Lab Matters Winter 2020 - Page 31

MEMBERSHIP the Laboratory Response Network. After almost three years there, Davis said, “my parents got sick.” Wanting to be closer to their Detroit home, he applied for the directorship of the Marion County Public Health Laboratory, “and that was successful.” He began his tenure in mid-2017. Staff The 22-member staff includes nine clinical technologists, most of whom rotate among the laboratory’s three locations, three microbiologists, three chemists, an informatics specialist, three managers, the laboratory director and two laboratory support specialists who assist with accessioning and media prep. Revenue The laboratory’s $2.1 million annual budget comes mostly from county general funds, supplemented by fee income and federal grants. Testing Safety Program. Chemists test for asbestos in bulk samples; lead in soil, dust wipes, and paint chips; and heavy metals, VOCs, herbicides and other inorganic contaminants in well water, surface water and various sources of city drinking water. Environmental microbiologists test food samples for pathogens of public health concern—such as Enterobacter, Staphylococcus, Salmonella and E. coli 0157:H7—and drinking water and pool water samples for coliforms, E. coli and bacterial plate counts. Successes In early 2019, the automated, laboratory- wide Digi ® SmartSense temperature monitoring system was installed. The system runs independently of all other laboratory networks and alerts staff to aberrant temperature changes in any of the facility’s incubators, water baths, refrigerators or freezers. In addition, the automated temperature log assists with quality assurance monitoring and laboratory inspections. This year, the laboratory acquired a new, automated platform for syphilis testing—the AIX1000 ® from Gold Standard Diagnostics—and the GeneXpert platform for gonorrhea, chlamydia and trichomonas testing. Overall, the public health laboratory performs about 80,000 clinical tests and 85,000 environmental analyses each year. The highest-volume clinical service is STD testing. A sampling of other clinical services includes testing for HIV, blood lead, cholesterol, pregnancy status and hemoglobin A1c levels (for screening of diabetes). On the environmental side, the laboratory supports the MCPHD Water Quality and Hazardous Materials Management Program, Housing and Neighborhood Health Program, and Food and Consumer In December 2018 the laboratory went live with an updated laboratory information management system (LIMS)—the HORIZON ® LIMS. “We used a lot of APHL resources to design our LIMS specifications,” said David Sosbe, the laboratory informatics lead. This two-year project affected the entire laboratory staff, many of whom had to “reprioritize to-do lists” around the LIMS upgrade. Over the course of 16 months in 2017- 2018—in the aftermath of the Flint, Michigan, water crisis—the laboratory performed lead testing on almost 9,000 drinking water samples from about 300 county schools. From all samples taken, 5.4% exceeded the US Environmental Protection Agency standard at the time of 20 parts-per-billion. They were remediated by fixture replacement or removal. Chemist Samamtha Kumfer preps the IC instrument for anion analysis. Photo: Marion County PHL PublicHealthLabs @APHL Since 2016, the laboratory has had the US Centers for Disease Control and Prevention SURRG grant to test for antibiotic-resistant gonorrhea. In 2016, the laboratory implemented the Clinical Laboratory Standards Institute’s standards for quality management systems. In 2015, the laboratory implemented new tests for soil metals analysis and boron analysis. Said Environmental Laboratory Manager Andrea Olson, MS, “Soil metals analysis allows us to...offer urban garden soil testing to the public, such as the Keep Indiana Beautiful [initiative] and public school garden projects.” Challenges The “main challenge,” said Davis, is “we’re out of space and out of power. We need a new laboratory building.” Although a new public health laboratory facility has been on the county’s long-term capital budget, “it manages to roll over” from year to year. In the meantime, Davis said, “In order to add new instrumentation and new tests, we have to remove something.” A second challenge is dealing with the loss of long-term staff members and the institutional knowledge they possess. “They will be hard to replace,” said Davis. Goals • Acquiring a new laboratory building. • Instituting a respiratory disease testing program. • Instituting PCR testing for foodborne pathogens. • Instituting oil and grease analysis—a repeated request from the county’s water quality program to enable identification of the source of select surface water pollutants. • Instituting a program for arsenic speciation. • Interfacing the laboratory’s new LIMS with the Indiana Department of Environmental Management web portal to facilitate water quality results reporting. • Partnering with LabCorp—which performs confirmatory HIV testing and a few other tests for the public health laboratory—to implement electronic accessioning and electronic results reporting. n Winter 2020 LAB MATTERS 29