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Laboratory ‘Network’ Update

Laboratory ‘Network’ Update. Max Salfinger New York State Department of Health Princeton October 24, 2006. ‘It is health which is real wealth not pieces of silver and gold’ Mahatma Gandhi, 1869-1948. 3 questions Survey Systems thinking. Adherence/ Cure. 3 Time to negativity?.

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Laboratory ‘Network’ Update

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  1. Laboratory ‘Network’ Update Max Salfinger New York State Department of Health Princeton October 24, 2006

  2. ‘It is health which is real wealth not pieces of silver and gold’ Mahatma Gandhi, 1869-1948

  3. 3 questions • Survey • Systems thinking

  4. Adherence/Cure 3 Time to negativity? 2 RIF resistance? 1 Tuberculosis? sees a doctor Chest x-ray History / physical exam

  5. 1.Tuberculosis yes or no ? Identification Growth detection Microscopy Nucleic acid amplification

  6. 2. RIF res. yes or no ? Clinical course Egg based AST Agar based AST Radiometric / Non-rad. rpoB analysis (line probes)

  7. Testing concentrations: Drug 460TB MGIT 7H10 7H11 INH 0.1/0.4 0.1/0.4 0.2/1.0 0.2/1.0 RIF 2.0 1.0 1.0 1.0 EMB 2.5/7.5 5.0 5.0/10 7.5 SM 2/6 1/4 2/10 2/10 PZA 100 100 N/A N/A

  8. What gets captured in the TB database? • Result - susceptible; resistant? • Method - BACTEC 460; MGIT, etc? • Concentration tested? • Percent resistant colonies? • Mutation found, type?

  9. 3. Time to negativity • Follow up specimens until 2 consecutive specimens are culture negative... • Initial cavitation & mo-2 culture pos: extend INH/Rif from 4 to 7 months • Repeat susceptibility testing after 3 mo • Pos culture @ mo-4: Treatment failure

  10. Survey [N=11]: CT, DE, IN, MA, MI, NJ, NYC, NYS, PA, VT, WV

  11. NAA: YES: 6 NO: 5

  12. DST: Bactec 7 MGIT 2 7H10, ESP ea 1

  13. DST - screening: SIRE-PZA 5 4 drugs 4 3 drugs 1

  14. DST - 2nd-line: YES 6 NO 5

  15. Quantiferon: YES 2 NO 9

  16. Work days: 7 days: 1 6 days: 1 5 days: 8

  17. Biggest concerns: • Not enough resources • Federal TB grant reduction • Gamma Interferon assays: PHL or hospital-based labs • Ability to keep high level of testing • Delayed delivery of specimens and isolates • Loosing 40+ years of experience (retirement) • Staff shortage • Time and money • Maintaining staff competency • Reduction of Federal $$$

  18. Success stories: • FAST TRACK program • Being a member of the LIMS RFQ • Moving into better lab space • Implementation of NAA (homeless case) • NAA turnaround time • Staff cross-training • Surpassing CDC turnaround time guidelines • Improving TAT & client relationship with less staff • Molecular identification and drug susceptibility

  19. Systems Thinking ‘We tend to focus on snapshots of isolated parts of the system, and wonder why our deepest problems never seem to get solved.’ Peter Senge in The Fifth Discipline, 1990

  20. Did you hear Claudia’s husband?

  21. If you suspect DR, MDR, or XDRTB you have a moral responsibility to get the results in the shortest TAT possible!

  22. $$$

  23. ?

  24. Laboratory standards New York: NAA mandatory for newly diagnosed patients whose sputum tested AFB smear positive.

  25. Reference Laboratory System

  26. TB ThinkBig

  27. Be Bold !

  28. Picasso: Peace Dove

  29. WE can do it !

  30. Thank YOU for Working TOGETHER!

  31. The Journey sets the Destination see you ALL in Tallahassee, FL !

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