assay for key pathogens like Lyme disease and Rocky Mountain spotted fever.” The program, now in its second year, is a huge success, Massen said,“ we actually have so many ticks we’ re wondering what we’ re going to do.”

• Developed a multiplex assay for key mosquito-borne pathogens, thanks to“ super-creative” technologist, Maggie Kuklok. The assay is now used to test live mosquitos and mosquito pools submitted through a statewide trapping network.“ There’ s nothing interesting yet to report, but if you don’ t look, and you don’ t have the negative data, you don’ t know how valuable the positive data is.”

• Tested patient stool and product samples to support the investigation of a 2018 multistate Salmonellosis outbreak linked to kratom, a plant native to southeast Asia and used as a dietary supplement or recreational drug. The lone North Dakota case was definitively linked to the national outbreak.

• Implemented Hepatitis C viral load testing and genotyping to support investigation of a 2013 Hepatitis C outbreak. Those services are now available to all members of the Northern Plains Consortium, comprising public health laboratories and epidemiology leadership in MT, ND, SD, WY and ID.

• Won the 2018 APHL Healthiest Laboratory award.

Challenges

•“ The budget is always a challenge.”

•“ Because we have two buildings— the old building and new addition— we struggle with twice the problems: two separate air handling systems, two separate reverse osmosis water systems, etc. But that also means we have some duplication in case something happens; it’ s a double-edged sword.”

Goals

• Keep technology current: At the moment, Massen is in the process of securing funding and spending authority to purchase a MALDI-TOF mass spectrometer. She said,“ We spend a lot of time trying to identify naughty isolates, like mycology and mycobacteria species, for smaller [ clinical ] facilities. MALDI-TOF will be fast and inexpensive.”

• Find money to upgrade the laboratory information management system.

• Staff development:“ We experienced quite a bit of turnover a couple years back, so we have a lot of newer staff, a couple more experienced folks who are nearing retirement and a director who has only been here for five and a half years.” In fact, about half of Massen’ s staff joined the division in 2012 or later. Retaining“ more seasoned techs,” promoting the sharing of knowledge, and welcoming“ fresh ideas” from newer staff are all goals. n

Ashley Schuck and Kristi Bullinger work in the Virology / Immunology Lab. Photo: ND PHL