THE EDITORIAL OFFICE WELCOMES YOUR FEEDBACK, SUGGESTIONS AND NEW IDEAS

OCTOBER 2015 ISSUE 138

IN THIS ISSUE Thank you! And Moving Forward Advances in Diagnosing Respiratory Viruses BRIGHT Run 2015 – Rhonda’s Warriors News from HRLMP Administration News from Chemistry Education News News from Pathology Quality News Editorial Board: Chemistry: Dr C Balion Microbiology: Dr M Smieja Pathology: Dr C. Ross Genetics: Dr E McCready Hematology: K Moffat Editorial Office: Co-Editors: Dr C Ross; K Moffat

Thank you! And Moving Forward We would like to extend a sincere THANK YOU to Dr. Cheryl Main for her hard

work and dedication over the last four years as our Editor for the HRLMP

Newsletter. During her tenure, Dr. Main facilitated many

improvements to our newsletter that included specific

“News from …” sections for each of our disciplines, an

Education section and a focus on Quality. In addition, Dr.

Main completed a major transformation in the overall

format of the newsletter. Each newsletter is highly-valued

and an excellent resource for sharing information and the

happenings from the HRLMP to colleagues and allied health professionals both

internal and external to the HRLMP.

As the newly appointed Co-editors of the HRLMP newsletter our goal is to build

on Dr. Main’s great foundation and continue to provide an informative and

meaningful newsletter for you. If you have a contribution for an upcoming

edition, please contact either Dr. Ross (rossca@hhsc.ca) or Karen Moffat

(moffat@hhsc.ca). We welcome your feedback and contributions.

Karen Moffat, Dr. Cathy Ross

Advances in Diagnosing Respiratory Viruses Respiratory viruses are the most common of all human infections, with symptoms from the “common cold” with inflammation of the nasal mucosa, sinuses, and throat, to “influenza-like illness”, consisting of fevers, cough, and body aches.

Snapshot of this edition:

Thank you! and Moving Forward

Advances in Diagnosing Respiratory Viruses

NEW – Trace Metal Program and Facility (TMPF)

1 Lab Connections

Rhinosinusitis, otitis media, pharyngitis, croup, bronchitis, bronchiolitis, pneumonia, and asthma exacerbations are all frequently caused by respiratory viruses. These infections cause both individual misery and widespread outbreaks, both in the community and within institutions such as nursing homes or hospitals. A wide range of viruses cause respiratory infections, from influenza and respiratory syncytial virus (RSV) to the lowly rhinovirus. The HRLMP Virology Laboratory at St. Joseph’s Healthcare Hamilton has long provided state-of-the-art diagnostic testing to detect common respiratory viruses. Over forty years, the laboratory has progressed from inoculation of eggs to diagnose influenza, to cell-culture based methods (which took up to two weeks), to rapid antigen staining and rapid shell vial culture (hours to days). Currently, we use polymerase chain reaction (PCR), which takes 2-3 hours. All respiratory specimens submitted for respiratory viruses are tested using highly sensitive, lab-developed multiplex PCR for influenza A and B, RSV, human metapneumovirus, para-influenza types 1, 2, and 3, adenovirus, and rhinovirus/enterovirus. Our tests do not distinguish rhinovirus from enterovirus, although that can be done on special request. Lower respiratory tract specimens, such as broncho-alveolar lavage (BAL), are also tested for herpes simplex and cytomegalovirus (CMV) in immunocompromised patients, as well as for bacterial, mycobacterial, and fungal pathogens. With an appropriate travel history, infections such as MERS-coronavirus or avian influenza may be investigated through Public Health Ontario Laboratories; these must be appropriately labeled to ensure safe lab handling. (1) Testing is performed after a health care provider obtains a nasopharyngeal swab (NPS) or other respiratory specimen. A flocked swab

is inserted through the nose into the nasopharynx--a distance of 8 to 10 centimetres in an adult--and turned three times to collect epithelial cells lining the nose and upper throat. Respiratory viruses multiply within epithelial cells, and proper collection improves our ability to detect these viruses. The swab is placed into viral transport medium and sent to the laboratory for same-day or next-day testing. Testing is done three times daily during influenza season (roughly November to May), and once or twice daily during non-influenza time periods. A specimen is lysed and total nucleic acids (RNA and DNA) are extracted, followed by reverse transcription (conversion of RNA into DNA) and multiplex amplification using virus-specific primers and probes on a RotorGene thermocycler. We currently test over 10,000 respiratory specimens per year from Hamilton and regional hospitals. Prior to 2013, the most common virus detected in children was RSV, a cause of severe respiratory illness such as pneumonia and bronchiolitis. In 2013, our laboratory became one of Canada's only labs to perform routine testing for rhinovirus/enterovirus, which is now the most common virus detected. We estimate that 90% of these are rhinoviruses, and 10% are enteroviruses, except in the fall of 2014 when 30% were enterovirus D68. With rapid development of a specific PCR for EV-D68 by Candy Rutherford, Molecular Technical Specialist, in collaboration with Kathy Luinstra in research, our lab was able to offer rapid EV-D68 testing. We diagnosed over 180 children and adults with EV-D68 in 2014, and recently published our clinical experience—which showed some increase in severity, but no excess ICU admissions or mortality (2). We also verified our previous studies showing that rhinovirus itself can be a severe infection (3). We have no specific treatments for respiratory viruses, apart from influenza. A fair question is,

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“Why test for respiratory viruses?” An accurate lab diagnosis: provides a prognosis, may allow stopping antibiotics, minimizes other investigations, and may lead to quicker hospital discharge. An economic analysis showed that testing for respiratory viruses in hospitalized children is likely cost-saving (4). Importantly, rapid diagnosis together with appropriate infection control helps keep staff and patients safe by preventing or minimizing hospital transmission of these viruses. What is the future of respiratory virus testing? Dr. Padman Jayaratne is developing tests for Mycoplasma pneumoniae and Chlamydophila pneumoniae, bacterial infections that mimic viral infections but are susceptible to antibiotics. We are also working to detect coronaviruses, which cause influenza-like illness. But the biggest advances will be affordable, rapid, point-of-care molecular tests, such as those under development by Dr. James Mahony, that will enable decisions to be made in clinics or hospital emergency departments. References: 1. Mahony JB, Petrich A, Smieja M. Molecular

diagnosis of respiratory virus infections. Crit Rev

Clin Lab Sci. 2011 Sep-Dec;48(5-6):217-49.

2. Mertz D, Alawfi A, Pernica JM et al. Clinical

severity of pediatric respiratory illness with

enterovirus D68 compared with rhinovirus or

other enterovirus genotypes. CMAJ. 2015 Oct

13.

3. Asner SA, Petrich A, Hamid JS et al. Clinical

severity of rhinovirus/enterovirus compared to

other respiratory viruses in children. Influenza

Other Respir Viruses. 2014 Jul;8(4):436-42.

4. Mahony JB, Blackhouse G, Babwah J et al. Cost

analysis of multiplex PCR testing for diagnosing

respiratory virus infections. J Clin Microbiol.

2009 Sep;47(9):2812-7.

Dr. Marek Smieja, MD PhD FRCPC, Microbiology

BRIGHT RUN 2015– RHONDA’s Warriors

An amalgamated laboratory team participated in this year’s BRIGHT Run in support of our beautiful friend and colleague Rhonda Birse (who sadly lost her amazingly courageous fight with breast cancer). Our BRIGHT Run fundraising total was $9,258 from 92 sponsors. We are so proud of the lab warriors! Thanks everybody!

THANK YOU!

News from HRLMP

News from HRLMP Administration

There is a hospital wide effort to highlight the value and importance of hand washing in the reduction of hospital transmission of bacteria to and from patients and staff. All staff are reminded of “Your 4 Moments for Hand Hygiene”.

http://mystjoes/teams/handhygiene/default.aspx

3 Lab Connections

News from Chemistry NEW – Trace Metal Program and Facility (TMPF)

Through the Hamilton Health Sciences initiative in support of Clinical and Academic Excellence, the HRLMP is proud to announce the formation of a new Trace Metal Program and Facility (TMPF). The TMPF builds upon over 25 years of experience in trace metal testing currently provided through our Atomic Absorption Facility. With the addition of a state-of-the-art mass spectrometer, we have been able to significantly expand our trace metals test catalogue and customize our services to meet the ever changing needs of hospitals and clinical/basic research groups. Under the direction of Dr. Joseph Macri (Clinical Biochemist/HRLMP), the TMPF has partnered with industry and other trace metal facilities as well as established collaborations with clinical and basic science research groups. Such program interactions are key to ensuring service excellence for today and helping develop and improve future diagnostic testing.

Dr. Joseph Macri, Clinical Biochemist, HRLMP We are pleased to announce that Dr. Cynthia Balion has accepted the position as Quality lead for analytic phase testing for the HRLMP. Dr. Waliul Khan has accepted the position as the Clinical representative on the Executive Committee of the University’s Department of Pathology and Molecular Medicine.

Education News In September, Clinical Educators were reminded of the importance of labeling specimens right away.

For further information please click on: http://hrlmp.ca/

CONGRATULATIONS to Mr. John Korver, MLT, ART, Manager, Microbiology, on being awarded the 2015 OSMT Richard Lafferty Excellence in Writing. The Advocate Editorial Committee selected Mr. Korver’s article “The times they are a-changin” published in the fall 2014 (Volume 21, Issue 3). The Committee believed that this article was the most outstanding written contribution to the OSMT Advocate magazine. This award was presented to Mr. Korver September 19, 2015 at the 2015 OSMT Conference in Richmond Hill, Ontario. Again, our sincere congratulations to Mr. Korver on receiving this award.

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Reminder - the 8th Annual Rapid Fire Showcase is fast approaching …

The annual Laboratory Medicine Residents’ and Fellows’ Research Day was held October 15, 2015 and was a success again this year! Congratulations to all of our award winners. Best platform presentations (all specialties):

Jennifer Dmetrichuk Ipshita Kak David Farnell

Best Poster (AP & GP Residents):

Linda Kocovski Jay Maxwell

Best Poster (Laboratory Medicine Programs – MM & MB residents):

Fatimah Al-Mutawa Lei Jiao

Best Platform/Poster Presentation – (all specialties fellowship program):

Andrew Shih Sebastien Theriault

Department of Laboratory Medicine Chief’s Award Quality Improvement in Laboratory Medicine Award (paid by the hospital)

Mary Anne Brett

News from Pathology Dr. Harkiran Kaur has resigned and is moving to a community hospital position. A search committee has been struck with active ongoing recruitment for a replacement in this role. Our performance, as assessed by Cancer Care Ontario, for synoptic completion continues to be excellent at 99 percent at both HHS and St. Joseph's for July 2015, with the provincial average at 92 percent. This reflects our ability to help get our patients into treatment in a timely fashion. From the AP lab: We welcome our new technical staff;

Stephanie Mckeown, MLA at HGH Michelle Wells, MLT HGH Anna Pineda, PA at HHS

Good luck to Teri Johnson who recently left IHC to join Cathie McCallum’s team as Quality Specialist, HRLMP.

5 Lab Connections

Quality News Tom Dorland, HRLMP Quality Specialist, has taken on a new role at Haldimand War Memorial Hospital (HWMH) in Dunnville, effective October 16, 2015. Tom’s new role at the HWMH will be Director of Medical Laboratory, Diagnostic Imaging, and Quality. Tom began his work with the HRLMP in November 2008 as a Registered Technologist in the Core Laboratories at the HGH and JHCC. He moved to the Quality Specialist position in November 2009 and has been instrumental in leading some significant changes across our Program. Tom will be greatly missed, but we wish him the best in his new role and future endeavors. A tea in Tom’s honour was held on Friday, October 16, 2015. Welcome to our New Quality Specialists Please welcome both Susanne Maia-Castellan and Teri Johnson to the role of HRLMP Quality Specialist as of October 5,2015. Susanne comes to us from the Public Health Laboratory in Hamilton where she has worked as a MLT since 2009. Susanne has completed courses in Quality Management and Project Management, in addition to completing her Bachelor of Technology in 2012. Teri Johnson comes to us from the Immuno-Histochemistry and Histology laboratories at the St. Joseph’s site within the HRLMP. Teri obtained her Bachelor of Medical and Applied Biotechnology in 2006 and has taken a number of courses to expand her knowledge. We wish Susanne and Teri well as they transition to their new roles. Cathie McCallum, Manager of Quality and Point-of-Care Testing