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Revenue
we also provide services for our
environmental health division, county
epidemiologists and the medical
examiner’s office. In the last few years,
we’ve helped our epi group with several
cases linked to Salmonella poisoning.
We also provide STAT testing for
forensic examiners who have needle
stick injuries or cuts.”
The laboratory’s annual operating budget
runs to $2.6 million. About $1 million
of the total comes from state aid, state
contracts and laboratory fees, which are
mostly for environmental testing. The
remainder comes from county funds.
Pope said, “We bill insurance [for clinical
testing] when it’s available, but we don’t
otherwise bill for clinical services.”
Laboratory Assistant Maria Stein prepares media in the
Scientific Support Lab. Photo: ECPHL
Testing
The laboratory conducts roughly 35,000
tests each year, split fairly evenly
between clinical work—mostly sexually
transmitted disease (STD) testing—
and environmental work—mostly
water testing. This past summer, the
clinical laboratory began implementing
Mycoplasma genitalium (Mgen) testing
on Hologic’s Panther® platform. Mgen
is considered the “silent STD,” and
often mimics gonorrhea. “We have
no idea what the prevalence is in Erie
County,” said Pope. “The plan is to test
all symptomatic patients for Mgen over
a six-month period; that will determine
whether the prevalence is high enough
to justify continued testing.” The Erie
County laboratory is one of the only
labs in Western New York offering a test
to distinguish between herpes simplex
virus I (HSV-1) and HSV-2, also using the
Panther platform. And it is in the process
of bringing on the QuantiFERON ® Gold
Plus test for tuberculosis. In addition to
routine clinical testing, the laboratory is a
Tier 2 member of the Laboratory Response
Network for Biological Threats, serving the
17 western New York counties.
On the environmental side, the laboratory
tests drinking water for public water
systems and water treatment plants,
groundwater for private well owners,
irrigation water for farms monitored
by the US Department of Agriculture,
wastewater for regional water treatment
plants and recreational water for Erie
County and other localities on New York’s
Finger Lakes. The laboratory is one of only
a handful in New York—and the only lab
in Western New York—offering the US
EPA-approved test for microcystins, a class
of toxins produced by blue-green algae.
Pope said, “Lake Erie’s Ohio area has had a
lot of issues with blue-green algae in the
PublicHealthLabs
@APHL
last few years. The algae haven’t made it
to our end of the lake yet, but we’re ready
for it.”
Aside from its testing services, the
laboratory is a rotation site for ten to
15 students/year from three academic
programs: University of Buffalo Medical
Technology Program, Erie County
Community College Medical Technology
Program and the University of Rochester
Post-doctoral Residency in Medical and
Public Health Laboratory Microbiology.
Successes
• Updating all of the instrumentation
in the environmental chemistry
laboratory. “We went to the county
every other year for several years
with proposals to update our
instrumentation. Finally, we got the
funding through the county’s capital
projects office. This has helped us
decrease test turn-around-times
and increase testing capabilities and
capacities. For example, one of the first
new instruments we got was an ion
chromatography mass spectrometer.
We are one of only a handful of
US laboratories using this hybrid
technology, which we’ve been running
for about six or seven years for some of
our analyses of disinfection byproducts
in drinking water. With the new
methodology, we can eliminate sample
extractions prior to testing and deliver
faster, more precise test results.”
• Implementing Qualtrax quality
management software. “We’ve just
started bringing this on and hope it will
streamline some of our work.”
• Collaborating with other county
divisions. “While we serve clinics,
APHL.org
• Implementing an interface between
clinic electronic health records and the
laboratory information management
system. “Our clinics will be able to
electronically order tests and receive
results much more efficiently.”
Challenges
• Staffing. “Staffing is tough. We’ve lost
positions as a result of decreased
funding, and we’ve got staff nearing
retirement. Probably 90% of our staff
have been here 15 years or more. It’s
difficult to find people who will work
for our public-sector salaries. Retaining
new employees has been somewhat
difficult.”
• Funding. “As in most PHLs, funding is a
challenge.”
• Shortage of qualified laboratory
directors. “Even with our restructured
organization, it’s difficult for us to find
and retain a medical director who
meets CLIA and New York regulatory
requirements. We’ve been fortunate to
have had our current medical director
for the last five years.”
Goals
• To finalize implementation of the
laboratory’s Mgen and tuberculosis
tests.
• To implement Qualtrax quality
management software and restructure
our quality management system.
• To continue to reduce test turnaround
times and to replace older
instrumentation with state-of-the-art
laboratory technology.
• To modify and expand our current
service menu to better meet the
evolving needs of county clinics and
health division partners and to address
emerging public health concerns. n
Summer 2019 LAB MATTERS
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