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Laboratory Response Network
Elizabeth A. Macias, Ph.D., D(ABMM)Gatekeeper, Air Force LRN LaboratoriesAir Force Institute for Operational HealthEpidemiological Surveillance Division
(AFIOH/SDE)Brooks City-Base, TX
What is the Laboratory Response Network ?
Laboratory Response Network (LRN)
• Established in 1999 by the Centers for Disease Control and Prevention (CDC)
• Integrated network of laboratories – state and local public health, hospital, military, veterinary, and international
• Respond quickly to biological and chemical terrorism, as well as emerging infectious diseases and other public health threats
LRN Structure
LRN Structure – Sentinel Laboratories
If you perform routine diagnostic Microbiology cultures, then you are a Sentinel laboratory.
Minimum requirements:
- Follow BSL-2 guidelines- Plate cultures on blood and chocolate agar- Microscopy capability (Gram stains, wet
mounts)
• Recognize, rule-out, and refer to Reference or National laboratories for further testing
LRN Structure – Sentinel Laboratories
• Perform testing on clinical specimens, not environmental samples
• Presumptive testing - protocols on American Society for Microbiology (ASM) website http://www.asm.org/Policy/index.asp?bid=6342
LRN Structure
Basic SentinelClinical
Laboratory
Advanced SentinelClinical Laboratory
Basic SentinelClinical Laboratory
1. Certified under CLIP/CLIA for the applicable subspecialty within the specialty of Microbiology
2. Inspected by CMS-approved accreditation organization (i.e., CAP)
3. Policies/procedures for referral of specimens to an Advanced Sentinel Lab
4. Policies/procedures for direct referral of suspicious specimens or isolates to the nearest LRN Reference Lab
Advanced SentinelClinical Laboratory
First three same as for Basic Sentinel Labs:
1. Certified under CLIP/CLIA for the applicable subspecialty within the specialty of Microbiology
2. Inspected by CMS-approved accreditation organization (i.e., CAP)
3. Policies/procedures for direct referral of suspicious specimens or isolates to the nearest LRN Reference Lab
Advanced SentinelClinical Laboratory
Additionally…
4. Have a Class II or higher certified Biological Safety Cabinet
5. Comply with BSL-2 practices AND
6. Policies for additional respiratory protection
7. Use LRN Sentinel Level Clinical Guidelines from the ASM Website
Advanced SentinelClinical Laboratory
8. Personnel trained and demonstrate competency in LRN Sentinel Level Clinical Microbiology Guidelines
9. Personnel trained and certified in Packing and Shipping of Infectious Substances Guidelines
10. Procedures to track and account for decontamination of laboratory biological waste
Advanced SentinelClinical Laboratory
11. Microbiology laboratory operates under negative pressure (applies only to new construction or remodeling)
12. On-site terminal decontamination capability, e.g., autoclaving, for disposal of wastes categorized as BSL-3 or Select Agent
It is further highly recommended…
LRN Sentinel Labs
LRN Sentinel Labs
Laboratory Response Network (LRN)
USAF LRN Policies
Laboratory Response Network (LRN)
May 2001: HQ/USAF SG mandated all AF medical laboratories support homeland defense by participating in the LRN
“In support of the national laboratory response network and homeland defense, all AF medical laboratories will participate, at a minimum, at Level A [New terminology = Sentinel]….”
Laboratory Response Network (LRN)
August 2007 - National Laboratory Response Network Policy Letter
• Discusses Basic and Advanced Sentinel labs
• “AFMS laboratories will have the CDC technical protocols, notification procedures, and procedures to properly ship clinical samples in place by 1 October 2007…”
Air Force Laboratory Response Network
Sentinel Laboratories
Los AngelesMaxwellMcChordMisawaPetersonPopeRamsteinRandolphSchriever ClinicUpwoodVanceWhiteman
EllsworthGeilenkirchenGoodfellowGrand ForksHickamHollomanHurlburt FieldIncirlikKirtlandKunsanLajes Laughlin
AndersenAvianoBealeBollingBrooks CB (Clinic)BuckleyCannonCharlestonColumbusCroughtonEdwardsEielson
USAF LRN Basic Sentinel Labs
(CCLM Classification)
USAF LRN Advanced Labs
OsanPatrickRobinsScottSeymour JohnsonShawSheppardTinkerTravisTyndallUSAFAVandenburgWright-PattersonYokota
KeeslerLakenheathLangleyLittle RockLukeMacDillMalmstromMcConnellMcGuireMinotMoodyMountain HomeNellisOffutt
AltusAndrewsBarksdaleBitburg (Spangdahlem)Davis MonthanDover DyessEglinElmendorfFairchildF.E. WarrenHanscomHillKadena
(CCLM Classification)
State-Based Sentinel Lab Activities
State-Based Sentinel Lab Activities
FY2006 Public Health Emergency Preparedness Cooperative Agreement managed by the CDC
Each of the grantees (50 state PH labs plus PH labs in DC, NYC, LA County, and Chicago) must accomplish critical tasks in exchange for direct funding received through the cooperative agreement
State-Based Sentinel Lab Activities
Most of their activities focus on the capabilities and capacity in their own lab
A small percentage of these critical tasks and performance measures surround LRN sentinel lab activities, including the following…
State-Based Sentinel Lab Activities
• Maintain a database of all sentinel (biological) labs in the jurisdiction using the CDC-endorsed definition that includes:
– POC Information– Biosafety Level– Certification status– Capability to rule-out Category A and B
bioterrorism agents– Contact information for the reference labs
used by these sentinel labs
State-Based Sentinel Lab Activities
• Test the ability of the sentinel laboratories to send specimens to a confirmatory LRN lab on nights, weekends, and holidays
– Ensure all laboratory staff know how to contact the next level LRN lab
– Have properly trained staff for packaging and shipping (i.e., current biosafety training and IATA certification)
State-Based Sentinel Lab Activities
• Increase the exchange of laboratory testing orders and results
– Timely reporting of results from LRN confirmatory lab back to the submitting sentinel lab and reporting to CDC as appropriate
– Linkage of results to public health
Tri-Service LRN Initiative
CDC/LRN
DoD GatekeeperCOL Dan Harms
US ArmyBill Nauschuetz
USNCDR Sharon West
USAFElizabeth Macias
• True Network
• Standardized testing, procedures and reagents (no cost for oligo’s, Abs)
• Proficiency testing
• Administrative materials – Safety SOP, chain of custody forms, FBI contacts, vaccination information, etc.
Summary of LRN Benefits
What does the LRN offer to the Department of Defense and to the Nation?
• SARS Testing
• Vaccinia testing – for smallpox vaccination adverse effects
• Monkeypox testing
• Avian Influenza
Non-BT Missions of LRN
Missions of LRN
BW agents
Questions?
Elizabeth A. Macias, Ph.D., D(ABMM)
Laboratory Director
Air Force Institute for Operational Health,
Epidemiological Surveillance Division (AFIOH/SDE)
2730 Louis Bauer Drive
Brooks City-Base, TX 78235-5132
COMM: 210.536.1271
DSN: 240.1271
Email: [email protected]
