The Laboratorian - Volume 1, Issue 3

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The Laboratorian - Volume 1, Issue 3

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October 2010 - Volume 1, Issue 3

Article Index

- TB Hospital
- Lead in Dried Plums
- Flu Vaccine Update
- Biosafety
- Recycling Statistics

Editorial

The end of 2009 proved to be a busy one for the DSHS Laboratory. As Laboratory staff handled the usual testing load, the resurgence of Novel H1N1 Influenza A required further time and attention. Meanwhile, the Newborn Screening program expanded the testing panel to include Cystic Fibrosis screening— bringing the total disorders screened to 28 for our littlest Texans. As an expectant mother, this expansion is particularly meaningful.

The featured article, “Tuberculosis Hospital Re-Emerges,” details how our Women's Health Laboratory in San Antonio is at the epicenter of much-needed expansions to combat the resurgence of tuberculosis, including the construction of a new Biosafety Level 3 facility. “Laboratory Finds Lead in Imported Dried Plums” introduces the work of the Laboratory Metals Analysis Group; they identified elevated levels of lead in dried plums, resulting in a warning released by the DSHS. December 2009 also marked an increase in the limited H1N1 vaccine supply; easing the distribution difficulties faced by DSHS staff working in the MACC (Multi-Agency Coordination Center) in the Laboratory building. You will find a vaccination update in “Laboratory View of Texas Flu Vaccinations.”

With all the testing going on, the Laboratory Safety Office reminds laboratorians of the importance of safe practices in the article “Biosafety: Maximizing Control Over Potentially Infectious Material.” We are also proud of our recycling program and the impressive end-of-year recycling statistics.

I hope that you continue to enjoy the updates and information provided in The Laboratorian. I know that 2010 will bring even more challenges as we work to protect the health of the citizens of Texas.

by Jimi Ripley-Black 

Did you know?

The Texas Veteran Health Officer from 1936 to 1954, Dr. George W. Cox, was known as a pistol-packing quarantine officer during his early days working for the state in Brownsville, Texas.

From 1904 to 1927, the Texas state rabies department was under the direction of what was then called The Austin Lunatic Asylum. The department’s official name was the Texas Pasteur Institute.

In 1910, Texas was a pioneer in testing germicides. The first official Bacteriological Laboratory was opened in 1912—located in the Texas Capitol. However, until 1915, no one ran bacteriological tests on samples of drinking water.  


Tuberculosis Hospital Re-Emerges

Photo of new TB hospital construction

Groundbreaking for the new Tuberculosis (TB) hospital took place on December 15, 2008, in San Antonio, Texas. When completed in May 2010, this project will yield an 82,000 square foot facility, which will include 75 private rooms with special air-handling capabilities.

Originally built in 1953 as the State Tuberculosis Hospital, the 958 bed facility quickly became the largest of 21 TB sanatoria in Texas. Over the years, the Texas TB hospitalone of the few remaining in the United Stateswas renamed the State Chest Hospital in 1972 and Texas Center for Infectious Disease (TCID) in 1994.

Tuberculosis, though more manageable thanks to improved antibiotics, is not just a historical disease. The AIDS epidemic in the 1980s resulted in a new spike in TB cases, including variants of the virus that are drug resistant. Currently, one third of the world's population is infected with TB. More than 8,000 people die each day because of the disease. In Texas alone, there are over 1,500 confirmed TB cases each year.

TCID–located on a mixed-use campus in south San Antonio—is shared by other Department of State Health Services (DSHS) entities including the San Antonio State Hospital, Woman's Health Laboratory (WHL), and Heartland National Photo of WHL

TB Center. Also on the campus is the San Antonio State School, which is associated with the Texas Department of Aging and Disability Services (DADS). More than 300 DSHS employees work on the campus. Although TCID no longer meets modern accreditation standards, it remains the place where the most difficult to treat TB cases are sent, and where patients are sometimes quarantined by court order for six months or longer when they refuse treatment. Recently it was named by the Centers for Disease Control and Prevention (CDC) as one of four national TB centers providing training and consultation to doctors and hospitals in 13 states.

This is actually the second groundbreaking for the facility. In the early 1990's, when its deteriorating condition threatened TCID's accreditation, the Legislature agreed to rebuild it—first with tobacco settlement funds and later with $20 million in revenue bonds, approved in 2001. The first groundbreaking ceremony was held in 2002, and one ward was leveled in 2003. The project was then put on hold, while a proposal to relocate it to the South Texas Medical Center was considered. The project was finally dropped when attempts to move failed.

In 2007 the Legislature finally gave the go-ahead and released the money needed to complete the building project. Three existing buildings—administration, cafeteria, and the lab (WHL)—will be kept and renovated.

Microbiology tech working in a biosafety cabinet

Two Microbiology Techs in front of a biosafety cabinet

WHL specializes in preventative screening services. The largest components of its practice are anatomic pathology (cytopathology and surgical pathology) and screening services for sexually transmitted diseases. A wide range of clinical and microbiology laboratory services are also available, including maternity and family planning screens.

The Woman's Health Laboratory will be upgraded to a Bio Safety Level 3 (BSL 3) facility. A portion of the current microbiology section will receive structural improvements, which include: 

  • A vestibule with double doors to access the area where TB samples are handled. Technicians will first enter this area to prepare for transition.
  • A barrier fire wall around the entire section.
  • A new air conditioner with negative air.
  • Three new bio-hoods
  • A new refrigerator
  • Two Bactec TB analyzers
  • Two Mgit TB analyzers
  • One Therma incubator
  • New cabinets

Six microbiology technicians will all rotate through the area. Currently, WHL receives around 200 specimens per month—consisting mainly of sputum samples—and some are repeats for individual patients. These samples come from patients throughout South Texas and are known to be multi drug resistant. WHL will also test specimens from the new TB hospital.

by Rick Flores

 

Laboratory Finds Lead in Imported Dried Plums

In September 2009, the DSHS Laboratory identified elevated levels of lead in dried plum candies imported from China.

Dried plum candy samples were collected from various retail and wholesale locations in Texas by site surveillance inspectors from the DSHS Food and Drug Inspection Branch and sent to the Laboratory Metals Analysis Group for testing.

Candies are frequently tested for levels of lead due to the potential health effects to children. Testing benefits consumers by preventing further dispersal of products with this

Plums labeled for lead testing at the DSHS Laboratory
neurotoxic heavy metal, and it also aids in efforts to monitor these levels for the US Food and Drug Administration (FDA). For example, in a 2004 Consumer Product Safety Commission letter to candy importers, Mexican-based candy wrappers were identified as containing lead-based ink.

If elevated lead levels are found in a candy product, 10 more samples must be collected and analyzed separately to confirm the concentration. During a surveillance inspection, one inspector collected a dried plum candy from China that returned lead results greater than 0.1 ppm (parts per million). The FDA established a guidance policy mandating a level of less than 0.1 ppm of lead in candy “likely to be consumed by small children,” as of 2006.

Three laboratory staff members are responsible for lead testing of candy, with four additional personnel to aid during peak volume times. Suspected samples are tested for lead content using inductively coupled plasma mass spectrometry (ICP-MS). With preparation of each sample batch consisting of 10 samples and quality controls, this procedure can be time and labor intensive on larger numbers of samples.

In 22 dried plum products collected from 15 manufacturers, the Laboratory identified lead levels from 0.11 ppm to 30.3 ppm. On October 1, DSHS released a warning that elevated levels of lead were found in dried plum products.

The DSHS press release and a link to photographs of the products are available online: http://www.dshs.state.tx.us/news/releases/20091001.shtm.

by Monty Gomez


Laboratory View of Texas Flu Vaccinations

Flu vaccination being given

Influenza vaccinations have been popular this flu season. The Texas Department of State Health Services (DSHS) recognizes the importance of keeping employees healthy so that they can respond to public health needs. There were 1,943 seasonal flu vaccinations given at the DSHS.

No DSHS novel H1N1 influenza A clinics have been held due to insufficient vaccine supply. The DSHS is responsible for vaccine allocation in Texas, following recommendations established by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices. Initial target groups were pregnant women, children 24-59 months old, high risk children from 5-18 years, and healthcare workers.

Here is an outline of the process. Each weekday, the CDC adds small amounts of vaccine based on Texas’ population. At the end of the week, when the DSHS Immunization Branch knows how much vaccine is available, they allocate these doses to Texas providers who have registered to receive the vaccine and notify providers that they have vaccine available to order. Providers then complete the online confirmation process and the DSHS places an order with the distributor to ship that vaccine. Vaccine usually arrives within 10 business days of order placement.

In the week ending on October 2, 2009, Texas’ H1N1 vaccine allocation was only 142,400 doses—all of the nasal mist form of the vaccine. By October 9 that increased to 363,800 doses—235,000 of the injectable, or shot, form and 128,000 more doses of the mist. As of Tuesday, October 27, approximately 1.7 million H1N1 vaccine doses were made available to Texas providers. November 5 saw that figure jump to 2.5 million doses ordered with 3 million doses allocated to Texas; the remainder was in the process of being ordered and distributed.

The beginning of December 2009 marked a real turning point for those working hard to effectively allocate the limited vaccine supply. With H1N1 vaccine availability increasing, the priority groups were expanded to help protect those most at risk—pregnant women, people 6 months through 24 years of age, those 25 through 64 years of age with high-risk health conditions, health care workers, and close contacts of infants 6 months or younger. On December 18, availability was again expanded when DSHS sent out a news release urging everyone to get the H1N1 flu vaccination. Check with your health care provider about vaccine availability or use the flu vaccine locater service available on TexasFlu.org.

by Jimi Ripley-Black

 

Biosafety: Maximizing Control Over Potentially Infectious Material

Laboratorian working in a biosafety cabinet

Many laboratorians have an intimate knowledge of microbiological procedures and techniques, coupled with years of experience in biosafety principles. Having a full understanding of biosafety is important for maintaining the safest work environment possible. Thus, laboratorians working with potentially infectious materials should review biosafety principles from time to time to refresh their understanding of them.

The aim of biosafety is to maximize control over potentially infectious material in order to protect employees and the public from exposure and disease. Biosafety focuses on creating protective barriers between potentially infectious materials and people. These barriers are applied using several methods. One way is to use laboratory practices and procedures that minimize the risk of exposure. Another way is to use engineering controls and protective barriers like those provided by building systems and safety equipment.

Laboratory practices and procedures should clearly outline how to safely handle potentially infectious materials. Instructions for handling should emphasize the safest ways for manipulating, transporting, storing, and disposing of potentially infectious materials. Practices and procedures should include what personal protective equipment (PPE) to wear, protocols for entering and exiting areas with biohazard restrictions, spill clean-up steps, decontamination techniques, and what to do in the event of an exposure.

Laboratorian working in biosafety cabinet

The laboratory building is designed to prevent unauthorized access to potentially infectious materials by use of an electronic security card key system and video surveillance at points of entry. The laboratory building is also designed with specialized exhaust systems for areas of the lab working with potentially infectious materials. This exhaust system helps to maintain negative air pressure in areas where potentially infectious materials work

is being done. The negative pressure ensures that potentially infectious materials are contained in the biosafety level 2 and 3 areas and cannot escape to other parts of the laboratory.

A final protective barrier is safety equipment. Examples of safety equipment are biosafety cabinets, sharps containers and engineered safety devices. Biosafety cabinets act as primary safety barriers against exposure to potentially infectious materials. They provide protection to laboratory personnel, the community, and the environment by using laminar airflow and HEPA filters to isolate and capture potentially infectious materials. Sharps containers allow for the safe disposal of needles, scalpels, and other sharp objects contaminated with potentially infectious material that could pose a puncture or laceration hazard. Engineered safety devices are designed to retract needles and sheath sharp edges quickly, thus minimizing puncture and laceration hazards before disposal.

Armed with these reminders, both seasoned and newer laboratorians, can plot a course of biosafety with confidence—knowing that they are helping to maximize control over potentially infectious materials and, in doing so, they are protecting employees and the public from exposure and disease.

by Robert Black

 

Laboratory Recycling Update

Single Stream Recycling: Fiscal Year 2009

  • 5.5 to 17.5 average bins daily

 

Waste Generated: Fiscal Year 2009

  • From 5 times to 1 time weekly
  • $5,000 annual savings
  • From 120 yards to 24 yards
  • More than 75 percent reduction

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THE LABORATORIAN
October 2010, Volume One, Issue Three
(Publication #E14-13156)
Published by DSHS Laboratory Services Section
PO Box 149347, MC 1947
Austin, TX 78714

512 458 7318
888 963 7111, ext 7318 Toll Free
email The Laboratorian

 

LABORATORY DIRECTOR
Susan U. Neill, PhD
512 458 7318
email Susan

NEWSLETTER EDITOR
Jimi Ripley-Black
512 458 7318, ext 6505
email Jimi

Last updated April 06, 2011