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
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