News and Updates
Courier
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Cooler/Box Return Process
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At MTPHL, we have a simple process for returning coolers and boxes to our valued clients. Once we’ve removed all the samples from a container, we place a brightly colored “Empty” sticker on the outside. Our couriers use these bright stickers to differentiate return coolers from those meant for sample delivery. The couriers won’t open the boxes, so they rely on this helpful communication tool to ensure samples are delivered correctly and that empty coolers find their way back to the right sender. If you plan to reuse returned containers, please remember to take off the bright “Empty” sticker first; this helps us ensure everything runs smoothly!
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Thank you for helping us make this process as efficient as possible!
Molecular
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Candida auris identified in MT
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The first case of Candida auris has been identified in Montana. C. auris is a life-threatening, highly transmissible, often multidrug-resistant yeast that has caused outbreaks in healthcare facilities that can be difficult to control. Please click here to see the recent Health Alert Notification. (HAN)
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C auris is a very hardy organism that can thrive in environments for a long period of time when not properly disinfected. When C. auris is suspected, use healthcare disinfectants that are effective against C. auris and follow disinfectant instructions for use, including proper precleaning, dilution, and wet time. EPA’s Registered Antimicrobial Products Effective Against Candida auris [List P] | US EPA.
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In addition, C. auris can be mistaken for various other organisms when using traditional phenotypic methods for yeast identification. To help with our surveillance, please send the following to MTPHL for further species identification.
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Candida species not C. albicans, C. dubliniensis, C. tropicalis, C. krusei, nor C. lusitaniae.
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Candida isolates from urine or sterile sites.
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The MT DPHHS closely tracks all known C. auris cases and notifies healthcare facilities if a newly admitted patient should be screened. Feel free to reach out with any questions.
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Measles Testing
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MTPHL is currently performing Measles PCR testing in-house on a daily basis. Effective communication is crucial for our operational success; therefore, please notify us prior to sending any specimens for testing. The expected turnaround time (TAT) for results is one to two days. For guidance regarding specimen requirements, please consult the MTPHL Measles Testing Guidance.
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Additionally, please be advised that Measles IgM testing is currently a send-out test. The TAT for this test may vary, though it typically ranges from two to three days.
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Remember, per administrative rule, all positive Measles PCR or IgM specimens are required to be submitted to MTPHL. If you have any questions about testing, please give us a call.
Serology
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Brucella and Tularemia Serology temporarily Available
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The MTPHL obtained positive control for the Brucella and Tularemia serology assays to detect total antibodies to Brucella sp. and Francisella tularensis. Testing will become available again on May 14th, 2025. We anticipate being able to offer testing through the summer, but depending on the availability of the control, we may have to suspend testing in the fall. Brucella and Tularemia are offered together to detect cross-reactivity. To order testing in the lab portal, choose Tularemia serology, and the Brucella serology will automatically be added to the order. Please submit 2 mL of serum, transported at 2-8°C.
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Risk of False Positive Results with Certain Capillary Blood Collection Tubes Used with Magellan Diagnostics Lead Care Testing Systems
IT Corner
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Time is running out to switch to OKTA!!
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Thank you to the 400+ users who have transitioned to using OKTA for signing in to the lab portal! Last month, we gave a deadline of 5/1 to create an OKTA account. We have used messages in the portal and targeted emails to users, but we still have almost 200 users who have not notified us that they have an OKTA account.
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OKTA is the state of Montana’s required authentication method for accessing state applications, so we must convert all users to comply with state policy.
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Starting on May 15th, users who have not switched to OKTA will lose the ability to sign in to the lab portal and will need to contact us to reinstate access.
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After May 15th, if you attempt to use the username and password fields on the lab portal sign-in screen and get an error, you will need to create an OKTA account and notify us that you have done so. If you need immediate access, you can contact us, and we can temporarily reinstate your access until your OKTA account has been linked to the portal. Once you create your OKTA account and notify us, most often you will have access the next day (we will send you an e-mail when your OKTA account has been linked to the portal).
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If you have yet to create your OKTA account, rather than risk losing access, PLEASE CREATE YOUR OKTA ACCOUNT NOW AND NOTIFY US AT HHSLIMS@MT.GOV that you have done so. We will then complete the process and let you know when you can sign in with OKTA.
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Weekend and After-Hours Support for Lab Portal
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If you are having problems with the lab portal after 5 p.m. or on weekends, you can call us at 1-800-821-7284. If you call and reach the answering service, they can pass your message on to someone who can contact a LIMS team member to call you back. On Saturdays between 8 a.m. and 4 p.m., you can send an email to HHSLIMS@mt.gov. A LIMS Team member works on Saturdays and monitors this email.
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If you have switched to OKTA for authentication and are having problems signing in to your OKTA account, contact our DPHHS IT Help Desk at 406-444-9500. They have someone on call after hours and on weekends. You can leave a voicemail, and someone will get back to you.
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Lab portal procedures can be found on our website. These procedure can help you find results, place orders, or trouble shoot a few issues.
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Molecular and Whole Genome Sequencing Go-Live
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As of May 19th, our molecular and whole genome sequencing sections will be live in the new LIS. You should not notice much difference, as you will be ordering the same tests, and the reports will look the same.
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One exception is that since all whole-genome sequencing results are non-reportable, a report will no longer be produced for SARS-CoV-2 Variant Surveillance. If the report is viewed, it will say “No report to display.” Currently, the report includes a comment but no results. Sequencing information is used for epidemiologic purposes, and results are only shared within public health. Besides SARS-CoV-2 samples sent to us for sequencing, all positive SARS-CoV-2 samples tested in-house and some confirmed microbiology cultures reflex to whole-genome sequencing. Orders for these samples remain pending until the sequencing is complete. Therefore, you will see them in pending orders, and the order status will show “partial results” even after the reportable tests are complete. The report, however, says final once all reportable testing has been completed.
Preparedness
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Bacillus anthracis SOP Update
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The Association of Public Health Laboratories (APHL), in collaboration with the American Society for Microbiology (ASM), has updated the Sentinel Level Clinical Laboratory Guideline for Bacillus anthracis and Bacillus cereus biovar anthracis.
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The new SOP can be accessed with this link: Anthrax-SOP. Please print this updated procedure and put it in your Biothreat Agent procedure notebook.
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The Sentinel Laboratory is required to be able to perform five key tests to follow the new Rule Out Flowchart. These tests are colonial morphology, hemolysis, gram stain, catalase, and motility (tube agar).
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APHL and ASM are reviewing and updating the existing Sentinel Level Clinical Laboratory Guidelines. Ultimately, all the SOPs, bench cards, and associated training materials will be reviewed and updated. As each updated procedure is published, Kim Newman will post the link to the new procedure in this newsletter.
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For non-emergency inquiries, please contact Kim Newman, Laboratory Preparedness Specialist, at 1-406-444-3068.
Dear Labbey,
If we have been taught to use universal precautions when handling blood and other patient specimens, how are we able to ship blood following no regulatory requirements at all?
Sincerely and seriously,
Concerned
Dear Concerned,
The US Department of Transportation (DOT) Hazardous Materials Regulations (HMR), 49 CFR Parts 171-180, apply to materials that are determined to be capable of posing an unreasonable risk to health, safety, and property when transported in commerce (i.e., by commercial carriers.)
An infectious substance is a material known or reasonably expected to contain a pathogen that can cause disease in humans or animals. These substances are classified based on the level of harm the pathogen can do to otherwise healthy humans or animals when exposure occurs.
The more we know about a sample, i.e., the patient's symptoms and endemic conditions where the patient is from, the more clues we have about which pathogens might be present. For example, suppose a feral cat has bitten a patient, resulting in an infected wound and fever. In that case, we can logically assume that a slow-growing organism is a higher classification than a urine sample collected from a pregnant person in for a glucose check. Likewise, if a patient has a high fever and is traveling from the Democratic Republic of Congo, we can assume that the patient may have a high-consequence infectious disease.
Other examples of using your professional judgment include assessing risk based on the sample or information you may have about a patient’s history. For example, if you are transporting a cholesterol sample from a health screening facility, you would be less likely to consider an infectious disease than if someone were coming in for a Hepatitis C test or if one of your regular patients were coming in for a CD4 count.
Classification of samples also takes into account the type of sample (patient specimen or culture) to determine how exposures might occur (mucous membrane, respiratory, ingestion). In addition, all samples must be triple packaged, including a leakproof inner packaging with a biohazard label, a rigid outer packaging to minimize the risk of exposure, and an emergency response number for support in the event of package damage.
Regardless of the sample's classification (Category A, Category B, exempt when shipping by FedEx or UPS, or not subject to regulations), universal precautions still apply. We continue to wear gloves and use engineering controls when collecting and manipulating samples, and we always use a biohazard symbol when shipping samples. That is because, while this portion of the Code of Federal Regulations (49 CFR, DOT) may not always be applicable, other portions, such as the OSHA Bloodborne Pathogen Standard (29 CFR 1910.1030), are.
Shipping samples does indeed carry a level of risk, but this can often be mitigated through knowledge of the regulations, appropriate packaging and labels, and having competent staff completing the process.
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