The Laboratorian - Fall-Winter 2015-16

The Laboratorian Newsletter
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In this issue


Notices & Announcements

Important information regarding chikungunya, dengue, and Zika specimen submission

Posted 3/3/16

The guidance document for submission of chikungunya and dengue specimens to the DSHS Laboratory was recently updated to incorporate information on Zika specimen submission. This includes testing criteria for both Serology and PCR. Please refer to the new guidance document— Chikungunya, Dengue, and Zika PCR and Serology Specimen Criteria—for details.


Required Information for Specimen Submission Forms

Effective 3/1/16

Please see the letter distributed to submitters for further details.


Reminder regarding the G-THSTEPS specimen submission form

Effective 1/15/16

The Laboratory Services Section wants to remind you to use ONLY the G-THSTEPS specimen submission form to request testing of specimens collected as part of the Texas Health Steps medical checkup that now includes a requirement for HIV testing. Please see the letter distributed to submitters for further details.


Mumps IgM Antibody test to be discontinued December 1, 2015

Effective Dec. 1, 2015, the Mumps IgM Antibody test will no longer be offered at the DSHS Laboratory due to unavailability of reagents; however, the Laboratory will continue to offer Mumps IgG Antibody and Mumps PCR testing. Please refer to our Laboratory Testing Services Manual for appropriate specimen types and shipping conditions.


ICD-10 implemented 10/1/2015

Effective Oct. 1, 2015, DSHS Laboratory submitters must provide the appropriate ICD-10 code(s) for the laboratory (human) testing services requested. As a reminder, required fields for each laboratory specimen submission form are clearly marked with a double asterisk ** and/or the word “REQUIRED.” Failure to complete all required fields may result in the submitter being billed for the testing service, regardless of the payor selected.

More information on the ICD transition can be found on the DSHS ICD-10 pages.


Revised specimen submission forms now available

Effective 09/01/15

See the laboratory forms page for samples of current forms.

For additional information, see the 2015 form revision notice letter.


Revised fee schedules now available

Effective 09/01/15

To view the current fees for the Austin Laboratory and South Texas Laboratory, see the Laboratory Fee Schedule page.


New options for receiving rabies test results

Effective 09/01/15

The Laboratory Services Section (LSS) can now offer you the opportunity of receiving all rabies test reports (positive, non-negative, or negative) via Fax or through the LSS Results-Web Portal as soon as the test result reports are completed.

The LSS will continue to telephone you with all positive and non-negative test results. However, as of Sept. 1, 2015, the LSS will no longer call you with negative test results. These results will only be available via mail, fax, or web portal.

It is very simple for you to take advantage of the new reporting options.

  • To obtain access to the web portal, please visit the Remote Data Systems webpage and follow the instructions.
  • To obtain your reports by fax please use the Submitter ID # Request Form found on our laboratory forms page and follow the instructions to update your preference for delivery of test reports.

If you have questions, please contact Tiffunee Odoms at 512-776-6275.


Notice to all submitters who receive faxed report results

Effective 08/24/15

Effective August 24, 2015, the DSHS Laboratory upgraded the Public Health Laboratory Information Management System (LIMS). This upgrade changes the method for how reports are faxed to submitters. Previously, each submitter would receive one cover sheet followed directly by multiple reports. For the new LIMs, each faxed report will begin with a separate coversheet followed by a single independent report. This change will apply to all providers who receive single and multiple reports via fax.

If you have questions about reports please call 512-776-6275.


Special Chemistry Team Celebrates Full Year since Implementing Cutting-Edge Sysmex XN Series Technology

by Deborah Isenhour

SysmexXN

This October marked a full year since the Special Chemistry Team implemented the new Sysmex XN series automated hematology analyzer, specifically configured to support the team’s unique workflow and high test volume. The Sysmex XN series are quantitative automated hematology analyzers intended for in vitro diagnostic use in testing patient populations found in clinical laboratories. The XN series consists of three main components—analyzer, sampler section, and information processing unit (IPU).

Loading specimen racks onto the conveyor.
Loading specimen racks onto the conveyor.

The sampler section on the instrument is one part of the new automated functionality. Our XN series consists of three XN analyzers that are connected together via the conveyors. These conveyors, which are also part of the automated process, transport the racks with specimens onto the analyzer, and once the analysis is completed, shuttle the racks off into a “stockyard.” The sample section and the transportation system on the instrument help streamline the hemoglobin testing process, from specimen analysis to results reporting.

Previously, the Special Chemistry Team performed hemoglobin testing with five Sysmex KX manual analyzers and one Sysmex XT-1800i automated analyzer. The five KXs required a laboratory technologist to manually uncap each specimen that was collected in a fingerstick non-pierceable cap Microtainer® tube, hold the specimen up to an analyzer for sampling, recap the specimen, and return it to the specimen rack. The XT-1800i was used predominantly for venous specimens, since the venous specimens had the capability (volume and pierceable cap) to be processed through this automated analyzer.

Specimens awaiting analysis
Specimens awaiting analysis.

In fiscal year 2014, the Special Chemistry Team received approximately 225,000 requests for total hemoglobin testing from medical providers. Providers submit K2EDTA anticoagulated whole blood specimens collected by the fingerstick and venous methods. The laboratory receives approximately 80% fingerstick specimens and 20% venous specimens for hemoglobin testing.

The team analyzes 800 to 1,600 specimens a day. With the Sysmex XN system, both fingerstick specimens (collected in Microtainer® for Automated Process [MAP] tubes with a pierceable cap) as well as venous specimens can be loaded into racks that hold 9-10 specimens each, and placed onto the conveyor to be shuttled through a barcode reader. One of the analyzers picks up and mixes the specimen, re-reads the barcode, and pierces the cap for sampling—another component of the new automated functionality. After the analyzer samples the specimen, it places the tube back into the rack and shuttles the completed rack into a “stockyard,” from which the specimens are placed back into the original specimen rack. Each analyzer can analyze approximately 80 specimens per hour.

The Special Chemistry Team performs total hemoglobin testing for the Texas Health Steps program. Texas Health Steps is the Medicaid service in Texas for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). It is the most comprehensive prevention and treatment program for children of low income families and provides periodic evaluation of a child’s health and development. Total hemoglobin testing is used to detect anemia. The most common type of anemia is iron-deficiency anemia, which is usually due to a poor diet. Lead poisoning can also cause anemia. These conditions can cause developmental problems in individuals, but they can be prevented with early detection and treatment.

The Special Chemistry Team can now take advantage of the following features of the new Sysmex XN system when performing total hemoglobin testing:

  • Equipment configuration can be changed according to laboratory workflow needs
  • Maximization of workflow through automation
  • Efficient testing process
  • Reliability of analyzers and devices assures maximum testing productivity
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IT Updates & Upgrades

by Jessica Koepp

Since this past June, the DSHS Laboratory has been undergoing a series of software and hardware updates. The earliest update involved the Perkin Elmer’s laboratory information management system (LIMS), Labworks, which is used mainly in the Public Water System testing areas (radiochemistry, inorganic and organic chemistry, and metals analysis) because of its ability to merge collector data between TCEQ samplers and our lab. The update primarily consisted of a migration to the John H. Winters building virtual services environment— essentially, a move to a server in a state building across the street that supports a large “cloud” for information. It proved to be a quiet transition in comparison to the other software updates.

Another of our primary LIMS, LabWare, underwent a similar upgrade over the weekend of August 22, when the system also transitioned into the virtual environment of the Winters building. Although users experience only slight format differences from version 5, there have been some bugs with version 6. During the weeks following the update, some users could not log into the system or access lab results, but recently issues have been minimal. For the submitters who send TB, HIV/STD, virology, serology, parasitology, bacteriology, and rabies specimens, this is the system used to track test results and submission information. Results can now be accessed via the web through various Remote Data Systems portals. Providers for the Texas Health Steps and Newborn Screening programs can also access results through this site, but the corresponding testing areas use a system called Harvest, an Orchard software, which was upgraded from version 8.6 to 10.0 with only few complaints.

The most exciting technological update, with perhaps the widest impact within the lab, has been a hardware “refresh,” during which new monitors and computers are re-leased to the State of Texas for the Department of State Health Services. The upgrades come with Microsoft Office 2013, enhanced processing speed, and 64 bit Windows 7, with smaller Dell desktops replacing the huge HP towers from four years ago. Unfortunately, programs like Labworks, LabWare, and LifeCycle only run on 32 bit Windows operating systems, limiting use of this shiny, new hardware in the corresponding lab areas.

Another change, starting October 1, is the update from International Classification of Diseases (ICD) version 9 to version 10. The ICD has been used for decades to record consistent diseases, symptoms, and injuries across nations, and currently for coding medical diagnoses and billing. DSHS will start using the ICD-10-CM diagnosis codes, which have more details on identification and tracking of conditions. For more information on the ICD transition, see the DSHS ICD-10 webpages.

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Lab Tour: Clinical Bacteriology

by Tori Ponson

In recent years, most hospitals and reference laboratories have shifted to using rapid identification methods for bacteria. However, such methods (e.g., Vitek and Microscan) are not always able to identify organisms reliably. This is where the Clinical Bacteriology Team (CBT) comes in.

The CBT performs traditional biochemical identification on all clinical specimens requiring isolation or conclusive identification. In 2014, the CBT tested 3,567 specimens. Each one of these specimens takes 3-7 days to identify depending upon the organism. Specimens can come from outbreaks or as required for surveillance programs.

Clinical Bacteriology plate
CBT microbiologist plating a specimen for analysis.

One such example of a surveillance program is that for listeriosis. As specified in the Texas Administrative Code (TAC), all Listeria spp. isolated from cases of listeriosis are to be sent to the Texas Department of State Health Services Clinical Bacteriology Team for conclusive identification. The CBT then sends the confirmed Listeria spp. specimens to the Molecular Biology Team for PFGE (pulsed-field gel electrophoresis) and upload to the national database known as PulseNet. These activities, in collaboration with those of the epidemiologist team, allow for the rapid identification of outbreaks.

The CBT is also participating in the Gonococcal Isolate Surveillance Project (GISP) to perform surveillance for antimicrobial resistance in Neisseria gonorrhoeae. As one of only five national laboratory participants, our Clinical Bacteriology Team receives surveillance specimens from Louisiana, Arizona, Nevada, and Oklahoma.

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Fall Fun Feature

by Todd Borowski & Laura Robertson

For a flash of workday fun, try your hand at our featured word search, containing 16 microbiology-themed terms.

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The Laboratorian—a publication of the Texas Department of State Health Services, Laboratory Services Section
Publication #E14-13156
Last updated March 16, 2017