Lab Matters Winter 2018 | Page 16

public health preparedness and response APHL Deploys Laboratory Assessment Team to Puerto Rico By Tyler Wolford, MS, senior specialist, Laboratory Response Network On September 20, 2017, Hurricane Maria made landfall on the island of Puerto Rico. The storm, with gusting winds in excess of 100 miles per hour, dumped over 40 inches of rain in less than two days. The entire island was consumed, making this hurricane the worst natural disaster in Puerto Rico’s history. By storm’s end, more than 90 percent of the population did not have access to power or cellular phone coverage, and more than 50 percent of the population was without safe drinking water. The capacity of the island’s public health laboratories was a major concern. In October 2017, at the request of the US Centers for Disease Control and Prevention (CDC), APHL organized a team of staff and representatives from three APHL member laboratories— Dr. Christine Bean, New Hampshire Public Health Laboratories, Dr. Andrew Cannons, Florida Department of Health Bureau of Public Health Laboratories-Tampa and Dr. Martina McGarvey, Pennsylvania Department of Environmental Protection—to assess the Puerto Rico Department of Health’s laboratories post-Maria. The team visited Laboratorio de Salud-Puerto Rico Public Health Laboratory (PRPHL), Laboratorio Sanitario de Arecibo, Laboratorio Sanitario de Mayaguez and the Biological and Chemical Emergencies Laboratory (BCEL) to: • Evaluate laboratory capabilities and capacities • Review laboratory and departmental organization • Determine program needs for laboratory services • Recommend strategies to maximize use of laboratories supporting public and environmental health. Recommendations from the APHL Team 1. The Puerto Rico Department of Health Laboratories should conduct thorough assessments of their facilities to ensure they have access to consistent power to maintain reagents and run testing instruments, repair roofs to eliminate leaks, and contract with professionals to assess water damage, mold and air quality. 2. When power is restored, the laboratories should conduct an assessment to ensure lab equipment is working according to specifications and lost reagents are replenished in order to restore essential testing services. 3. Laboratories should improve security monitoring for all facilities to keep unwanted persons out of the laboratory, protect sample integrity and ensure staff safety. 4. PRPHL should ensure there is a staffing plan for bench level laboratorians as well as a succession plan in place for changes in leadership and to maintain Clinical Laboratory Improvement Amendments (CLIA) Certification. A Full Slate of Services, Interrupted Public health laboratories in Puerto Rico support numerous Department of Health programs such as water and milk testing; disease control, including tuberculosis, HIV and sexually transmitted diseases; and reference microbiological testing services for parasitology, rabies and influenza, among others. PRPHL also manages and maintains a proficiency testing program that is part of the Commonwealth’s regulatory program for over 900 private- sector clinical and environmental laboratories. Many of these services were interrupted after the hurricane. The APHL team found the four Puerto Rican laboratories to be impacted 14 LAB MATTERS Winter 2018 (from l to r:) Dr Martina McGarvey, Dr. Andrew Cannons and Dr. Christine Bean 5. PRPHL should sponsor a Laboratory System Improvement Program (L-SIP) assessment. This assessment is a facilitated evaluation of the public health laboratory system that has been developed by APHL. The assessment tool is designed around the Ten Essential Services of Public Health and cross-walked with the Core Functions of Public Health Laboratories. most by a lack of consistent power and damage to building infrastructure. Power outages led to equipment downtime and loss of refrigerated reagents. Moreover, without reliable internet or cellular service, communication concerning needs and restoration of test services was slow. Though most laboratories had backup generators, many failed and had to be replaced by mobile generators provided by the Federal Emergency Management Agency. which provided mobile generators. PRPHL and Laboratorio Sanitario de Mayaguez had the most evident water leakage in laboratory spaces, caused by structural damage to their roofs. Laboratorio Sanitario de Arecibo and the BCEL suffered little building damage but required PublicHealthLabs @APHL