Lab Matters Winter 2019 | Page 25

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 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 23