The State Public Health Laboratory System

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The State Public Health Laboratory System

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.