PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Are Sentinel Clinical Labs Ready for the Next Threat?
By Robert Nickla, M(ASCP), LRN coordinator, Oregon State Public Health Laboratory and
Samuel Abrams, MPH, specialist, Public Health Preparedness and Response
ability of public health laboratories
to provide these trainings will greatly
diminish.
Diseases such as Ebola and MERS may
be rare in the US but they are more
commonplace in other countries. Given
the ease of global travel in the 21st
century, such diseases are sure to reach
America’s shores as seen in recent years
with Ebola and Zika. To prepare for this
eventuality, the US Department of Health
and Human Services, Assistant Secretary
for Preparedness and Response’s (ASPR)
Hospital Preparedness Program (HPP)
provides funding to states and other
jurisdictions to assist healthcare systems
to plan for and respond to emergencies
such as an emerging infectious disease.
Expanding Resources &
Collaboration
No Dedicated Funding for Sentinel
Labs under HPP
However, the HPP provides no dedicated
funding to strengthen the hospital
laboratories that are often the first to
encounter an emerging threat. Scientists
at these facilities, known as “sentinel
clinical laboratories,” may be ill-equipped
to mount an effective response if
adequate funding is not available.
According to APHL’s Annual All-Hazards
Laboratory Preparedness Survey, there are
approximately 5,200 US laboratories that
meet the definition of a sentinel clinical
laboratory, yet only four public health
laboratories received federal funding
through the HPP Cooperative Agreement
to support biological preparedness in
clinical laboratories. This funding totaled
a mere $265,000 in federal fiscal year 2017.
Absent dedicated funding for clinical
laboratory preparedness, public health
laboratories rely on support from the
diminishing CDC Public Health Emergency
Preparedness (PHEP) Cooperative
Agreement to engage clinical laboratories
via training (e.g., on laboratory methods
and packaging and shipping) In federal
fiscal year 2017, public health laboratories
delivered 362 courses, reaching 4,787
laboratorians. Topics included risk
assessment, proper donning and doffing
techniques, and effective use of biosafety
cabinets. As PHEP funds decline, the
PublicHealthLabs
@APHL
State health departments and emerging
coalitions provide additional resources
to strengthen sentinel clinical laboratory
preparedness. For instance, the Minnesota
Department of Health designed a
High Consequence Infectious Disease
Readiness Toolbox to assist healthcare
facilities in responding to an emerging
disease. This resource was shared
at the National Healthcare Coalition
Preparedness Conference, itself a resource
for information on state preparedness
initiatives. At the federal level, the HPP
Cooperative Agreement brings together
healthcare organizations and partners in
coalitions to provide mutual support in
times of need. Similarly, ASPR convenes a
partners’ forum representing a wide range
of organizations that support the national
healthcare system. APHL participates
in this group to raise awareness of
laboratories’ crucial contribution to the
nation’s health.
APHL has long promoted the importance
of sentinel clinical laboratories as
the foundation of national response
capability. These laboratories will likely
be the first to encounter a patient sick
from an emerging threat and, as such,
they must be prepared. Preparedness
entails having laboratory staff trained to
safely perform testing including rule-out
and refer methods, a communications
network to notify public health partners,
the skills to correctly package and ship
patient specimens, and electronic systems
to exchange results. As we look to the
next five years of federal funding—
whether that be PHEP or HPP—resources
must be dedicated to strengthen
laboratories at all levels of the nation’s
Laboratory Response Network: national,
reference and sentinel clinical. n
APHL.org
Participants from a December sentinel laboratory
training held by Oregon State Public Health Laboratory
Laboratory Response Network Coordinator Rob Nickla.
Photo: OR PHL
A sentinel clinical laboratory is certified to
perform high complexity testing under the
Clinical Laboratory Improvement Amendments
of 1988 (CLIA) by the Centers for Medicare &
Medicaid Services (CMS) for the specialty of
Microbiology, or the laboratory is a Department
of Defense (DoD) Laboratory certified under the
DoD Clinical Laboratory Improvement Program
(CLIP), or the laboratory is a veterinary medical
diagnostic laboratory that is fully accredited
by the American Association of Veterinary
Laboratory Diagnosticians (AAVLD). Laboratory
in-house testing includes Gram stains and at
least one of the following: lower respiratory
tract, wound or blood cultures.
Source: APHL. Definition of Sentinel Clinical
Laboratories. 2018 Available from www.aphl.
org/aboutAPHL/publications/Documents/
Definition-Sentinel-Clinical-Laboratories.pdf
Winter 2019 LAB MATTERS
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