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ASCLS-NY Spring Seminar
June 9, 2017
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Definition of public health
Description of the components of public health
Characterization of the structure of the Laboratory
Response Network
Comparison of the roles of the clinical laboratory and the
public health laboratory
Description of the three testing areas of the Erie County
Public Health Laboratory
Overview of the role of the laboratory in a Sexually
Transmitted Disease Clinic
Discussion of career opportunities in public health
laboratories for clinical laboratory scientists
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Differentiate between the role of the clinical laboratory and
the public health laboratory
Describe the testing required to detect communicable
microorganisms, environmental toxins and irritants that
have an adverse effect on human health
Discuss career opportunities for clinical laboratory
scientists in the public health laboratory
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The body of knowledge dealing with illnesses that affect
the community
Determines practices that keep the community healthy
1. Education
- provide information to medical practitioners and the
public on which practices keep the community healthy
- examples: diabetes prevention, rabies prevention,
rodent control, insect control
2. Publicity
– inform the media of events threatening the
health of the community
- examples: chemical toxins, infectious microorganisms
- demonstrate that infectious and toxic agents do not
observe geographical or political boundaries
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Natural disasters – hurricanes, floods, evacuations, water
safety when spills occur
Food safety – recalls of food due to microbial or chemical
contamination
Biodefense (formerly Bioterrorism) – events where
suspicious substances were found
Communicable outbreaks – Ebola, Severe Acute
Respiratory Syndrome, West Nile Virus. Chikungunya Virus,
Zika Virus
3. Policy makers
- the President, Governors, Health Commissioners
4. Immunization Programs
- work with Clinicians and Practitioners to immunize
against communicable diseases
- provide immunizations for travel outside the US
5. Epidemiological Investigations
- determining the cause of a community sickness
ex. food borne outbreaks, contaminated water supplies
6. Laboratory Analysis
- epidemiologists depend upon rapid and accurate testing
for determining the cause of a community sickness
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Established by the Department of Health and Human
Services, Centers for Disease Control and Prevention (CDC)
in accordance with a Presidential Decision Directive
outlined national anti-terrorism policies and assigned
specific missions to federal departments and agencies
objective was to ensure an effective laboratory response to
bioterrorism by helping to improve the nation's public health
laboratory infrastructure
Involves laboratories on the national, state and local levels
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Sentinel Public Health Laboratories – recognize, rule out,
refer
o County public health laboratories
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Reference Public Health Laboratories – confirmatory testing
o State public health laboratories
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National Public Health Laboratories – definitive
characterization
1. National Level
- Center for Disease Control and Prevention (CDC)
National Public Health Laboratory
- United States Army Medical Research Institute for
Infectious Disease (USAMRIID)
Military Public Health Laboratory
- BS Level 4 laboratory facilities
2. State level
- each state has a Public Health Department
- New York State Wadsworth Center in Albany
3. County Level
62 counties in New York State
8 counties provide laboratory service
There are 3 public health laboratories in New York State
that are part of the LRN:
Wadsworth Center
Westchester County Public Health Laboratory
Erie County Public Health Laboratory (ECPHL)
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ECPHL is registered with the LRN
ECPHL serves 17 counties of Western New York and the
Finger Lakes regions
Responds to potential public health threats, including
bioterrorism
Aim of Clinical Laboratory
- patient with symptoms
diagnostic testing
- treatment and discharge of
patient
- offer testing services on
24/7 schedule
Aim of Public Health Laboratory
- diseases affecting populations
- screening/surveillance
testing
-treatment as part of
prevention/control of
disease
- offer services during defined
hours of operation
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Look at disease affecting a population not just an individual
Surveillance and prevention means working with field
personnel to coordinate information
Deals with environmental issues
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Three laboratories
Main laboratory – majority of laboratory testing
• located in Buffalo
Two STD Clinic laboratories:
Buffalo
Niagara Falls
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To provide proficient, cost-effective laboratory services
educational programs
method evaluations
epidemiological support
scientific study resources to health care services,
laboratories, environmental sciences, government and
private communities of Western New York
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Three major divisions:
Environmental
Clinical
Biodefense
1. Environmental testing
- test everything from A-Z
a. recreational water testing
- E. coli and enterococci, microcystin, Haloacetic acids
(HAA)
ex. beach closings
b. potable water testing
- well water, tap water, irrigation water
- total coliform, E.coli, lead
1. Environmental testing (con’t)
c. distilled water
- cadmium, chromium, copper, iron, lead, nickel, zinc
d. dialysis water
1. inorganics: fluoride, sulfate, nitrate
2. trace metals: aluminum antimony, arsenic, barium,
beryllium, cadmium, chromium, copper, lead,
manganese, mercury, nickel, selenium, silver,
thallium, zinc
1. Environmental testing (con’t)
e. soil, paint chips
- heavy metal analysis
ex. lead testing
f. Organic chemicals
- volatile organic compounds (VOCs)
- semi-volatile compounds (pesticides,
polychlorinated biphenyls [PCB], oil, grease, total
petroleum hydrocarbons [TPH])
1. Environmental testing (con’t)
g. inorganic chemicals
1. physical description
- color, pH, turbidity, total solids, dissolved solids,
suspended solids, settleable solids
2. chemical testing
- ammonia, calcium, chloride, cyanide, fluoride,
nitrate, nitrite, orthophosphate, sulfate
1. Environmental testing (con’t)
g. Disinfection byproducts
- haloacetic acid (HAA), trihalomethanes, chlorate,
chlorite, bromate, bromite
f. Food and restaurant testing
- coliform count, E.coli, enterococcus, endotoxin,
biological oxygen demand (BOD), chemical oxygen
demand (COD)
2. Clinical Testing
a. Microbiology
- Enteric pathogens in food and fecal outbreaks, urine
cultures, Group B streptococcus, Neisseria
gonorrhoeae
b. Clinical Chemistry
- liver function tests (for TB Clinic)
c. Immunology
- hepatitis, HIV, Herpes simplex, syphilis
d. nucleic acid amplification (NAAT) – chlamydia,
gonorrhea, Trichomonas vaginalis
2. Clinical testing (con’t)
e. Respiratory infectious agents
Influenza A&B, Bordetella pertussis, parapertussis,
holmesii, Zika, Dengue, Chikungunya
f. STD Clinics
- gram stains, wet preparations,
rapid HIV, pregnancy testing
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Satellite laboratories located in STD clinics
Perform gram stains and wet mounts immediately for
prompt treatment of patient and sexual contacts
Gram stains screened for sexually transmitted organisms
Wet mounts performed on vaginal swabs to screen for
Trichomonas vaginalis, yeast and clue cells
Immediate treatment to reduce non-compliance
Pregnancy testing performed if antimicrobial drugs would
be contraindicated in pregnancy
3. Biodefense testing
performed in a BS Level 3 facility
a. agents of bioterrorism
- Bacillus anthracis, Yersinnia pestis, Francisella,
Brucella, ricin
b. Respiratory viral agents, viral hemorrhagic fever agents
c. Air monitoring of events
ex. sports events
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In New York State, any reporting on patient samples must
be performed by a licensed Clinical Laboratory Technologist
or Laboratory Technician
Clinical laboratory practitioners also work in other areas of
a public health laboratory
A scientist with a degree in biology, chemistry,
environmental science or similar degree may work in the
environmental or biodefense sections but not in the clinical
section
Many employment opportunities for clinical laboratory
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Most testing in a PHL is performed during set business
hours
Generally PHL staff work Monday-Friday
Occasional weekend or evening work
Often work involves interactions with various practitioners
and agencies
Salary and benefits vary among laboratories
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Public health refers to any sickness that affects a community
Components of PH include: education, publicity, policy makes,
immunization programs, epidemiologic investigations, laboratory
analysis
Laboratory Response Network involves agencies that protect the
public against bioterrorism
The clinical laboratory detects illness within an individual; the
public health laboratory detects community illness
The ECPHL offers testing in 3 areas: environmental, clinical and
biodefense
Satellite laboratories in STD clinics provide immediate results for
timely treatment
PHL employ licensed Clinical Laboratory Technologist and Clinical
Technicians
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www.emergency.cdc.gov/lrn/index/asp
www.erie.gov/health/services/public_health_lab.asp