- Norman Crouch, Ph.D.
- Paula Snippes
|In Minnesota, the Laboratory
Program Advisor, Paula Snippes, who worked with the State Laboratory
Director, Norman Crouch, executed a comprehensive assessment of the
capabilities of the clinical microbiology laboratories throughout the state.
Surveying the capabilities of clinical laboratories was the first step in
ascertaining where public health testing could be diverted in case of
emergency. Based on preliminary survey data, an appropriate challenge set of
organisms was sent to clinical laboratories to assess accurate and timely
reporting for public health threats.
laboratory capabilities for infectious disease testing:
- The network of public-private laboratories in Minnesota is referred
to as the Minnesota Laboratory System (MLS), denoted by a trademark
symbolizing collaboration between public and private sectors. As a first
step, the MLS invited 165 clinical microbiology laboratories in the
state, including a few from out of state, to participate in the system.
Of those invited, 89% of laboratories responded to initial introductory
- As a second step, the Laboratory Program Advisor, completed an
initial phone survey of all the laboratories, allowing for a customized
and efficient on-site survey, which was administered during a site visit
to each laboratory.
- The survey identified all MN Level A labs, described referral
patterns, and established connectivity.
- Challenge set of microbiology samples was developed and sent to 132
- Grow and lyophilize organisms; develop instructions & answer sheets;
organize packaging and shipping; contact local postal service
- 129 labs accepted; overall, 92% sent back responses
- Bacillus megaterium, Streptococcus pneumoniae, E. coli O157:H7,
Oligella ureolytica, Klebsiella pneumoniae (ESBL)
- Overall, labs showed best performance testing S. pneumoniae for drug
resistance (86% got expected result); worst performance with O.
ureolytica (47% got expected result)
- Majority of participants wanted more challenges; biannually was most
||Using the assessment
to improve laboratory practices:
- Based on the phone assessment, 140 of the laboratories received
blinded challenge specimens to assess baseline laboratory practices
and testing accuracy. Specimens were sent in the spring of 2002.
- Immediate interventions included instruction in testing for E. coli
O157, ESBL (Extend Spectrum Beta-Lactamase) and Campylobacter
- Based on the results of the challenge specimens, educational
materials and resources will be collated and delivered.
- During the phone assessment, laboratories were offered information
about the National Electronic Data Surveillance System. The Minnesota
NEDSS Coordinator is apprized of specific laboratories that express
interest in NEDDS. Activities of MLS and NEDDS are coordinated to
- The comprehensive survey was intended to determine capability and
capacity, promote personal interaction, and encourage twoway dialogue.
laboratories for bioterrorism:
- Through early outreach activities by the MLS, the number of clinical
contacts to which laboratory alerts could be sent electronically
doubled from 60 to 120. This capacity allows alerts to be sent quickly,
informing laboratories about timely issues. This system was invaluable
to disseminate information about agents of bioterrorism, including how
to rule out BT agents and refer testing. Laboratories without electronic
capabilities were sent the same laboratory alerts via broadcast FAX.
- These laboratory alerts were sent several times in response to the
terrorist attacks and bioterrorism; the feedback from clinical
laboratories has been very favorable. The labs, especially in rural
areas, expressed that they were well informed and felt as though they
could count on the Minnesota Department of Health for up-to-date
information and that they werent forgotten way up here in Northern
Minnesota, for example. Some labs also used the information and links
that they received in the alerts to address some of the concerns of
- This electronic communication was also used to institute active
surveillance with 35 larger institutions throughout the state (4 labs
out of state) for daily reports of Bacillus sp. within each laboratory,
for which Bacillus anthracis could not be ruled out. This allowed for
more expedient confirmatory testing of these isolates in the MDH public
- Soon after, this system was used when three mysterious deaths
occurred in a very short time period, related to knee surgeries in the
state. An MLS alert was sent out to solicit information from labs as to
who might have detected any clostridium bacteria in their facilities.
The MLS lab contact list continues to be maintained and updated. Regular
laboratory alerts have been sent more recently concerning West Nile
Virus and SARS.
- The following shows the latest breakdown of the MLS members that can
be reached via the lab HAN/MLS list and via FAX:
- 159 = Total institutions receiving either FAX or e-mails
- 146 = Total e-mails sent
- 129 = Actual MLS e-mail contacts
- 116 = Total institutions e-mailed (some institutions have more
than one contact)
- 17 = non-MLS contacts (other MDH staff, other state health
- 43 = FAXs sent to institutions without e-mail addresses.
- Laboratories in the network will be provided with in-services that
will include the topics: bioterrorism, an overview of public health
laboratories, the Minnesota Laboratory System, and the relationship
between the Minnesota Laboratory System and the National Laboratory
System. These in-services will be presented either at regional
conferences, or provided at the time of the on-site lab survey.
A poster, showing grow characteristics and morphologies, which was
developed in collaboration with clinical stakeholders and produced by a
contractor, was disseminated to sentinel laboratories and made available to
other state public health laboratories.
This page last reviewed: 7/12/2004