The Laboratorian - Volume 6, Issue 3

 

The Laboratorian - Volume 6, Issue 3
Laboratorian Header

May 2015 - Volume 6, Issue 3

Article Index

- Blue Bell Ice Cream
- CQI Update
- Lab Scavenger Hunt


A Public Health Lab in Action:
The Blue Bell Ice Cream Scoop

For Chris Malota, the Consumer Microbiology Team Leader at the DSHS Laboratory, “it all started on Valentine’s Day.” On Saturday, February 14, 2015, Mr. Malota received a call on his cell phone from an official within the Texas DSHS Division for Regulatory Services. The regulatory official indicated that the South Carolina Department of Health and Environmental Control had isolated Listeria monocytogenes in two Blue Bell ice cream products. The Texas regulatory official wanted our lab to perform additional testing on the samples. Thus began our laboratory’s participation in the investigation of the Blue Bell ice cream listeria outbreak—an outbreak that has impacted several states and a major Texas ice cream producer.

Ready, Set, Test

We received a set of 20 samples for testing the following Monday, February 17. These samples were all taken from products manufactured at the Blue Bell facility in Brenham, Texas, and included the products that South Carolina had found to be positive for Listeria—Chocolate Chip Country Cookie Sandwiches and Great Divide Bars—as well as additional items from the same production line. On February 25, the results were in. Like South Carolina, we, too, had isolated Listeria in the Chocolate Chip Country Cookie Sandwiches and Great Divide Bars, but had also identified a third product as positive—the single-serving ice cream product called Scoops. Since testing began, Blue Bell issued a product withdrawal for products that had been implicated.

Blue Bell samples
Blue Bell products stored at the Texas DSHS Lab for testing.

Pass or Fail

Our state laboratory views Listeria as a “zero tolerance organism.” This means that we test for Listeria on a pass or fail scale—not to enumerate the degree of contamination, but rather to precisely and definitively identify whether a specimen is positive or negative for the organism.

That can be trickier than you might think. Because “Listeria is such a slow growing bug,” says Mr. Malota, "our lab uses both rapid testing and culture testing in conjunction with each other." A rapid test is exactly that—a faster way to detect the presence of Listeria in a specimen. The advantage of rapid testing is that it can sometimes produce a positive result much more quickly than other culture methods; however, a negative result from a rapid test is not considered conclusive for the samples tested for Listeria until culture testing is completed.

A Closer Look

Culture testing aims to grow more of the organism suspected to be present in the sample. As the cultures progress and specimens begin to propagate, testing specialists can sometimes surmise an early indication of a positive—this is called a presumptive result. A presumptive result can be shared with impacted entities in an outbreak investigation as an early indication of a positive—so that officials can get an early start on next steps necessary to contain the outbreak.

positive Listeria culture
A culture positive for Listeria monocytogenes.

As the investigation began to further unfold, Texas regulatory officials requested that we test samples from the other production lines in the Brenham facility. Over the course of several weeks the Texas DSHS Laboratory in Austin received additional samples for testing.

Connecting the Dots

Once rapid and culture testing was completed, the specimens tested by the Consumer Microbiology Team moved on to our Molecular Biology Team for molecular subtyping. By breaking down bacteria to their molecular components, we can pinpoint how closely related various strains are, and find and track disease outbreaks. The samples that our Consumer Microbiology Team found to be positive for Listeria were further analyzed by our Molecular Biology Team using pulsed-field gel electrophoresis (PFGE). PFGE is a technique used to generate a DNA fingerprint for a bacterial isolate. Once the PFGE banding patterns are analyzed, they are uploaded to a national laboratory network called PulseNet. PulseNet helps identify outbreaks at the local and national level by connecting the dots. In this case, the “dots” are the DNA fingerprints of bacteria making people sick.

After our Molecular Biology Team entered the PFGE data from the first set of samples we tested, the information became instrumental for the multi-state epidemiological investigation. The PFGE pattern we identified in the Scoops product matched the pattern of the strain that made eight people sick in a Kansas hospital. However, The Kansas Department of Agriculture’s (KDA) laboratory tested additional products from this hospital, and the PFGE pattern did not match that of our original positives. Further analysis revealed that these new samples did not originate in the Texas facility, but rather came from the Blue Bell plant in Oklahoma.

A Collaborative Response

Investigation into an outbreak does not, and cannot, occur in a vacuum. With only one out of the three Blue Bell production facilities located in Texas, other state and federal resources stepped in to perform the necessary testing within their jurisdictions. Alabama and Oklahoma laboratories began testing samples manufactured by Blue Bell facilities located in their respective states, and the FDA and CDC performed further analysis, including collecting environmental specimens directly from the facilities themselves. This comprehensive and collaborative investigation has drawn on data compiled from testing various product, clinical, and environmental samples—ultimately resulting in CDC and state health advisories, as well as product recalls issued from Blue Bell itself.

The Importance of Public Health

Without the collaborative effort of local, state, and federal public health agencies, United States citizens would be virtually defenseless against an outbreak of any kind. “The lab is really important in helping to minimize the impact these infectious diseases have on the citizens of Texas, and the United States, and really the world,” says Dr. Elizabeth W. Delamater, manager of the Texas DSHS Laboratory’s Microbiological Sciences Branch. Dr. Delamater goes on to add “I’ve got fantastic staff. All of my group managers are recognized experts in whichever field they’re in. They’re very smart, and know a lot about what they’re doing every day.” Suffice it to say, the people of Texas are in good hands, as the Texas DSHS Laboratory staff works diligently on a daily basis to keep us all safe.

by Dwaine Thompson & Carrie Perkins

 

^ Back to top

 

Lean Corner: CQI Happenings

While it may seem that it has been quiet on the Continuous Quality Improvement (CQI) front, there has been quite a bit of activity.

lean six sigma logoDid you know the lab currently has 12 continuous quality improvement projects in progress? Did you also know that since June 2014, four CQI projects have been completed? A couple may sound familiar to you—for example, the Shadow Program, which was created by two Yellow Belts, or the internal waste reduction project in Media Prep.

However, there are a few more you may not know about. Here is the full list:

Completed Projects

  • Media Prep: Internal Waste Reduction – Nora Berrios
    • Reduced error rate from 3.85% to 0.63%
    • Cost savings of more than $23,500
  • Shadow Program – Hala Ayad and Syra Madad
    • Lab-wide shadow program created
    • Over 150 tasks to choose from bench to administrative
  • Media Prep: 12 Week Schedule – Priscilla Trevino Gonzales (presented final results on April 14, 2015)
    • Process time reduction of 36 hours/month
    • Estimated soft cost savings of $7939.97
  • Media Prep: Graduated Cylinders – Achieving Traceability – Gayathri Kammalamal
    • Inventoried and organized all MPT glassware (over 1000 items)
    • All MPT glassware is now traceable with certificates as per ISO 17025
  • NBS: Galactosemia – Shawn Tupy
    Recommendations given:
    • Contact DSHS Clinical Care Coordination (CCC) program with preliminary results, and/or
    • Perform same-day testing for abnormal specimens

Projects in Progress

  • Artel Pipette Calibration SOP – Melanie Hines
  • Media Prep Inventory – Megan Snyder
  • Reduce Check-In Time of NBS Specimens – Tiffunee Odoms
  • NBS Tandem Mass Spectrometry: Reduce Turn-Around-Time (TAT) of Abnormal Specimens – Andrew Vinyard
  • Improve NBS Specimen TAT for Punching – Andrew Vinyard with NBS Team
  • Reduce TAT of abnormal T4 specimens - Linda Cao
  • Space Utilization Project for the Lab – Amy Schlabach
  • 5S Project of Microbiology Storage Room – Sue Cloud and Carol Brandt
  • Spatial Efficiency in the Lab – Tori Ponson
  • Communication in the Laboratory (Survey) – Jill Wallace
  • Tuberculosis Testing Process Improvements – Denise Dunbar
  • Improving Molecular Error Rates – Vanessa Telles

In addition to these projects, there is now a Quality Improvement (QI) Advisory Committee. The goal of the advisory committee is to improve communication, raise awareness, gather leadership input, and understand the implications of how quality improvement projects affect the lab. The purpose of the meetings will be to communicate project progress, road blocks, as well as prioritize projects.

The QI Advisory Committee is composed of the Laboratory Director, Branch and Unit managers, other key staff, and four Black Belts. Committee members include Dr. Grace Kubin, Dr. Susan Tanksley, Sherry Clay, Dr. Elizabeth Delamater, Dr. Rachel Lee, Rahsaan Drumgoole, Aurora Martinez (STL), Carl Hogberg, Lisa Simpson, Kathleen Street, Norma Vela, Eleanor Williams, Amy Schlabach, Denise Dunbar, Jill Wallace, and Vanessa Telles. Initially meetings will be held monthly as necessary then quarterly meetings will be evaluated. With the help of the Advisory Committee, projects will continue to progress while new projects will be prioritized. As we move forward, be on the lookout for more completed projects this year! If you have any questions, feel free to contact Vanessa Telles for further information.

by Vanessa Telles

 

^ Back to top

 

Lab Tour: 2015 Lab Week Scavenger Hunt
- Virtual Edition -

During our annual Lab Week festivities, the DSHS Lab held a lab-wide scavenger hunt. Newsletter readers can participate in a virtual version of this activity.

The scavenger hunt consists of 17 questions, the answers to which are found on the storyboards throughout the lab that each of our teams created, describing the work that they do. For the virtual edition, we've done the legwork for you. Below each question is a photo of the associated storyboard. Click on the photo to open a "zoomed-in" view of the team's storyboard, containing a hint to help you determine the answer. Once you know the answer, close the tab or window containing the hint to return to the scavenger hunt. The full answer key is included at the end of the article. Good luck!

  1. What chemical smells like geraniums and was a weapon of mass destruction during the 1910s?
    storyboard thumbnail

  2. A particular section in the Lab uses the Hemadsorption test to detect the presence of hemagglutination. A negative result for this test is indicated by what?
    storyboard thumbnail

  3. What product was implicated in a 2010 outbreak of Listeriosis in Texas that resulted in 5 deaths?
    storyboard thumbnail

  4. What are the most common causes of tuberculosis (TB) transmission?
    storyboard thumbnail

  5. Name an area in or around your home where lead might be found.
    storyboard thumbnail

  6. The DSHS Media Prep Team supplies media for how many departments in the Lab?
    storyboard thumbnail

  7. Severe Combined Immunodeficiency (SCID) is currently the only disorder newborn screening screens for that is completely curable. What is the treatment for a baby diagnosed with SCID?
    storyboard thumbnail

  8. What percentage of bats submitted for rabies testing (because they are downed or sick) are positive for rabies at DSHS?
    storyboard thumbnail

  9. What is the most common source of radionuclides in Drinking Water?
    storyboard thumbnail

  10. Name one of the 4 most common mutations found in Galactosemia?
    storyboard thumbnail

  11. Where is hemoglobin E most prevalent?
    storyboard thumbnail

  12. FDA has set a gluten limit of less than 20 ppm for foods to be labeled "gluten-free."  What area of the Laboratory analyzes food samples for Gluten?
    storyboard thumbnail

  13. Which strain of rabies has been eradicated in Texas?
    storyboard thumbnail

  14. Name three sources of exposure to radiation from everyday activities.
    storyboard thumbnail

  15. What is the function of hemoglobin in the human body?
    storyboard thumbnail

  16. What are the 4 main molecular techniques used in our lab to help track disease outbreaks?
    storyboard thumbnail

  17. List 3 reasons why it is important to have an arbovirus surveillance program.
    storyboard thumbnail

Scavenger Hunt Answer Key

Created by Amy Schlabach
Photographs by Carrie Perkins

 

^ Back to top

 

Note: External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to people with disabilities.

SUBSCRIPTIONS
To receive new issue notifications via email, please click on "Sign Up for E-mail Updates" logo on the main newsletter web page:  http://www.dshs.state.tx.us/lab/newsletter.shtm.

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

512 776 7318
888 963 7111, ext 7318 Toll Free
email The Laboratorian

LABORATORY DIRECTOR
Grace Kubin, PhD
512 776 7318
email Grace

NEWSLETTER EDITOR
Carrie Perkins
512 776 6134
email Carrie

Last updated October 30, 2015