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Teresa Miller, Chemical Threat Response Training
Coordinator, MDHHS Bureau of Laboratories
The State Public Health Laboratory System is defined as “An
alliance of laboratories and other partners within a state that supports the
ten essential public health services under the aegis of the state public health
laboratory. The system members and stakeholders operate in an interconnected
interdependent way to facilitate the exchange of information, optimize
laboratory services, and help control and prevent disease and public health
threats.”
State Public Health Laboratory (PHL) Systems are charged
with eleven core functions to provide a foundation for measurement of a variety
of PHL quality system goals. To fulfill this role, state and local PHLs engage
the entire healthcare community to varying degrees within the PHL system. The
State Public Health Laboratory System is responsible to assure their laboratory
services are in support of public health. Many of these systems range from
small systems, with just one PHL to large complex state, regional, county, and
local PHLs with multiple partners. Regardless of the structure, they are guided
by the eleven core functions, and play a central role in providing their system
partners with a full range of laboratory services required in support of public
health.
The Eleven Core Functions of Public Health Laboratories are:
- Disease Prevention, Control, and Surveillance
- Integrated Data Management
- Reference and Specialized Testing
- Environmental Health Protection
- Food Safety
- Laboratory Improvement and Regulation
- Policy Development
- Public Health Preparedness and Response
- Public Health Related Research
- Training and Education
- Partnerships and Communication
How does the PHL support the eleven core functions? The Michigan
Department of Health and Human Services Bureau of Laboratories (BOL) must
provide accurate and precise analytical data in a timely manner for support of Disease Prevention, Control, and
Surveillance. This includes testing for emerging and re-emerging microbial
agents, immune status, antibiotic resistance, screening for inherited neonatal
metabolic disorders, environmental toxins, and heavy metals. The PHL must recognize
outbreaks and other public health events by identification and characterization
of the causative agents of disease, provide early detection of congenital
disorders in newborns for timely diagnosis and treatment, and provide testing
of communicable or environmental disease when testing is not available in the
private sector.
Integrated Data
Management is the conduit for scientific data and information that supports
public health programs. Laboratory data is essential for public health analysis
of trend and events. The PHLs must use standardized data formats, participate
in statewide disease report networks, link with the Centers for Disease Control
and Prevention (CDC) and other national and international surveillance
databases.
The BOL serves as a center of excellence using expertise to
provide Reference and Specialized Testing.
The BOL confirms atypical laboratory test results and verifies results of other
laboratories’ tests. They also provide testing for diseases directly to
providers when testing is not readily available, too rare, or unusual when
other laboratories have difficulty in maintaining their testing capacity.
The BOL supports Environmental
Health and Protection by providing scientific analysis of environmental and
human samples to identify, quantify, and monitor potential threats of toxic chemicals
and microbiological contaminates in air, water, soil, and hazardous waste, and
coordinate testing with other state agencies and PHL partners. The BOL participates
in the Chemical Laboratory Response Network (LRN-C) and the Environmental
Response Laboratory Network (ERLN). They maintain compliance with regulatory
agencies and test samples to support state and federal regulations. The BOL conducts
biomonitoring of fish and human samples for toxic chemical exposures.
Detection and response to Food Safety concerns is supported by testing samples from Michigan
citizens and food and beverages associated with food-borne illness outbreaks for
identification of potential food-borne pathogens. Characterization of isolates
and participation in national characterization databases, such as PulseNet,
along with participation in the Food Emergency Response Network (FERN) are
examples of our collaborative effort to support this core function of PHLs.
The BOL provides leadership for Laboratory Improvement and Regulation through training,
consultation, and proficiency testing with partner laboratories and health care
facilities in Michigan. The quality management program promotes improvement of
the State Public Health Laboratory Systems through implementation of the
Laboratory System Improvement Program (L-SIP). The BOL has provided
contribution to the creation and support of regulations that have significant
impact on laboratory improvements and promote safe laboratory practice.
The BOL plays a role in state and federal health policy by generating
scientific evidence that influences public health practice on health outcomes,
law, and Policy Development. Subject
Matter Experts (SMEs) serve as references and resources in biological,
chemical, and other emerging issues of public health importance. Scientists participate
in the development and evaluation of standards related to the operation and
performance of laboratories involved in public health testing, as well as
engagement in strategic planning at the local, state, and national laboratory
levels.
Public Health
Preparedness and Response are key partnership roles the BOL maintains in
local, state, and national disaster preparedness and response plans. A Continuity
of Operations Plan is adhered to in the event of a disruption of laboratory
services that assures surge capacity is operational during a public health
emergency. The BOL functions as a LRN confirmatory laboratory for biological agents
and a LRN-C level one laboratory designated by the CDC.
Training and Education
is fulfilled by providing continuing education in the area of laboratory
practice. The BOL has partnered with academia to provide learning and training
opportunities for both domestic and international scientists.
The BOL maintains a strong communication plan supporting Partnership and Communication throughout
the State Public Health Laboratory System. The BOL supports the PHL system by
highlighting the importance of laboratory contributions in public health,
utilizing information technology for robust connectivity with our partners, and
coordinating activities for Michigan’s public health laboratory systems.
Development, evaluation, and implementation of new
technologies and methodologies, partnering with other public health entities,
and collaboration with academic practices, engages the BOL in Public Health Related Research.
By continual support of these eleven core functions of State
Public Health Laboratory Systems, the BOL is dedicated to continuing leadership
in providing quality laboratory science for healthier people and communities
through partnerships, communication, and technical innovation with a vision of
being a stronger, more diverse team within an integrated public health system.
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