• Norman Crouch, Ph.D.
• Paula Snippes

• The network of public-private laboratories in Minnesota is referred to as the Minnesota Laboratory System (MLS), denoted by a trademark symbolizing collaboration between public and private sectors. As a first step, the MLS invited 165 clinical microbiology laboratories in the state, including a few from out of state, to participate in the system. Of those invited, 89% of laboratories responded to initial introductory mailing.
   
• As a second step, the Laboratory Program Advisor, completed an initial phone survey of all the laboratories, allowing for a customized and efficient on-site survey, which was administered during a site visit to each laboratory.
   
• The survey identified all MN Level A labs, described referral patterns, and established connectivity.
   
• Challenge set of microbiology samples was developed and sent to 132 laboratories:
  • Grow and lyophilize organisms; develop instructions & answer sheets; organize packaging and shipping; contact local postal service
  • 129 labs accepted; overall, 92% sent back responses
  • Bacillus megaterium, Streptococcus pneumoniae, E. coli O157:H7, Oligella ureolytica, Klebsiella pneumoniae (ESBL)
  • Overall, labs showed best performance testing S. pneumoniae for drug resistance (86% got expected result); worst performance with O. ureolytica (47% got expected result)
  • Majority of participants wanted more challenges; biannually was most favored rate.

• Based on the phone assessment, 140 of the laboratories received blinded challenge specimens to assess baseline laboratory practices and testing accuracy. Specimens were sent in the spring of 2002.
   
• Immediate interventions included instruction in testing for E. coli O157, ESBL (Extend Spectrum Beta-Lactamase) and Campylobacter transportation.
   
• Based on the results of the challenge specimens, educational materials and resources will be collated and delivered.
   
• During the phone assessment, laboratories were offered information about the National Electronic Data Surveillance System. The Minnesota NEDSS Coordinator is apprized of specific laboratories that express interest in NEDDS. Activities of MLS and NEDDS are coordinated to maximize results.
   
• The comprehensive survey was intended to determine capability and capacity, promote personal interaction, and encourage twoway dialogue.

• Through early outreach activities by the MLS, the number of clinical contacts to which laboratory alerts could be sent electronically doubled from 60 to 120. This capacity allows alerts to be sent quickly, informing laboratories about timely issues. This system was invaluable to disseminate information about agents of bioterrorism, including how to rule out BT agents and refer testing. Laboratories without electronic capabilities were sent the same laboratory alerts via broadcast FAX.
   
• These laboratory alerts were sent several times in response to the terrorist attacks and bioterrorism; the feedback from clinical laboratories has been very favorable. The labs, especially in rural areas, expressed that they were well informed and felt as though they could count on the Minnesota Department of Health for up-to-date information and that they werent forgotten way up here in Northern Minnesota, for example. Some labs also used the information and links that they received in the alerts to address some of the concerns of their communities.
   
• This electronic communication was also used to institute active surveillance with 35 larger institutions throughout the state (4 labs out of state) for daily reports of Bacillus sp. within each laboratory, for which Bacillus anthracis could not be ruled out. This allowed for more expedient confirmatory testing of these isolates in the MDH public health laboratory.
   
• Soon after, this system was used when three mysterious deaths occurred in a very short time period, related to knee surgeries in the state. An MLS alert was sent out to solicit information from labs as to who might have detected any clostridium bacteria in their facilities. The MLS lab contact list continues to be maintained and updated. Regular laboratory alerts have been sent more recently concerning West Nile Virus and SARS.
   
• The following shows the latest breakdown of the MLS members that can be reached via the lab HAN/MLS list and via FAX:
  • 159 = Total institutions receiving either FAX or e-mails
  • 146 = Total e-mails sent
  • 129 = Actual MLS e-mail contacts
  • 116 = Total institutions e-mailed (some institutions have more than one contact)
  • 17 = non-MLS contacts (other MDH staff, other state health departments)
  • 43 = FAXs sent to institutions without e-mail addresses.
     
• Laboratories in the network will be provided with in-services that will include the topics: bioterrorism, an overview of public health laboratories, the Minnesota Laboratory System, and the relationship between the Minnesota Laboratory System and the National Laboratory System. These in-services will be presented either at regional conferences, or provided at the time of the on-site lab survey.

A poster, showing grow characteristics and morphologies, which was developed in collaboration with clinical stakeholders and produced by a contractor, was disseminated to sentinel laboratories and made available to other state public health laboratories.