On October 14, 2010, the DSHS Laboratory was presented with two awards recognizing excellence in public health response and outstanding outreach.
The awards—jointly sponsored by the Association of Public Health Laboratories and the national Centers for Disease Control and Prevention—were presented at the national meeting of the Laboratory Response Network (LRN). The LRN is a consortium of mostly state labs that provides support against biological and chemical threats and during public health emergencies.
The entire DSHS Laboratory Services Section (LSS) received the Excellence in Public Health Response Award for its all-out response last year to the threat of pandemic influenza. Laboratory Director, Susan U. Neill, PhD, was singled out for her success in implementing surge-capacity strategies that included quickly securing additional testing instruments, implementing new technologies, creating a triage system, working with other states, and hiring and training temporary staff.
The DSHS Laboratory usually tests a total of 1,500 flu-related specimens during flu season. That number jumped to as many as 1,410 specimens per day during the first week of the H1N1 outbreak. From late April through early July, the Laboratory tested 13,500 specimens. For further details on how the Laboratory handled this surge in testing volume, see the October 2009 issue of The Laboratorian.
“The DSHS Laboratory was able to manage the response to the 2009 H1N1 influenza outbreak through the cooperation and assistance of a variety of entities and through the tenacity and hard work of the laboratory staff,” says Grace Kubin, PhD, manager of the Laboratory Operations Unit. “Temporary staff were hired from a scientific staffing agency to triage specimens, test them, and enter the results. Staff from other parts of the laboratory quickly volunteered to help, too. At the height of our response, we had more than 100 DSHS laboratory staff working on H1N1 response.”
That means that a quarter of employees at the responding Laboratories in Austin and Harlingen dedicated their time to the H1N1 response. When fully staffed, the section has 426 full-time employees—373 in Austin, 16 in Harlingen, and 37 in San Antonio.
“All of the staff, both DSHS and temporary, had to be trained for H1N1 work,” says Kubin. “Our biothreat coordinator, Rahsaan Drumgoole, developed a program for quickly training all laboratory staff, and our quality-assurance officer, Cathy Edmonson, ensured that all training complied with certification requirements. After all equipment had been validated for the testing, workflows were devised to use personnel and equipment to provide maximum sample throughput.”
“We continue to perform testing for H1N1 and antiviral-resistance testing to detect any additional outbreaks,” says Kubin.
The second award, for Outstanding Outreach for Laboratory Response Network Chemical Terrorism Preparedness, went to the DSHS Chemical Threat Laboratory in Austin. The award recognizes laboratories for sustained outreach to poison-control centers and hospitals. The DSHS Chemical Threat Laboratory achieved that goal and also strengthened awareness of chemical threats and preparedness for emergency response through outreach to law enforcement, public health, public schools, and the environmental community.
Outreach is an important component of the Chemical Threat Laboratory’s mission. The award recognizes the work of the chemical laboratory’s four employees, who improved chemical-threat training materials for hospitals and then developed additional online training when they discovered that limited funding and staff prevented some hospitals from participating in regular training.
“We’ve hosted a national meeting for the past four years to address issues related to both chemical and biological threats,” says David Klein, PhD, the laboratory’s team lead. “Outreach to our poison-control centers has developed strong working relationships, and we’ve held seminars for the Capital Area Council of Governments. Training is also provided around the state to hospitals on how to collect and ship samples if there’s a chemical emergency.”
Laboratory staff also train first responders in the operation of portable testing equipment and work closely with the local Army National Guard’s civil-support team on exercise procedures; these teams, equipped with mobile laboratories for field testing of chemical and biological samples, respond to biological and chemical incidents when local hazardous-materials teams need assistance. They also meet quarterly with the Central Texas Counter Terrorism Working Group and participate in numerous other public outreach programs—from teaching advanced placement high school students to working with Johns Hopkins University to investigate samples of unknown white powders.
“Testing unknown chemicals is not part of our direct responsibilities,” says Klein. “However, we’ve built the capability to do rapid screening for specific chemicals in samples of unknown white powder.”
The DSHS Chemical Threat Laboratory continues to explore outreach opportunities to improve knowledge and preparedness.
The public health laboratory is a distinctly American development. Although a few other countries have borrowed the idea, most of them still rely on university facilities and staff, or else must work with selected departments of major hospitals. This unique experiment has grown along a remarkably varied pathway from state to state but, in general, has placed the definitive services of a laboratory at the fingertips of health officials who can most readily use them for community benefit. The benefit has appeared in the form of disease prevention and control, education, economic stability in the food producing industries, trend prediction, and peace of mind for the average citizen.
Even in the absence of a generally accepted definition of a public health laboratory, there has always been a conscious effort by these agencies to avoid even the semblance of competition with private laboratories. Unfair competition was understood to be the use of public funds to take business away from a company that sought a profit from its work.
Three most notable characteristics of the public health laboratory in its development over the past one hundred years have been: 1) the determination on the part of laboratorians to set high standards of performance, 2) the motivation to broaden impulsively the scope of the work until it encompassed any new services that were requested or just perceived by the laboratorian as essential, and 3) the acceptance of the responsibility for the improvement in techniques throughout the laboratory field as a moral obligation.
Public health laboratorians at first worked alone or with an extremely small staff, often in dangerously insufficient quarters, at low salaries, but with high individual integrity to build confidence, reputation, and reliance. The favorable consequence of the reputation was seen in the two decades of the 1950s and 1960s. Public health laboratories received excellent legislative support. New, spacious, and modern facilities and instrumentation were funded, and larger, more qualified staff were provided. Enforcement regulations placing them over certain industries and over independent laboratories were promulgated in many states.
Texas 1690-1820. The story of the development of public health and the Texas Department of Health is closely associated with the colonization of Texas and the health problems and conditions which resulted. The migration of pioneer settlers introduced smallpox to the Indians of Texas and brought cholera, yellow fever, and tuberculosis to all of the settlements along the coast. The first organized hospital was established by the Spaniards around 1806, where some of the first vaccinations for smallpox were given in Texas.
Texas 1821- 1889 With the establishment of the Austin colony in 1821, the first Anglo-Saxon doctors came to Texas. The Mexican government and the Austin colony decreed that each town should "establish a board of health, even in settlements or towns where there is but one physician." These boards were to oversee and regulate the sanitary conditions, register births, marriages, and deaths, and to regulate the practice of medicine. Between 1837-1867, yellow fever epidemics were reported almost every year in the coastal towns of south Texas and a prevalence of smallpox in the inland towns. This resulted in the quarantine era. The first public health work occurred in Galveston in 1850 when the first quarantine regulations were passed within the state of Texas in response to the repeated epidemics of yellow fever.
In 1852, the physicians of Austin, Texas issued an invitation to all authorized physicians in the state to attend a meeting and the Texas Medical Association was born. In 1856, and again in 1870, the Texas State Legislature passed increasingly more stringent quarantine laws to control the yellow fever and smallpox epidemics. On April 10, 1879 the existing quarantine law was once again revamped and a position for the first State Health Officer was created. Dr. Robert Rutherford was appointed to the office.
Public health work had a long way to go, but establishing an official presence was the first step to address an important need for the citizens of Texas.
This article is part one of a three-part series on the history of the DSHS Laboratory.
In March 2010, the DSHS Laboratory Specimen Acquisition Branch (SAB) in Austin implemented a new tracking system. The SCLogic Tracking System allows easier receiving and sorting of packages containing specimens and samples for testing at the laboratory. “Work is completed with half the time and with fewer resources,” says Salvador Arreola, Microbiology Check-In Team Lead.
SCLogic is a software system with a barcode scanning mechanism. This system replaces the previous manual entry method.
The main challenge for the SAB was the length of time it took to process packages. On a busy day, the team usually receives approximately 100 boxes. Before the use of SCLogic, a team of six processed these boxes, which took at least an hour and 15 minutes. With the use of SCLogic, a team of five can process the boxes in 30-45 minutes. This extra time allows the group to meet deadlines with confidence.
Another beneficial feature of the SCLogic system is its capacity to generate and customize reports. With this system, staff can select criteria (for example, by submitter or by city) and produce more meaningful reports. The system also enhances customer service by letting personnel query information readily available for submitters.
Arreola also states that, because of the convenience and simplicity of using the software, the task of receiving packages is more enjoyable. “More staff are willing to be cross-trained in this previously dreaded manual task,” says Arreola. Training on the software only takes a day or two, which quickly leads to positive results for the workflow of the branch and, consequently, all testing areas of the DSHS Laboratory.
SAB processes and accessions approximately 6,000 specimens per day and approximately 1.5 million specimens per year.
by Jan Adversario
In the 1930s, cervical cancer was the number one cancer killer of women in the United States. The widespread use of the Papanicolaou's smear (or Pap test) has resulted in a major decline in cervical cancer. The Pap test is a screening test designed to detect cancer and precancerous lesions of the uterine cervix. The large majority of abnormalities are diagnosed and treated at precancerous stages.
Nearly all cases of cervical cancer are caused by a few types of human papilloma virus (HPV). There are over
100 types of HPV, with most types causing benign skin warts. About 40 HPV types can infect the genital region and are sexually transmitted. HPV is the most common sexually transmitted disease in the US with over 6 million infections annually. Most HPV infections are fought off by a person’s immune system, but some become persistent. These are the infections that can eventually lead to cancer. The HPV types that are known to be associated with cancer are called high-risk HPVs.
Pap smear information
A thin layer of cellular tissue covers the cervix. Sometimes during cellular development, cervical cells become damaged or abnormal. These abnormal cells may develop into cervical cancer.
The Pap Smear was developed by a Greek physician, Georgios Papanicolaou. Cervical cells are stained and examined for the presence of abnormal or precancerous cells.
Abnormal cells are classified into several degrees of severity:
- ASCUS: Atypical Squamous Cells of Undetermined Significance. This indicates the presence of cervical cell changes which may be due to mild infection, cervical inflammation, the presence of HPV, or dysplastic changes in the cervical cells.
- LGSIL: Low Grade Squamous Intra-epithelial Lesion. This indicates the presence of HPV or mild precancerous changes in the cervical cells.
- HGSIL: High Grade Squamous Intra-epithelial Lesion. This indicates more serious cervical cell changes with a higher risk of developing into cancer.
- INVASIVE CANCER.
There are 2-3 million abnormal PAP smears found each year in the US.
In the Pap test, a cytotechnologist examines every area of the slide preparation under the microscope for changes in the cells that indicate HPV infection, giving particular care to examining abnormal nuclei. WHL has 12 cytotechnologists and two cytopathologists involved in screening Pap smears.
Women’s Health Laboratory (WHL) offers two versions of the Pap test: the conventional Pap smear and SurePath® liquid-based preparation (LBP). The LBP technology shows promise for more sensitive detection of precancerous lesions. It also allows for ancillary testing for HPV, Chlamydia and Gonorrhea (Amplified DNA CT/GC) from the same specimen.
In accordance with state statutes, Women’s Health Laboratory offers PAP testing only to submitters who receive Federal support, such as that provided by Title V, Title X and Title XX.
by Keith R. Haye, PhD