Lab Matters Winter 2018 - Page 31

member spotlight The laboratory also works closely with many programs in Oregon’s Public Health Division, including epidemiology, sexually transmitted diseases, emergency preparedness and environmental programs. Oregon is one of 10 CDC EIP states, which, along with ELC funding, keeps the laboratory busy providing new and ongoing testing services. In addition, Virology/Immunology and General Microbiology perform Select Agent testing for the Laboratory Response Network for Biological Terrorism. All in a day’s work: The Illumina MiSeq is in good hands with microbiologists Michael Bitzer, Veronica Williams and Kristie Ryder. Photo: OSPHL infants. It has four major sections: General Microbiology, Virology/ Immunology, NBS and Operations: Success Stories • Operations provides support services for testing as well as building systems infrastructure. This includes specimen receiving, CD and NBS data entry, safety, facilities management, security, result reporting, laboratory information management systems (LIMS) administration, coordination of the statewide courier system, purchasing, reception services, mail processing, and Category A and B infectious shipping. • As the analytical hub of the Northwest Regional Newborn Screening Program, the NBS section receives specimens from infants born in Oregon, as well as Alaska, Idaho, New Mexico, Hawaii, Guam, Saipan and the Navajo Nation. In 2016, OSPHL screened more than 234,000 infant bloodspot specimens for 31 conditions on the federal Recommended Uniform Screening Panel, and is gearing up for screening Lysosomal Storage Disorders next year. • Virology/Immunology performs about 200,000 tests annually on 120,000 specimens. Target analytes include sexually transmitted pathogens as well as those responsible for influenza, Zika, MERS, norovirus, astrovirus and rotavirus. • General Microbiology tests enteric pathogens, EIP pathogens, B. pertussis, CRE and tuberculosis. In addition, this program tests retail meats for FDA NARMS for select enteric pathogens, such as Salmonella spp., Enterococcus spp. and Shiga toxin-producing E. coli (STEC), using PFGE and whole genome sequencing (WGS). PublicHealthLabs @APHL • Filling vacant positions. “One of my first challenges was to staff up. And we did, with help from the Public Health Division, while keeping within our position limits. We’ve hired many staff who are relatively young and love being in public health.” • Attaining CDC certification for submitting WGS data for Listeria monocytogenes, E. coli O157 and other STEC, Salmonella spp., Shigella spp. and Campylobacter spp. And hiring a bioinformatics intern from Oregon Health & Science University for much-needed technical support. • Achieving 90% recovery of laboratory testing fees—“a dramatic improvement in the last two years.” • Accrediting cannabis testing laboratories using the most rigorous standards in the nation to ensure the safety of any product being sold in Oregon. • Through a state public health modernization effort to improve the health of all Oregonians (HB3110), OSPHL has focused on laboratory process improvements; streamlining workflows within and between sections; building testing efficiencies; and enhancing electronic data exchanges with clients. A program analyst has been hired to work on laboratory-wide process improvement, including a true cost-analysis of laboratory services—studies of how long it takes and how many resources are used for each test the laboratory performs. “This will help us know how much it really costs to do our work and change our processes so we can keep above water.” • Achieving electronic data exchange for about 60% of the lab’s General Microbiology and Virology/ Immunology specimens. • Installation of new servers, roof and generator, and implementation of remote temperature monitoring. Challenges • Keeping up with new technologies, such as WGS, without the resources of laboratories with a large research budget. • Dealing with the widespread clinical use of culture-independent diagnostic tests. “We bear the burden of isolating bacteria from specimens that test positive, and timing is critical to recover the isolates for outbreak investigations.” • Harmonizing electronic data exchange between the laboratory and its customers. Currently, the public health laboratory uses two LIMS: one for CD testing and the other for NBS. “We have to integrate all this data,” said Fontana. “We’re also trying to get more electronic data exchange with our clients. Most of the connections we have are virtual private networks. We’d like to use the Health Information Exchange standard—it saves everybody a lot of time.” • Getting new positions approved for needed staff as the laboratory evolves. As technologies have advanced, client services and LIMS support staff have taken on additional roles and responsibilities to meet changing business needs. In addition, bioinformatics support will be an ongoing need due to the increasing complexity of the data. n Winter 2018 LAB MATTERS 29