Lab Matters Summer 2018 | Page 33

membership

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