Webcast Transcript
CDC Responds: Coping with Bioterrorism—The Role of the Laboratorian
(November 9, 2001)
(View the webcast on the University of North Carolina School of Public Health site.)
Segment 8 of 9
1
| 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
<< previous
| contents | next >>
Dr. Martin:
Thank you very much, Susan, for sharing that information with
us. That was really important information from practical field experiences.
Norman, what I would like to do now is as you to talk about one of
the more important issues that we’ve heard here and that is issues
related to communication. Oftentimes we hear a lot about technology
and the importance of implementing technology, but we’ve also heard
here today that communication issues are critical for the public and
federal laboratories to relate to the hospital laboratories. Can you
describe some of your recent experiences and what steps have been
taken in Minnesota to address those issues described by Dr. Sharp,
including what you’re doing about improving communications between
public and private laboratories?
Dr. Norman Crouch:
Yes, thank you, Dr. Martin. I’d be glad to. Let me point out
first, however, that each of the 50 state public health laboratories
is a Level B facility, either for all the agents or at least for some
of the agents. Some of these are actually level C laboratories and
as such, it’s very important that each of the state public health
laboratories realize that they have a very essential role to play
in the laboratory training network.
On my first slide, I want to talk about some of the kinds of materials
that we get in the state laboratory to test, as I want to point out
that the public health laboratory, its main role, or one of its main
roles, is to confirm the existence of a bioterrorism agent in materials
that come into the laboratory. The referred isolates are isolates
that we receive from clinical laboratories, the Level A laboratories,
where they have isolated an organism that they cannot rule out as
a contaminant. So it’s sent to our laboratory to determine if it is
in fact a bioterrorism agent. We also get environmental samples, and
the environmental samples are generally brought the state laboratory
by public safety. This can be the fire or police personnel or it can
be other federal agencies. We get also powders to test for anthrax
spores; certainly the last few weeks this has been a real concern.
And I want to point out, again, it’s been mentioned before, that these
are potentially very dangerous materials, and they should not be handled
in Level A laboratories. It’s required, or it’s certainly recommended,
that these only be handled where there are BSL-3 conditions.
Finally, the clinical specimens that we receive in the Level B laboratory
or the state laboratory are materials that are sent to us directly
for diagnostic testing. And this happens when we have an outbreak,
if we have a concern about bioterrorism, or actually there are patients
who are becoming ill. This certainly has not happened to a large extent
in this current situation, but if a major attack would occur. These
are specimens that are not sent to the Level A laboratory, but they’re
sent directly to the state laboratory for confirmation and testing
for diagnostic purposes.
On this next slide, I want to point out that the state laboratory
really plays a pivotal role in the LRN. It, on the one hand, works
closely with the Level A laboratories, and, on the other hand, it
works directly with the CDC to implement federal recommendations for
laboratory practices, and also to implement new methods that are being
brought to us from the CDC and their research laboratories. As shown
on this slide, the role of the state lab is to first of all confirm
suspicious isolates found by the Level A labs in their communities.
This is a very important role, of course, for the Level A laboratories.
In doing so, the public health laboratory is responsible for accurate
and timely reporting of the test results, and they provide this data
to the public health officials, and this assures rapid intervention
and prevention—for prevention and control. And as Dr. Sharp pointed
out, it becomes very important that we not only report to our own—within
our own health department but we also need to report back to the Level
A laboratories what we have found in our confirmations investigations.
A second part of what the state laboratory does, in addition to testing,
is to provide information and guidelines to the Level A laboratories.
In Minnesota, we provide the Level A laboratories with community alerts
to keep them up to date on what is happening in the community, and
particularly what is necessary for them to know regarding laboratory
testing. We provide them with technical information, and we provide
them with assistance that they may need to have to decide what kind
of required actions they might need to take. If a laboratory in the
Level A category, the clinical laboratory, has any questions, they
should call the state laboratory to get assistance.
Another area of the state laboratory is to effectively facilitate
communication. As Dr. Sharp mentioned, communication is really a very
key component here. If we’re going to have a network where we interact
between public health laboratories, state laboratories and the clinical
laboratories out there on the front line, we have to have excellent
communications. It has to be between the state laboratory and the
clinical laboratories. It also has to be clearly a good communication
between the state laboratory and the CDC. The state laboratories have
a key role in developing a strong intrastate network between the clinical
and public health laboratories. This is what we really are trying
to do in Minnesota, is to try to establish an integrated network to
make this work well.
These are the key elements that I put on this slide that I think are
important in developing this kind of interactive intrastate interaction
and laboratory system. In our state, we are trying to address each
of these. The first is a statewide database. We’re trying to build
this through a comprehensive survey being done with all of our Level
A laboratories in the state.
Secondly, we’re trying to develop a communications system that is
multifaceted and also very robust, and we’re trying to develop a courier
system. This is a continual problem state laboratories, to develop
a courier system that is reliable, that transports materials and samples
and referral isolates and such from Level A laboratories to the public
health laboratory.
And finally, we’re working hard to develop a surge capacity plan.
If we’re faced with a situation where we have a major attack, it’s
going to be very important to have something in place to be able to
deal with this. We can’t do it retrospectively, but we really need
to take proactive action. Now, I’d like to discuss each of these separately.
First of all, Minnesota is developing a comprehensive statewide database
of all the Level A laboratories in the state, and that includes all
of our clinical as well as public health laboratories other than the
state laboratory. The first part of this is to develop lab contact
information. We need to know who are the key contact persons in each
lab, their phone, their e-mail, and their fax numbers and also, if
it’s very important (I think Dr. Sharp mentioned this) that the Level
A laboratories also need to have this kind of information. They need
to have phone numbers of people to contact at the state laboratories
so when there are questions or concerns or an emergency, they know
where to go. So in Minnesota what we’ve done is we’ve provided a laminated
list of key phone numbers and key personnel to all of our Level A
laboratories so that they know where to call.
A second part of this is personnel experience in the statewide database.
We want to know what is the level of staff training in these laboratories
in the state and what kind of technical expertise is available. As
Dr. Sharp mentioned, there’s a lot of technical expertise in these
clinical laboratories. It’s important for the state laboratory to
know what these are and where they are. Laboratory capability and
capacity is another important item. What is the technical capability
of the various clinical laboratories? And what are the lab’s capacities
to increase this activity in case we would have a situation where
there is a need for expanding our surge capacity, and, finally, our
communication capability, and that’s the kingpin that we’ve talked
about here. We need to find out what our clinical labs—what is their
capability to communicate with the state lab? Do they have access
to the Internet? Do they have e-mail? Do they have fax capabilities?
And it’s not always the case, and we need to know that and add that
into our database.
Secondly, we’re developing in Minnesota an effective communications
system between all of the clinical laboratories and the state laboratory.
First of all, we are trying to develop very broad-based e-mail and
broadcast fax capability. We want to be able to reach all of the Level
A laboratories, and in doing so not just getting the information out
there and wondering if it actually got to these laboratories, but
having a way of knowing whether this communication has really reached
all of the laboratories that we’re trying to reach.
A second part of this is the Health Alert Network. Now, the Health
Alert Network is not part of the LRN, this is separate, but we are
using this in Minnesota, because we do have a robust Health Alert
Network, and we’re trying to use this as also a way to communicate
with our clinical laboratories. The Health Alert Network was originally
set up to provide electronic communication infrastructure between
the state health departments and all of the local public health agencies.
But we have found that we can add on to this group, the public health
and the clinical laboratories in the state, which will then provide
us with an ability to provide them with clear, short laboratory alert
messages and concise information and recommendations, and it really
will facilitate our ability to communicate, Another part of this,
and linked to the Health Alert Network, is the use of a secure Web
site so that we can put on this Web site, password-protected essential
information that we might need to get out to the laboratories.
And finally, active surveillance. I want to just give you an example
of active surveillance that we’ve put in place using this kind of
communication network in Minnesota. With the situation that is occurring,
we are now in a situation where we have active surveillance for gram-positive
rods in Minnesota. And we are sending out a message every morning
to all of these clinical laboratories to ask them to report back immediately,
to find out if they have isolated any gram-positive rods that might
be contaminants or they might in fact be isolates of Bacillus anthracis.
We are doing this in a way that we can get a quick request out there
and a quick reply back. We hope it’s meaningful, and we hope it also
will become habit forming. I say habit forming not in jest, but I
think that’s what we’re faced with. We need to develop communication
systems that are routine and every day; there’s an expectation of
communication.
Next is the reliable courier system. In Minnesota, we’re trying to
establish a reliable courier system between the Level A laboratories
and the state. And this is essential for the network, but there are
problems with the current system, and this is probably the case in
most states. One of the problems is the scheduled transport. When
we try to rely on scheduled transport where a clinic may have a pick
up early in the morning, and if we miss that we might have to wait
another day before we can get the material we need, it may cause delay
if the pick up is missed, so we need to have some kind of on call
backup in place.
Another problem is remote out-of-state services. In the rural areas
it’s very problematic to getting access minimums and such to the state
laboratory. This can cause significant delays and specimen compromise
if there are extended delays.
Finally, multiple couriers per sample. In some of the situations,
particularly remote areas, couriers pass off a sample from one to
the other, and samples can get lost and also samples can be delayed
in getting to the state laboratory. What is needed is a well-defined
courier system that will ensure delivery at any time. Finally, we’re
putting into place a surge plan so that the state laboratory can quickly
expand its capacity to handle an extremely large volume of testing.
The development of this plan hinges on what I’ve just talked about:
a statewide database, having a statewide database, having an effective
communication system, and also having a reliable courier system. We’re
interested in looking at facilities. The state lab might not have
enough space to conduct all the necessary testing. We need to prearrange
this. Confirmatory testing might be delayed. We need to have prearranged
ability to utilize appropriate additional laboratories, either Level
A or extending some of the Level A to Level B capabilities. Personnel
recruitment, we need to have in place the ability to recruit additional
staff. We might have space but might not have the staff to do all
the testing.
Emergency training—If we’re going to recruit additional staff from
other places, we need to be able to train them quickly. We’re preparing
a CD-ROM for this purpose and also developing a rapid training format.
And, finally, reagent distribution. If there would be a surge, would
need to be able to contact the CDC to acquire additional reagents
that might be necessary for dealing with the surge. Finally, from
the state laboratory perspective, at least the one I’m talking from,
the LRN is becoming a very powerful network, but there still remain
some challenges. One of these challenges is the communication capabilities.
What we have found in Minnesota, that the clinical laboratories vary
greatly in their communication ability. Some differ markedly. And
so we have to try to link all of the laboratories in a way that we
can really completely build this robust communications system.
Another problem with is with out-of-state laboratories. Many clinical
laboratories submit specimens that go out of state to these large
commercial laboratories, which do an excellent job, and these are
actually Level A laboratories, but we have a problem with a loss of
the rule-in isolates. If they find what they consider to be a contaminant,
it’s not sent to the state laboratory for further analysis. And so
we need to correct that by developing a relationship with these large
commercial laboratories. And finally, sustained collaboration. In
order to have a laboratory network where we have an integrated system
of the public health laboratories and the clinical laboratories, we
have to work on a system that we can sustain. And I think one way
to do that is to develop the laboratory, the national laboratory system
where we have a system where we have an integration of the clinical
laboratories in the state with the public health laboratories so that
we can meet the needs of an attack that might be perpetrated upon
our country. Thank you.
Dr. Martin:
Well, thank you very much, Norm.
1
| 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
<< previous
| contents | next >>
- Page last updated November 20, 2002
Get email updates
To receive email updates about this page, enter your email address:
Contact Us:
- Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333 - 800-CDC-INFO
(800-232-4636)
TTY: (888) 232-6348
24 Hours/Every Day - cdcinfo@cdc.gov