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Laboratories Participating in Multiple Response Networks

“Challenges and Solutions”

Integration, Innovation, Implementation in Support of Multiple Laboratory Networks

June 6, 2010 APHL

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Preparedness is not profitable but in an event

readiness is rewarded.

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Objectives – To Understand

1. Challenges affecting public health laboratory participation in multiple laboratory response networks.

2. Solutions to increase laboratory capability and capacity to serve multiple networks.

3. How participation in multiple laboratory response networks can improve laboratory efficiency and increase laboratory funding potential.

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Laboratory Response Networks

• CDC – Laboratory Response Network (LRN)

• EPA – Environmental Response Laboratory Network (ERLN)

• USDA / FDA – Food Emergency Response Network (FERN)

• USDA - National Animal Health Laboratory Network (NAHLN)

• USDA/NIFA/Land Grants Univ. – National Plant Diagnostic Network (NPDN)

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Participation in Multiple Response Networks “The ICLN”

Integrated Consortium of Laboratory Networks (ICLN) - A coordinated and

operational system of laboratory networks.

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ICLN - Can you see it?

Its time has arrived but public health laboratories and laboratory

networks are still waiting for it to materialize.

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ICLN Structure

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Participation in Multiple Response Networks

Vision“A coordinated and operational system of laboratory networks that provide timely, high quality, and interpretable results for early detection and effective consequence management of acts of terrorism and other events requiring an integrated laboratory response.”

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Scope of ICLN

“The ICLN assesses and fills gaps in coverage across multiple sample types, including clinical and environmental samples; potential victim groups, including humans, animals, and plants; and chemical, biological, and radiological analytes associated with terrorist as well as natural events.”

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ICLN coverage is intended to cross multiple sample types.

Public health and state environmental laboratories already test them.

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During a response support is derived across multiple public health laboratory sections

Clinical, Environmental, Forensic,Biological and Chemical Sciences

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Funding for public health laboratory participation often requires dedicated resources

Network grants to fund public health laboratories often depend on exclusive commitment of personnel, equipment, space.

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Participation in multiple laboratory networks compounds resource requirements if each

network requires exclusivity.

number of laboratory networks

served

dedicated resources

required

(methods, equipment,

proficiencies, personnel,

space)

X

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Networks may be able to reduce costs while increasing benefits

There are benefits to laboratories sharing resources between routine analytical services and participation in multiple response networks.

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Networks should eliminate overlapping requirements for multiple network

participation.

• Quality System

• Method Performance

• Proficiency

• Resources

• Personnel

• Reporting

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Participation in Multiple Response Networks

Public health laboratories can eliminate redundancy, coordinate their own resources and increase their capability and capacity to support multiple emergency response networks.

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Not all laboratory capability lies under a single roof or location

In the majority of states clinical, environmental and food labs are in separate agencies. Is this advice intended for them too? What can they do?

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Regardless of a facility’s scope, routine work helps to increase and maintain readiness

This applies to clinical, environmental, food or animal health laboratories. Cross training and using equipment within chemistry or microbiology sections to perform both routine and specialized testing for emergencies maximizes the time when laboratory and staff are running and ready.

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ICLN - Interoperability is key

“Interoperability” is key for networks supporting each other

(methods sharing, information management and flow)

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Interoperability is also key to public health laboratories

serving multiple response networks.

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Networks can enable laboratories to stretch their dollars by allowing them to coordinate network funded resources for routine and emergency response testing.

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“Interoperable Participation”To efficiently shift from routine to emergency response support for multiple networks, public health laboratories should:

– Cross-train laboratorians,

– Multi-purpose analytical instruments to keep them running and ready,

– Centralize IT and communications,

– Standardize electronic reporting

– Define these efforts in the QA Manual

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Networks should be encouraged to find “common ground” for laboratory participation including:

• chemical and biological methodology

• analytical instrumentation

• analytes of concern

• FTE requirements

• clear concise reporting

• proficiency

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Expanding Network CoverageCapability expands as laboratories tighten internal

coordination to serve multiple networks.

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In a broad event when samples pour inmultiple network participation increases

coordinated response capacity

sample

flow

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Increased Capacity for Response

By tightening the “mesh” of coordinated resources for testing and reporting, laboratories increase their response capacity and serve multiple networks more efficiently.

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Centralize Laboratory Communications and Information Technology

to Serve Networks

• Laboratories assign a central contact, response facilitator and IT support to coordinate communication between the laboratory and networks.

• Networks count on consistently accessible information from laboratories as scientists focus on testing.

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Currently, laboratory response networks require their own collection of standard

analytical methods.

• ERLN - Standard Analytical Methods (unrestricted)

• FERN methods (restricted)

• LRN methods (restricted)

• Army methods (classified)

• FBI methods (classified)

• EPA methods (unclassified)

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Standardizing methods of analysis and equipment requirements among response

networks will increase laboratory capability to participate in multiple networks.

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Routine testing increases instrument reliability and readiness. Problems are more likely to develop if instruments exist solely to run proficiency samples and remain in a state of readiness.

• GC/MS

• ICP-MS

• LC/MS

• LC/MS/MS

• GC, • HPLC

• PCR

• ELISA

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Networks also benefit when routine analytical testing procedures can be adapted to support laboratory response during events.

• preparation

• purification

• cleanup

• extraction / digestion

• screening

–headspace,

–ELISA

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Personnel and Equipment

Maintaining readiness alone without routine testing involves periods of inactivity that can weaken network capability and capacity.

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Personnel and Equipment

Sharing full time equivalents (FTE) and equipment between routine laboratory support services and emergency readiness keeps personnel and equipment fresh and in a steady state of productivity.

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Reducing the Cost of Equipment Support

Service contracts are a major laboratory expense. Eliminate redundancy of maintaining identical instruments exclusively for individual networks.

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Funding criteria for laboratory network participation should include:

• Cross-trained chemists or microbiologists in environmental and clinical laboratory sections,

• Multi-purposed analytical instruments for food emergency, chemical terrorism, or environmental applications.

• QA Manual describing how laboratory coordinates resources to support routine services while increasing readiness to serve multiple networks.

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Conclusion

• Participation in multiple laboratory response networks is challenging to public health laboratories.

• Solutions exist for laboratories to efficiently provide routine support and serve multiple networks.

• Interoperable participation by laboratories increases the capability and capacity of networks to respond.

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Questions?

Henry Leibovitz, Ph.D., henry.leibovitz@health.ri.gov

Ewa King, Ph.D.,Ewa.King@health.ri.gov

Rhode Island State Health Laboratories