Wisconsin:

On September 11, 2006 the Wisconsin State Laboratory of Hygiene (WSLH) was awarded a three year National Lab System (NLS) cooperative agreement from the Centers for Disease Control and Prevention (CDC) as part of a federal initiative to integrate clinical laboratories into public health testing. Wisconsin has been one of several states that have successfully developed a robust clinical laboratory network that addresses both emergency preparedness issues and routine microbiology issues. Over the last two decades, WSLH has provided training resources, regional meetings and teleconferences that benefit both local public health departments and private laboratories statewide. The laboratory surveillance conducted by the WSLH, a collaborative effort with the Wisconsin Division of Public Health (DPH), has also resulted in quality public health data that impacts state and local public health policy decisions.

The funds from this new cooperative agreement will allow WSLH to: 1) share successful methods of laboratory network development with other state public health laboratories by developing and distributing a media-rich lessons learned toolkit; 2) further assess clinical laboratories on their basic laboratory training needs and preferred methods of training delivery; 3) develop and deliver prioritized, competency-based training that is transferable to other states; 4) implement selected antimicrobial susceptibility testing surveillance and clinical laboratory methods validation; and 5) expand the laboratory electronic messaging and web-based data systems that are both Public Health Information Network (PHIN) and Wisconsin Electronic Disease Surveillance System (WEDSS) compatible. Development and delivery of training will be accomplished in cooperation with CDC, the Association of Public Health Laboratories (APHL) and the National Laboratory Training Network (NLTN).

Nebraska:

Antibiotic susceptibility testing (AST) of pathogenic bacteria is arguably the most important function that a clinical microbiology laboratory performs. However, due to the rapid change in testing methodology and interpretation of results, significant educational efforts are needed to address the number of changes that occur each year. The Centers for Disease Control and Prevention has awarded the Nebraska Public Health Laboratory a 3-year cooperative grant to develop a comprehensive antibiotic susceptibility testing educational program. It is our hypothesis that a clear understanding of the mechanisms of action of the antibiotic and the bacterial mechanisms of resistance, in combination with discussion of AST methods/rules/updates, can significantly address these educational needs.

The current proposal builds on the capability and expertise that has been developed over the past three years with the APHL/CDC NLS program. In our first proposal we developed personal relationships with the commercial and private clinical laboratorians, including both urban and rural areas of the state. This was accomplished through the hiring of a public health laboratory representative, a Laboratory Program Advisor, who traveled throughout the state sharing educational information about current issues and providing training for recognition of microorganisms of particular concern. The program resulted in a laboratory advisory committee that also included key representatives from the state health department. The next challenge we addressed was to make our resources available to both laboratory directors and bench technologists on a 24 hour, real time basis; an important concept which recognizes that problems and issues may arise at any time and that an effective partnership demands that we provide services to the customer when they need it, not at our convenience. A second need that was brought to our attention was the need to view the culture plates or other diagnostic materials as they appeared to the bench technologist seeking advice and consultation. To address this need we developed a secure video telecommunications system or STATPack (Secure Telecommunications Application Terminal Package). In our current proposal we propose to bring training and hands on experience with common and advanced AST issues to the front line laboratories and combine that training with the ability to provide real time consultation on AST via the STATPack. The educational content that is developed for this proposal or adapted from existing content will be leveraged to provide material for Nebraska, and potentially other states that adopt the STATPack system. The specific aims of this application are as follows:

Specific aim 1: To determine the needs of clinical microbiology laboratories in the state of Nebraska in regards to antimicrobial susceptibility testing. This assessment will be used to determine which aspect of AST is most needed (i.e. CLSI updates, ESBL testing, etc.)

Specific aim 2: To develop and implement "hands on" wet labs and lectures to be held at six different sites throughout the state to provide hands on experience and personal guidance regarding AST issues.

Specific aim 3: Develop a long term consultation solution for continuous improvement in function and outcomes through consultative telemedicine.

Montana:

The Montana Public Health Laboratory's Initiative to Integrate Clinical Laboratories into Public Health Testing proposes to enhance testing and reporting practices with regards to antimicrobial susceptibility testing (AST) and sexually transmitted diseases (STDs) for rural, clinical laboratories and laboratories servicing Native American populations in Montana, North Dakota, South Dakota, and Wyoming.

A number of compelling factors shaped the focus of this proposal. A 2006 survey of clinical laboratories in Montana identified significant gaps in knowledge of and adherence to guidelines for AST practices between "urban, large capacity" laboratories and "rural, smaller capacity" laboratories. Public health related testing pertaining to STD testing and reporting in our Native American populations is also a concern, as rates of STDs are higher in this population despite intervention efforts. MT, ND, SD and WY share similar demographic statistics that contribute to common challenges facing our rural, clinical laboratories. Providing educational opportunities to this large geographic, sparsely populated area is a challenge, as many rural laboratories do not have the staffing or resources to attend off-site workshops and seminars. Activities funded by this initiative will increase the knowledge base of clinical laboratory professionals while improving their ability to conduct public health related testing and reporting in these frontier states, as we work toward a National Laboratory System.

• Assess status of AST testing, barriers to compliance with AST standards, and training needs of small, rural clinical laboratories, in MT, WY, ND, and SD. Provide and/or assist in training and practical application of AST standards in order to increase adherence to voluntary guidelines.
• Assess status of sexually transmitted disease (STD) testing at clinical laboratories that service Native American populations in MT, WY, ND, and SD and promote adherence to testing and reporting standards.

• Continued assessment of AST practices through yearly surveys and refined AST educational opportunities targeting identified needs.
• Review status of electronic laboratory data reporting from rural, clinical laboratories in MT, WY, ND and SD and find common ground that will promote reporting tests of public health concern to local public health authorities and improve rates of submission of isolates to state public health laboratories.
• Assess status of public health knowledge, communication, and training needs for rural, clinical laboratories in MT, WY, ND, and SD and establish sustainable mechanisms to strengthen/promote relationships between rural, clinical laboratories and local public health authorities.

Foundation for Health Care Quality:

• Objective I
  
  To implement a quality management system in Washington State to assess the inter-laboratory variability of clinical microbiology laboratory practice, policies and processes in small hospital laboratories
   
• Objective II
  
  To implement a platform for a quality management system in small hospital laboratories in Washington for service delivery, customer service, reduction of variability that occurs in laboratory practice, policies, and processes.
   
• Objective III
  
  Plan and implement a quality management system in collaboration and consultation with the Directors of the Alaska, Oregon and Washington State Public Health Laboratories to: a) provide a platform for continuous improvement in service delivery, communication with clinical laboratories, customer services, and processes in their laboratory and, b) to study factors that impede the clinical laboratories in each state from adhering to voluntary national laboratory practice guidelines in microbiology, reporting of results, and submission of isolates and specimens to the state public health laboratory