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National Laboratory System (NLS)
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National Laboratory System Logo Washington

Clinical Laboratory Initiative

  • Jon Counts, DrPH
The work occurring in Washington under the direction of the principal investigator, Dr. Jon Counts, former Director of the Washington Public Health Laboratory is using a model based at the University of Washington School of Public Health, where he is a professor. Dr. Counts is continuing work he began in the 1990's to effect systematic improvements for public health testing under the auspices of the Clinical Laboratory Initiative. Through the Initiative, Dr. Counts has made improvements ranging from creating standards for appropriate use and interpretation of public health testing to increasing Medicare payments for testing of public health importance.
    
bullet Building strong partnerships:
  • Strategic partnerships are designed to effect grass root changes under guidance of world renown experts in public health practice and laboratory testing; partners include:
    • Pacific Northwest Center for Public Health Practice
    • Clinical Laboratory Advisory Council of practicing laboratory professionals
    • Regional focus groups with laboratory professionals
    • A Steering Committee of experts in infectious disease clinical practice, epidemiology and clinical laboratory science and health care public policy
       
bullet Assessing the need to improve testing for antimicrobial resistance:
  • Microbiology laboratories throughout the state were surveyed for understanding of, and adherence to, guidelines for appropriate testing for resistance to antibiotics, a problem of high national priority.
     
  • Survey questions were designed with input from experts at the CDC, UCLA and expertise within Washington.
     
  • Of the approximately 100 laboratories that perform testing for resistance to antibiotics, more than 75% responded to the survey.
     
  • Laboratories appear not to be following voluntary laboratory practice guidelines, which may affect patient care and public health surveillance, such as failure to:
    • utilize current NCCLS charts which may contribute to erroneous results, leading to treatment failures and false assumptions about antimicrobial resistance
    • respond appropriately to case studies, revealing a level of competence by individuals performing AST which may contribute to  inappropriate and costly testing
    • utilize appropriate number and type of antimicrobials in AST, which may contribute to treatment failures and insufficient data on antimicrobial resistance in an institution of community 

 

bullet Defining strategies to deliver training where it is needed most:
  • Appropriate interventions for target audiences are being designed based upon survey questions correlating laboratory characteristics, access to educational media (PCs, Internet, satellite downlinks, etc), and measured gaps in laboratory practice.
     
  • Dr. Counts is investigating reasons why voluntary guidelines for testing for resistance to antibiotics are not being following (e.g. lack of awareness, insufficient credibility of experts, insufficient resources (personnel, time or money).

 

bullet Translating knowledge into improved practices:
  • An educational series on testing for resistance to antibiotics will be disseminated throughout the state using VHS tapes and/or CD ROM materials as well as utilization of the MASTER website; world-class lecturers will participate. Data from the survey was presented to the laboratory community in a videoconference on November 15th, 2001. The debut lecture on general topics in quality assurance of clinical microbiology testing will be broadcast via videoconference April 16, 2002 to clinical laboratories throughout the Northwest.
     
  • A CD-ROM "Antimicrobial Susceptibility Testing" developed in cooperation with CDC NCID, will be demonstrated April 15, 2002 in a "Train-the-Trainer" format.  These trainers will include CMS inspectors, academicians and bench technologist who will demonstrate and promote the CD-ROM to Level A laboratorians throughout the states.
     
  • A pilot project in a local county has already resulted in hospital laboratories agreeing to standardize their testing for Streptococcus pneumoniae, i.e. the antimicrobials that should be tested and the testing scheme which would reduce turnaround time in results.
     
  • A website was developed to describe and promote the Clinical Laboratory Initiative and there is a link to the CDC MASTER website to improve antimicrobial susceptibility testing with education with case studies.
bullet Assessing the Impact
  • Laboratories were surveyed to determine their awareness of efforts to implement changes in laboratory practices. The publication eLaborations was especially effective but generally the Initiative was found to need more effective promotion.
bullet Investigating factors that influence decision-making and establishment of clinical laboratory policies and testing protocols
  • Factors a laboratory considers in selecting methodologies, testing procedures and protocols
     
  • Evaluation of new procedures
     
  • Factors that influence adoption of national and local standards of laboratory practice
     
  • Factors that should be considered in determining the scope of clinical microbiology services that should be offered on-site versus those that should be referred
     
  • Factors that should be addressed in a survey of clinicians and clinical laboratorians concerning their perceptions of the quality of microbiology reference testing services.

This page last reviewed: 7/12/2004
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