Lab Matters Spring 2019 - Page 37

MEMBERSHIP • Instituting an internal career ladder and a merit pay system that boosts salaries beyond the city’s periodic cost-of-living increases and mandatory, step-level increases based on years of service. Said Tran, “Our salaries have to be competitive with the federal government and with area hospitals.” Challenges • The laboratory’s “rarely say no” ethos and limited staff mean leaders must “be innovative and think outside- the-box” to meet their commitments. At present, a major strategy is to “move toward robotics and automation to reduce the burden on staff” said Tran. The LEED platinum certified facility at 401 E Street, SW. Photo: DC PHL Success Stories • Developing a “sequencing core” that processes and tests biological samples on behalf of other laboratory units and provides the data back to them. Over the course of 2018, DC PHL “went from no PulseNet WGS and one sequencer to PulseNet WGS certified and four sequencers.” In addition, staff are “taking the manual work out of next generation sequencing (NGS)” and applying NGS technologies to novel areas; for example, using automated nucleic extraction and library preparation and developing CLIA- approved field protocols to enable NGS at point-of-care sites • Achieving surveillance of nearly all heroin and most other synthetic opioids and cannabinoid drugs seized by DC law enforcement personnel in undercover buys or arrests—perhaps the only US jurisdiction to do so. Laboratory drug testing—supported by a cooperative agreement from CDC—is independent of any legal proceedings and has so far identified roughly half a dozen opioid analogues and half a dozen synthetic cannabinoids previously unseen in DC. • Providing technical expertise to DC government leaders. Despite its national and global prominence, the DC government is small enough that “we’re able to interact intimately with other agencies,” said Tran. A recent collaboration with the DC Office of the Attorney General led to the SAFE PublicHealthLabs @APHL DC Act, which completely revamps the city’s controlled substance’s list. Said Luke Short, PhD, chief of the PHL’s chemistry section, “As you find new, opioid analogues and synthetic cannabinoids on the street, if they’re not in the law, you can’t arrest anyone for possessing or selling them.” Instead of enumerating such analogues drug- by-drug, the SAFE DC Act creates a taxonomy of controlled substances, based on the class of chemical compounds in the drugs. “DC is pioneering a whole new approach to dealing with controlled substances,” said Short. • Working with the DC medical examiner on quick-turnaround “STAT” requests. As Tran explained, “STAT requests might seem unusual for someone who is no longer living. But here, if the medical examiner, upon autopsy, finds signs of anything potentially highly contagious, they will request a STAT test to quickly identify the cause of demise. A couple weeks ago, we had such a request, and the cause of death was identified as meningitis, which is highly contagious and can pose a severe public health threat, if that is what killed the person.” • Ramping up the city’s influenza surveillance program, which increased its scope by 700% between 2017 and 2018, in terms of specimens analyzed. “In 2019, we will double that,” said Tran. • Being part of a stand-alone, laboratory- based department means the PHL has to “work a little harder to assure optimal coordination with the [city] health department.” Tran said, “We want folks to know we’re here and available for them.” • Although there are well over a million people present in DC at any time, day or night, the PHL is sometimes stymied by funding algorithms based solely on the size of its residential population (about 700,000 people). • The complex interplay between the DC and federal governments sometimes creates extra challenges. “If there is a Legionnaires’ disease outbreak at the NASA facility across the street,” said Tran, “DC Health would be responsible for responding to that outbreak, even though it’s a federal property.” Goals • Provide city agencies with “the best available laboratory expertise to recognize and respond to emerging health and safety threats.” • Continue building the laboratory’s next generation sequencing testing capabilities. • Re-establish the laboratory’s STD, HIV and TB testing program. • Employ the PHL’s state-of-the-art facility as a demonstration laboratory for other PHLs. n Spring 2019 LAB MATTERS 35