challenges in laboratory services april 2006

8/9/2019 Challenges in Laboratory Services April 2006

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Challenges in DiagnosticSupport Services:

Laboratory Services


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Role of The Laboratory

1. Support for rapid investigation ofdisease outbreaks

2. Support for improved surveillance

3. Provide early warning system foremergence/reemergence pathogens


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1. Analyse data and provide feedback of theresults to public health authorities

Main Challenges to the Laboratory

. ,standard procedures and qualityassurance

3. Provide technical support, training,guidance and quality assurance to alllaboratories within the country


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Outbreak Detection and Response

70

80

90

FirstCase

Detection/

ReportingConfirmationInvestigation

Opportunity

for control

Response

DAY

CASES

0

10

20

30

40

50

1 4 7 10 13 16 19 22 25 28 31 34 37 40


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Responsibilities of Hospital Labs

Identification of infectious agent using

standard procedures and reagents Refer to the National Ref lab for

Reporting results

Coordination with case investigators

Coordination and implementation ofcontainment activities


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Responsibilities of National Reference Labs (1)

Identification of infectious agent by

serology and/or isolation using standardprocedures and reagents

Referral of isolates (eg: influenza) to

the Global Specialized Labs / WHOCollaborating Centre

Reporting results in a timely manner

Serve as centre for training thelaboratory personnel from hospital

laboratories


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Responsibilities of National Reference Labs (2)

Provide guidelines for proper specimencollection, transportation and laboratorytesting

Coordination and implementation ofcontainment activities

Coordination with case investigators


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Responsibilities of Global Specialized Labs

Definitive identification of isolates usingall available technologies, includinggenetic characterization, to reveal theorigin of isolates

reparation an istri ution o re evantstandards, reference reagents andtraining materials

Provision of consultants to evaluate andadvise on lab services and providespecialized training


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1. Bio-safety Level 3 Laboratory (P3 Lab)

2. Training

Preparedness: Some measures needed

.

4. Resources

5. Guidelines for Collection and

Transportation of Specimens


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The Outbreak Control Team

Membership

LeadershipCo-ordinate further investigation andresponse

Responsibilities Lines of communication

Communication and decision makingprocess

Report to and advise higher authorities


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- In 2002 initiated focus surveillance for:

HFMD Influenza Dengue

Virology Unit, IDRC, IMR

- 16 March 2003, designated NationalReference Laboratory for SARS

- 2004 designated as the National ReferenceLaboratory for Avian Influenza


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(i) BSL3 facilities and BSL3 workpractices:

samples processing and virus

SARS OUTBREAK

Laboratory Facilities:

iso ation

(ii) BSL2 facilities with stringent BSL3

work practices:PCR, IFA and EM


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Setting up of the operations room

Teams by function

Retraining

Virology Laboratory, IMR

All staff buy-in Morale building

Guidelines


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Specimen collection

Specimen transport Containment

Guidelines

ocumentat on Information flow


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Specimens collection

The following should be considered forcollection of specimen for culture:

Timing

Appropriate site

Proper collection Proper transportation

Alert the laboratory of diseasesuspected especially agents thatrequires special culture media


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Clinical Specimen

Use PPE

Transfer Specimen to biohazard cabinet

Flow Chart For Specimen Receipt At IMR Specimen

Reception Counter

If Class 3 or 4 Pathogen

DO NOT OPEN

Other specimen, process inusual manner

Leave specimen in biohazard cabinet

Contact Virology Unit


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Flow Chart for Specimen Receipt At Virology Unit SpecimenReception Counter/Guard House

Clinical Specimen

Inform Officer and Technician in-charge

Use PPE

Transfer Specimen to P3 Laboratory

Place Specimen in Containment Box


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Processing

Cell culture

Nucleic acid testing

Laboratory Tests Investigation (1)

Specimen P3

Electron microscopy

Immunoflourescence


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use validated test methods

standard operating procedures

Laboratory Tests Investigation (2)

false positive/false negative results

verify test results


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Laboratory results Head of Virology

Director GeneralOf Health

Verification process

Deputy Director General of Health

CDC

Minister of Health


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- Prepared for future pathogen level 3outbreak investigation

- P3 laboratory adequately equipped

Virology Unit, IDRC, IMR (4)

- Staff confident and prepared to copewith future outbreaks.


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Process Specimen in theBSL-3 Cabinet

PPE

Collect Specimen From Pass-through Box

Autoclave BiohazardBag/Waste


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Conclusion

Both the public health authority and the lab have arole in ensuring optimum lab services:

Public health: to educate the health-care

providers on the importance of lab testing nd tomake sure that the lab resources are accessible

Lab: to develop and maintain testing resources, SOP& QAP, and to analyze data and provide feedback tothe public health authorities


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Lessons learnt

Be prepared for eventualities -training Contingency plans- evaluate capabilities O timize resources : team work

Leadership role Hands on Keep cool and level headed


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challenges in laboratory services april 2006

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