Laboratory Response Network
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Laboratory Response Network Elizabeth A. Macias, Ph.D., D(ABMM) Gatekeeper, Air Force LRN Laboratories Air Force Institute for Operational Health Epidemiological Surveillance Division (AFIOH/SDE) Brooks City-Base, TX. What is the Laboratory Response Network ?.

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Laboratory Response Network Elizabeth A. Macias, Ph.D., D(ABMM)

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Laboratory response network elizabeth a macias ph d d abmm

Laboratory Response Network

Elizabeth A. Macias, Ph.D., D(ABMM)

Gatekeeper, Air Force LRN Laboratories

Air Force Institute for Operational Health

Epidemiological Surveillance Division (AFIOH/SDE)

Brooks City-Base, TX


Laboratory response network elizabeth a macias ph d d abmm

What is the Laboratory Response Network ?


Laboratory response network elizabeth a macias ph d d abmm

Laboratory Response Network (LRN)

  • Established in 1999 by the Centers for Disease Control and Prevention (CDC)

  • Integrated network of laboratories – state and local public health, hospital, military, veterinary, and international

  • Respond quickly to biological and chemical terrorism, as well as emerging infectious diseases and other public health threats


Laboratory response network elizabeth a macias ph d d abmm

LRN Structure


Laboratory response network elizabeth a macias ph d d abmm

LRN Structure – Sentinel Laboratories

If you perform routine diagnostic Microbiology cultures, then you are a Sentinel laboratory.

Minimum requirements:

- Follow BSL-2 guidelines

- Plate cultures on blood and chocolate agar

- Microscopy capability (Gram stains, wet mounts)


Laboratory response network elizabeth a macias ph d d abmm

LRN Structure – Sentinel Laboratories

  • Perform testing on clinical specimens, not environmental samples

  • Presumptive testing - protocols on American Society for Microbiology (ASM) website http://www.asm.org/Policy/index.asp?bid=6342

  • Recognize, rule-out, and refer to Reference or National laboratories for further testing


Laboratory response network elizabeth a macias ph d d abmm

LRN Structure

Basic Sentinel

Clinical Laboratory

Advanced Sentinel

Clinical Laboratory


Laboratory response network elizabeth a macias ph d d abmm

Basic Sentinel

Clinical Laboratory

  • 1. Certified under CLIP/CLIA for the applicable subspecialty within the specialty of Microbiology

  • Inspected by CMS-approved accreditation organization (i.e., CAP)

  • Policies/procedures for referral of specimens to an Advanced Sentinel Lab

  • Policies/procedures for direct referral of suspicious specimens or isolates to the nearest LRN Reference Lab


Laboratory response network elizabeth a macias ph d d abmm

Advanced Sentinel

Clinical Laboratory

  • First three same as for Basic Sentinel Labs:

  • 1. Certified under CLIP/CLIA for the applicable subspecialty within the specialty of Microbiology

  • Inspected by CMS-approved accreditation organization (i.e., CAP)

  • Policies/procedures for direct referral of suspicious specimens or isolates to the nearest LRN Reference Lab


Laboratory response network elizabeth a macias ph d d abmm

Advanced Sentinel

Clinical Laboratory

Additionally…

4. Have a Class II or higher certified Biological Safety Cabinet

5. Comply with BSL-2 practices AND

6. Policies for additional respiratory protection

7. Use LRN Sentinel Level Clinical Guidelines from the ASM Website


Laboratory response network elizabeth a macias ph d d abmm

Advanced Sentinel

Clinical Laboratory

8. Personnel trained and demonstrate competency in LRN Sentinel Level Clinical Microbiology Guidelines

9. Personnel trained and certified in Packing and Shipping of Infectious Substances Guidelines

10. Procedures to track and account for decontamination of laboratory biological waste


Laboratory response network elizabeth a macias ph d d abmm

Advanced Sentinel

Clinical Laboratory

It is further highly recommended…

11. Microbiology laboratory operates under negative pressure (applies only to new construction or remodeling)

12. On-site terminal decontamination capability, e.g., autoclaving, for disposal of wastes categorized as BSL-3 or Select Agent


Laboratory response network elizabeth a macias ph d d abmm

LRN Sentinel Labs


Laboratory response network elizabeth a macias ph d d abmm

LRN Sentinel Labs


Laboratory response network elizabeth a macias ph d d abmm

Laboratory Response Network (LRN)

USAF LRN Policies


Laboratory response network elizabeth a macias ph d d abmm

Laboratory Response Network (LRN)

May 2001: HQ/USAF SG mandated all AF medical laboratories support homeland defense by participating in the LRN

“In support of the national laboratory response network and homeland defense, all AF medical laboratories will participate, at a minimum, at Level A [New terminology = Sentinel]….”


Laboratory response network elizabeth a macias ph d d abmm

Laboratory Response Network (LRN)

  • August 2007 - National Laboratory Response Network Policy Letter

  • Discusses Basic and Advanced Sentinel labs

  • “AFMS laboratories will have the CDC technical protocols, notification procedures, and procedures to properly ship clinical samples in place by 1 October 2007…”


Laboratory response network elizabeth a macias ph d d abmm

Air Force Laboratory Response Network Sentinel Laboratories


Laboratory response network elizabeth a macias ph d d abmm

USAF LRN Basic Sentinel Labs

(CCLM Classification)

Andersen

Aviano

Beale

Bolling

Brooks CB (Clinic)

Buckley

Cannon

Charleston

Columbus

Croughton

Edwards

Eielson

Ellsworth

Geilenkirchen

Goodfellow

Grand Forks

Hickam

Holloman

Hurlburt Field

Incirlik

Kirtland

Kunsan

Lajes

Laughlin

Los Angeles

Maxwell

McChord

Misawa

Peterson

Pope

Ramstein

Randolph

Schriever Clinic

Upwood

Vance

Whiteman


Laboratory response network elizabeth a macias ph d d abmm

USAF LRN Advanced Labs

(CCLM Classification)

Altus

Andrews

Barksdale

Bitburg (Spangdahlem)

Davis Monthan

Dover

Dyess

Eglin

Elmendorf

Fairchild

F.E. Warren

Hanscom

Hill

Kadena

Keesler

Lakenheath

Langley

Little Rock

Luke

MacDill

Malmstrom

McConnell

McGuire

Minot

Moody

Mountain Home

Nellis

Offutt

Osan

Patrick

Robins

Scott

Seymour Johnson

Shaw

Sheppard

Tinker

Travis

Tyndall

USAFA

Vandenburg

Wright-Patterson

Yokota


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities

FY2006 Public Health Emergency Preparedness Cooperative Agreement managed by the CDC

Each of the grantees (50 state PH labs plus PH labs in DC, NYC, LA County, and Chicago) must accomplish critical tasks in exchange for direct funding received through the cooperative agreement


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities

Most of their activities focus on the capabilities and capacity in their own lab

A small percentage of these critical tasks and performance measures surround LRN sentinel lab activities, including the following…


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities

  • Maintain a database of all sentinel (biological) labs in the jurisdiction using the CDC-endorsed definition that includes:

  • POC Information

  • Biosafety Level

  • Certification status

  • Capability to rule-out Category A and B bioterrorism agents

  • Contact information for the reference labs used by these sentinel labs


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities

  • Test the ability of the sentinel laboratories to send specimens to a confirmatory LRN lab on nights, weekends, and holidays

  • Ensure all laboratory staff know how to contact the next level LRN lab

  • Have properly trained staff for packaging and shipping (i.e., current biosafety training and IATA certification)


Laboratory response network elizabeth a macias ph d d abmm

State-Based Sentinel Lab Activities

  • Increase the exchange of laboratory testing orders and results

  • Timely reporting of results from LRN confirmatory lab back to the submitting sentinel lab and reporting to CDC as appropriate

  • Linkage of results to public health


Laboratory response network elizabeth a macias ph d d abmm

Tri-Service LRN Initiative

CDC/LRN

DoD Gatekeeper

COL Dan Harms

US Army

Bill Nauschuetz

USAF

Elizabeth Macias

USN

CDR Sharon West


Laboratory response network elizabeth a macias ph d d abmm

Summary of LRN Benefits

What does the LRN offer to the Department of Defense and to the Nation?

  • True Network

  • Standardized testing, procedures and reagents (no cost for oligo’s, Abs)

  • Proficiency testing

  • Administrative materials – Safety SOP, chain of custody forms, FBI contacts, vaccination information, etc.


Laboratory response network elizabeth a macias ph d d abmm

Missions of LRN

BW agents

Non-BT Missions of LRN

  • SARS Testing

  • Vaccinia testing – for smallpox vaccination adverse effects

  • Monkeypox testing

  • Avian Influenza


Questions

Questions?

Elizabeth A. Macias, Ph.D., D(ABMM)

Laboratory Director

Air Force Institute for Operational Health,

Epidemiological Surveillance Division (AFIOH/SDE)

2730 Louis Bauer Drive

Brooks City-Base, TX 78235-5132

COMM: 210.536.1271

DSN: 240.1271

Email: [email protected]


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