PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Model Training in Michigan Connects
Sentinel Clinical Labs, Epidemiologists
by Carrie Anglewicz, MS, biosafety officer, Michigan Department of Health and Human Services–Bureau of Laboratories and
Sean Page, associate specialist, Public Health Preparedness and Response
BRUCELLOSIS — Brucella spp.
As soon as Brucella is suspected, perform all further work in a Class II BSC using BSL-3 practices. If Brucella spp. cannot
be ruled out with tests below, do not attempt further ID using commercial automated or kit identification systems.
Conference developers designed an
agenda that balanced the needs of
epidemiologists and clinical laboratory
scientists. The day opened with an
update by a regional epidemiologist on
1) outbreaks occurring in their region
and 2) current outbreaks across the state.
Breakout sessions followed with clinical
laboratory scientists participating in
sessions on such as Identifying Select
Agents and Laboratory Biosafety and
Risk Assessments, and epidemiologists
in sessions on Surveillance and
Outbreak Investigations and Healthcare
Epidemiology/Statistics. At the end of the
day, the two groups came together for a
biosafety tabletop exercise.
Exercise Turns to Networking Event
The tabletop exercise was designed to
educate scientists from both disciplines
in their respective roles and to provide an
opportunity to learn from one another.
Small groups comprised of both clinical
laboratory scientists and epidemiologists
reviewed the exercise scenario—a potluck
luncheon where several attendees had
become ill. Conference hosts provided
LAB MATTERS Winter 2019
5-10% CO 2 at 35°C?
Note: Incubate plates for at least two additional days if no growth in 24h.
Note: May retain crystal violet stain and be mistaken for Gram positive cocci
□ Subculture positive aerobic blood culture to BAP, CHOC?
Satellite negative at 24-48 hours?
Note: Spot BAP with S. aureus ATCC 25923
Oxidase and catalase positive?
Note: Consider extended incubations up to 2-3 weeks.
□ Organism not growing on MAC?
□ Slow growing in automated blood culture systems?
NO TO ANY
YES TO ALL
Strong Agenda Drives Participation
□ Aerobic, slow, poorly growing colonies after 24h incubation in
Gram stain morphology
□ Faint staining, not clustered, tiny (0.4 x 0.8µm), Gram
In an effort to provide training
opportunities to clinical laboratories
across the state, the Michigan Department
of Health and Human Services–Bureau of
Laboratories worked with the Michigan
Bureau of Epidemiology and Population
Health to develop and host free, one-day
Biosafety and Healthcare Preparedness
conferences in seven cities over a span of
three months. The conferences attracted
both clinical laboratory and epidemiology
staff, bringing them together in a single
room where they could network with their
counterparts and share information and
Refer to ASM sentinel procedures
24h growth on CHOC
Use internal laboratory procedure
Brucella spp. not ruled-out. Do not attempt further identification and contact your LRN
Reference Level Laboratory to refer the isolate. Suggested Reporting Language: Possible
Brucella spp. submitted to LRN Reference Level Laboratory for confirmatory testing.
48h growth on BAP
Each group worked to determine which test they should perform to identify
the organism based on Gram stain and colony morphology. To assist with
identification, each group received APHL bench cards.
timelines of ill patients—such as when
blood culture became positive—along with
pictures of the organism grown on culture.
Each group worked to determine which
test they should perform to identify the
organism based on Gram stain and colony
morphology. To assist with identification,
each group received APHL bench cards.
Results were reviewed using a polling
system. Each group answered multiple
choice questions presented on a large
monitor screen, allowing participants
to share results and review the answers
together. Then each group performed a
risk assessment using the method typical
at their laboratory, either Gram stain
or blood culture. They were provided
with the corresponding laboratory
procedures and APHL risk assessment
templates. Finally, the groups created an
epidemiology curve to determine which
food item was the culprit at the potluck
Participants ranked the tabletop
exercise as the most valuable part of the
conference. Clinical laboratory scientists
found it very beneficial to network with
their counterparts in epidemiology.
Strengthening these public-private
partnerships, as well as all levels of public
health, remains critical for state and local
preparedness response. n