Lab Matters Winter 2019 - Page 24

PUBLIC HEALTH PREPAREDNESS AND RESPONSE Model Training in Michigan Connects Sentinel Clinical Labs, Epidemiologists by Carrie Anglewicz, MS, biosafety officer, Michigan Department of Health and Human Services–Bureau of Laboratories and Sean Page, associate specialist, Public Health Preparedness and Response BRUCELLOSIS — Brucella spp. Rule-Out Algorithm SAFETY As soon as Brucella is suspected, perform all further work in a Class II BSC using BSL-3 practices. If Brucella spp. cannot be ruled out with tests below, do not attempt further ID using commercial automated or kit identification systems. Conference developers designed an agenda that balanced the needs of epidemiologists and clinical laboratory scientists. The day opened with an update by a regional epidemiologist on 1) outbreaks occurring in their region and 2) current outbreaks across the state. Breakout sessions followed with clinical laboratory scientists participating in sessions on such as Identifying Select Agents and Laboratory Biosafety and Risk Assessments, and epidemiologists in sessions on Surveillance and Outbreak Investigations and Healthcare Epidemiology/Statistics. At the end of the day, the two groups came together for a biosafety tabletop exercise. Exercise Turns to Networking Event The tabletop exercise was designed to educate scientists from both disciplines in their respective roles and to provide an opportunity to learn from one another. Small groups comprised of both clinical laboratory scientists and epidemiologists reviewed the exercise scenario—a potluck luncheon where several attendees had become ill. Conference hosts provided 22 LAB MATTERS Winter 2019 5-10% CO 2 at 35°C? Note: Incubate plates for at least two additional days if no growth in 24h. Note: May retain crystal violet stain and be mistaken for Gram positive cocci Growth □ Subculture positive aerobic blood culture to BAP, CHOC? Satellite negative at 24-48 hours? Note: Spot BAP with S. aureus ATCC 25923 Oxidase and catalase positive? Note: Consider extended incubations up to 2-3 weeks. Consider Haemophilus NO NO YES Urea positive? □ Organism not growing on MAC? □ Slow growing in automated blood culture systems? NO TO ANY YES TO ALL YES Strong Agenda Drives Participation □ Aerobic, slow, poorly growing colonies after 24h incubation in Gram stain morphology □ Faint staining, not clustered, tiny (0.4 x 0.8µm), Gram negative coccobacilli? Brucella In an effort to provide training opportunities to clinical laboratories across the state, the Michigan Department of Health and Human Services–Bureau of Laboratories worked with the Michigan Bureau of Epidemiology and Population Health to develop and host free, one-day Biosafety and Healthcare Preparedness conferences in seven cities over a span of three months. The conferences attracted both clinical laboratory and epidemiology staff, bringing them together in a single room where they could network with their counterparts and share information and key resources. NO Consider Francisella Refer to ASM sentinel procedures 24h growth on CHOC Reincubate Use internal laboratory procedure YES, STOP Brucella spp. not ruled-out. Do not attempt further identification and contact your LRN Reference Level Laboratory to refer the isolate. Suggested Reporting Language: Possible Brucella spp. submitted to LRN Reference Level Laboratory for confirmatory testing. 48h growth on BAP 21 Each group worked to determine which test they should perform to identify the organism based on Gram stain and colony morphology. To assist with identification, each group received APHL bench cards. timelines of ill patients—such as when blood culture became positive—along with pictures of the organism grown on culture. Each group worked to determine which test they should perform to identify the organism based on Gram stain and colony morphology. To assist with identification, each group received APHL bench cards. Results were reviewed using a polling system. Each group answered multiple choice questions presented on a large monitor screen, allowing participants to share results and review the answers together. Then each group performed a risk assessment using the method typical at their laboratory, either Gram stain or blood culture. They were provided with the corresponding laboratory procedures and APHL risk assessment templates. Finally, the groups created an epidemiology curve to determine which food item was the culprit at the potluck luncheon. Participants ranked the tabletop exercise as the most valuable part of the conference. Clinical laboratory scientists found it very beneficial to network with their counterparts in epidemiology. Strengthening these public-private partnerships, as well as all levels of public health, remains critical for state and local preparedness response. n PublicHealthLabs @APHL APHL.org