challenges in laboratory services april 2006
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Challenges in DiagnosticSupport Services:
Laboratory Services
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Role of The Laboratory
1. Support for rapid investigation ofdisease outbreaks
2. Support for improved surveillance
3. Provide early warning system foremergence/reemergence pathogens
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1. Analyse data and provide feedback of theresults to public health authorities
Main Challenges to the Laboratory
. ,standard procedures and qualityassurance
3. Provide technical support, training,guidance and quality assurance to alllaboratories within the country
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Outbreak Detection and Response
70
80
90
FirstCase
Detection/
ReportingConfirmationInvestigation
Opportunity
for control
Response
DAY
CASES
0
10
20
30
40
50
1 4 7 10 13 16 19 22 25 28 31 34 37 40
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Responsibilities of Hospital Labs
Identification of infectious agent using
standard procedures and reagents Refer to the National Ref lab for
Reporting results
Coordination with case investigators
Coordination and implementation ofcontainment activities
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Responsibilities of National Reference Labs (1)
Identification of infectious agent by
serology and/or isolation using standardprocedures and reagents
Referral of isolates (eg: influenza) to
the Global Specialized Labs / WHOCollaborating Centre
Reporting results in a timely manner
Serve as centre for training thelaboratory personnel from hospital
laboratories
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Responsibilities of National Reference Labs (2)
Provide guidelines for proper specimencollection, transportation and laboratorytesting
Coordination and implementation ofcontainment activities
Coordination with case investigators
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Responsibilities of Global Specialized Labs
Definitive identification of isolates usingall available technologies, includinggenetic characterization, to reveal theorigin of isolates
reparation an istri ution o re evantstandards, reference reagents andtraining materials
Provision of consultants to evaluate andadvise on lab services and providespecialized training
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1. Bio-safety Level 3 Laboratory (P3 Lab)
2. Training
Preparedness: Some measures needed
.
4. Resources
5. Guidelines for Collection and
Transportation of Specimens
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The Outbreak Control Team
Membership
LeadershipCo-ordinate further investigation andresponse
Responsibilities Lines of communication
Communication and decision makingprocess
Report to and advise higher authorities
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- In 2002 initiated focus surveillance for:
HFMD Influenza Dengue
Virology Unit, IDRC, IMR
- 16 March 2003, designated NationalReference Laboratory for SARS
- 2004 designated as the National ReferenceLaboratory for Avian Influenza
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(i) BSL3 facilities and BSL3 workpractices:
samples processing and virus
SARS OUTBREAK
Laboratory Facilities:
iso ation
(ii) BSL2 facilities with stringent BSL3
work practices:PCR, IFA and EM
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Setting up of the operations room
Teams by function
Retraining
Virology Laboratory, IMR
All staff buy-in Morale building
Guidelines
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Specimen collection
Specimen transport Containment
Guidelines
ocumentat on Information flow
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Specimens collection
The following should be considered forcollection of specimen for culture:
Timing
Appropriate site
Proper collection Proper transportation
Alert the laboratory of diseasesuspected especially agents thatrequires special culture media
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Clinical Specimen
Use PPE
Transfer Specimen to biohazard cabinet
Flow Chart For Specimen Receipt At IMR Specimen
Reception Counter
If Class 3 or 4 Pathogen
DO NOT OPEN
Other specimen, process inusual manner
Leave specimen in biohazard cabinet
Contact Virology Unit
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Flow Chart for Specimen Receipt At Virology Unit SpecimenReception Counter/Guard House
Clinical Specimen
Inform Officer and Technician in-charge
Use PPE
Transfer Specimen to P3 Laboratory
Place Specimen in Containment Box
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Processing
Cell culture
Nucleic acid testing
Laboratory Tests Investigation (1)
Specimen P3
Electron microscopy
Immunoflourescence
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use validated test methods
standard operating procedures
Laboratory Tests Investigation (2)
false positive/false negative results
verify test results
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Laboratory results Head of Virology
Director GeneralOf Health
Verification process
Deputy Director General of Health
CDC
Minister of Health
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- Prepared for future pathogen level 3outbreak investigation
- P3 laboratory adequately equipped
Virology Unit, IDRC, IMR (4)
- Staff confident and prepared to copewith future outbreaks.
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Process Specimen in theBSL-3 Cabinet
PPE
Collect Specimen From Pass-through Box
Autoclave BiohazardBag/Waste
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Conclusion
Both the public health authority and the lab have arole in ensuring optimum lab services:
Public health: to educate the health-care
providers on the importance of lab testing nd tomake sure that the lab resources are accessible
Lab: to develop and maintain testing resources, SOP& QAP, and to analyze data and provide feedback tothe public health authorities
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Lessons learnt
Be prepared for eventualities -training Contingency plans- evaluate capabilities O timize resources : team work
Leadership role Hands on Keep cool and level headed
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