Lab Matters Summer 2019 - Page 35

MEMBERSHIP Revenue we also provide services for our environmental health division, county epidemiologists and the medical examiner’s office. In the last few years, we’ve helped our epi group with several cases linked to Salmonella poisoning. We also provide STAT testing for forensic examiners who have needle stick injuries or cuts.” The laboratory’s annual operating budget runs to $2.6 million. About $1 million of the total comes from state aid, state contracts and laboratory fees, which are mostly for environmental testing. The remainder comes from county funds. Pope said, “We bill insurance [for clinical testing] when it’s available, but we don’t otherwise bill for clinical services.” Laboratory Assistant Maria Stein prepares media in the Scientific Support Lab. Photo: ECPHL Testing The laboratory conducts roughly 35,000 tests each year, split fairly evenly between clinical work—mostly sexually transmitted disease (STD) testing— and environmental work—mostly water testing. This past summer, the clinical laboratory began implementing Mycoplasma genitalium (Mgen) testing on Hologic’s Panther® platform. Mgen is considered the “silent STD,” and often mimics gonorrhea. “We have no idea what the prevalence is in Erie County,” said Pope. “The plan is to test all symptomatic patients for Mgen over a six-month period; that will determine whether the prevalence is high enough to justify continued testing.” The Erie County laboratory is one of the only labs in Western New York offering a test to distinguish between herpes simplex virus I (HSV-1) and HSV-2, also using the Panther platform. And it is in the process of bringing on the QuantiFERON ® Gold Plus test for tuberculosis. In addition to routine clinical testing, the laboratory is a Tier 2 member of the Laboratory Response Network for Biological Threats, serving the 17 western New York counties. On the environmental side, the laboratory tests drinking water for public water systems and water treatment plants, groundwater for private well owners, irrigation water for farms monitored by the US Department of Agriculture, wastewater for regional water treatment plants and recreational water for Erie County and other localities on New York’s Finger Lakes. The laboratory is one of only a handful in New York—and the only lab in Western New York—offering the US EPA-approved test for microcystins, a class of toxins produced by blue-green algae. Pope said, “Lake Erie’s Ohio area has had a lot of issues with blue-green algae in the PublicHealthLabs @APHL last few years. The algae haven’t made it to our end of the lake yet, but we’re ready for it.” Aside from its testing services, the laboratory is a rotation site for ten to 15 students/year from three academic programs: University of Buffalo Medical Technology Program, Erie County Community College Medical Technology Program and the University of Rochester Post-doctoral Residency in Medical and Public Health Laboratory Microbiology. Successes • Updating all of the instrumentation in the environmental chemistry laboratory. “We went to the county every other year for several years with proposals to update our instrumentation. Finally, we got the funding through the county’s capital projects office. This has helped us decrease test turn-around-times and increase testing capabilities and capacities. For example, one of the first new instruments we got was an ion chromatography mass spectrometer. We are one of only a handful of US laboratories using this hybrid technology, which we’ve been running for about six or seven years for some of our analyses of disinfection byproducts in drinking water. With the new methodology, we can eliminate sample extractions prior to testing and deliver faster, more precise test results.” • Implementing Qualtrax quality management software. “We’ve just started bringing this on and hope it will streamline some of our work.” • Collaborating with other county divisions. “While we serve clinics, APHL.org • Implementing an interface between clinic electronic health records and the laboratory information management system. “Our clinics will be able to electronically order tests and receive results much more efficiently.” Challenges • Staffing. “Staffing is tough. We’ve lost positions as a result of decreased funding, and we’ve got staff nearing retirement. Probably 90% of our staff have been here 15 years or more. It’s difficult to find people who will work for our public-sector salaries. Retaining new employees has been somewhat difficult.” • Funding. “As in most PHLs, funding is a challenge.” • Shortage of qualified laboratory directors. “Even with our restructured organization, it’s difficult for us to find and retain a medical director who meets CLIA and New York regulatory requirements. We’ve been fortunate to have had our current medical director for the last five years.” Goals • To finalize implementation of the laboratory’s Mgen and tuberculosis tests. • To implement Qualtrax quality management software and restructure our quality management system. • To continue to reduce test turnaround times and to replace older instrumentation with state-of-the-art laboratory technology. • To modify and expand our current service menu to better meet the evolving needs of county clinics and health division partners and to address emerging public health concerns. n Summer 2019 LAB MATTERS 33