laboratory professionals

A COVID Reflection

Usually, I talk about some of the more administrative happenings in the laboratory world (accreditation, competency, etc.). Today, however, as there is seemingly a glimmer of light at the end of the nation’s pandemic tunnel, I thought I would reflect on what we have collectively experienced.

Like much of the nation, it has been a difficult journey for laboratorians. It has been particularly trying for those who were asked, who were required, to rise up and meet the unprecedented challenges of the times while suffering from the same burdens of fear, uncertainty, and physical ailments as those they were serving.

Dying Alone

One year ago, my uncle died from COVID-19. He died alone and afraid in the nursing home where he never wanted to be. We visited him after being given special permission from the president of the company operating the nursing home. After being told about how unusual it was to be allowed to see him, we dressed in full PPEs and went into his room. We found him curled in a fetal position, dead and cold to the touch. It was so unfair.

I think about all of the laboratorians who had to endure similar or worst experiences: those who lost close family members and even those who themselves suffered through the disease.

Unseen Warriors

Laboratorians have always been the silent warriors in the life-long battle to defeat pain and disease. More often, nurses and doctors received public gifts of admiration and praise for their service to patients. With quiet satisfaction, laboratory technologists, technicians, and support personnel are dedicated 24 hours a day, seven days a week, to providing the information on which 70% of medical decisions are based. Information that no other group of professionals can provide.

I think about all of the effort and skill required in the mad rush to set up tents and collection sites needed across the nation. And then, too, there were the laboratories needing to scale up testing or create entirely new testing areas with new instruments and new tests kits. The chaos was magnified by constantly changing guidelines, reagent shortages, and a lack of trained personnel.

Amid all the confusion, misinformation, and anger, laboratorians were themselves experiencing disease, death, and social isolation. Yet still, they delivered the results the nation needed to understand the pandemic’s depth and breadth.

Needless Death

Now the Delta variant has taken hold just when the nation thought the disease, if not bested, had at least been brought under some semblance of control. Unfortunately, the refusal of many to get vaccinated contributes to the virus’s persistence. More will suffer, and more will die.

How many needless deaths will the nation have to experience? Will there ever be a point when everyone who can be vaccinated will be? Or, two years later, will we be mourning preventable COVID-19 deaths. Will we still have to watch our loved ones perish with a tube down their throat, or worst, alone in a room far away surrounded by cold walls and quiet indifference?

Sigh.

Regardless of where this pandemic leads or how the nation reacts, laboratorians will continue to remain steadfast in their dedication to their profession and their patients. We have often considered ourselves the stepchild of the healthcare industry because, despite the criticality of what we do, we go unnoticed and unremarked on as long as we deliver the results our patients need. We are okay with that.

We are also tired and worn.

Conclusion

Thanks, fellow laboratorian, for reading this minor soliloquy of frustration and sadness. I will probably be back next quarter discussing inspections, competency, or some other administrative aspect of laboratory operations. I hope, also, to discuss how the nation has reached or is close to reaching the theoretical goal of herd immunity because of high vaccination levels. However, if I were honest, I know the likelihood of this happening is disappointingly low.

If you can get vaccinated, please do.

-Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ), has been an ASCP Medical Technologist for over 30 years and has been performing CAP inspections for 15+ years. Dr. Elzie provides laboratory quality oversight for four hospitals, one ambulatory care center, and supports laboratory quality initiatives throughout the Sentara Healthcare system.

Zika Diagnositics in the Media

Today NPR featured a write up about how to test for the Zika virus. While It didn’t delve into the diagnostic testing side of things as much as Lab Medicine’s recent podcast, it does give readers a good overview. In addition, it highlights how critical laboratory professionals and pathologists are to public health and infectious disease prevention.

Listen: Zika Virus Podcast

Dr. Diamond from the Washington University School of Medicine talked with Lab Medicine about all things Zika Virus: a brief history of the virus, modes of transmission, and the implications for laboratory professionals and pathologists.

Give it a listen.

Times are Definitely Changing

Just returning from the ASCP 2015 conference in Long Beach, California, I can’t help but reflect on what a wonderful experience I had. The weather was picturesque, attendees at an all time high, and a variety of educational offerings and speakers on point.

The highlight for myself (and I know I am not speaking out of line when I mention the four other amazing ladies) was being recognized as ASCP’s Top Five from the 40 Under Forty program this year. I cannot begin to tell you how refreshing and energizing it is to be a part of an amazing group of five women who are all dedicated to advancement in Pathology and Laboratory Science.

To be honest, I was a little nervous going into the meeting… What would the other honorees be like? What would they think of me? Am I going to be completely out of my league there? Well let me tell you, everyone that I met was wonderful! We discussed a variety of topics, and even tossed around an idea for future collaboration.

Yes, I could go on and on about my new friends, but I think what I want to point out is that it cannot, and should not go unnoticed that the Top 5 this year consisted of all women, all WELL deserving women at that. How were we chosen? Yes, we blogged, but don’t forget that we also submitted CVs and biographies. We wrote essays as well as recorded videos (some of us spending hours re-shooting and cringing at ourselves). Not to mention, votes were cast by a dedicated panel as well as online voters. Your 40 Under Forty, including the Top Five, came from all over the country and represent various specialties in our field.

Unfortunately, at some point I had to come down from the “girl power” high. I returned to Milwaukee and thought to myself, I wonder what the ratio of men to women is in our laboratory alone? A few short minutes later, I crunched the numbers and it was easy to see that women make up 85% of laboratory staff at our organization. The totals are inclusive of all laboratory departments and shifts as well as administrative support, Pathologists, and Directors at Children’s Hospital of Wisconsin.

It was during these thoughts on women in science and recognition, that I remembered an article I had read quite a while back. The article had discussed how historically, women occupied most of the laboratory jobs (the strange term, “lab gals” sticks out in my mind). This was thought to be the case because it was believed that women had more patience, were more detail oriented, and therefore were trained to perform the work that doctors did not want to do. At the same time, men typically occupied the higher-level decision making positions (those that required an advanced degree, PhD, and MD). I thought to myself that even today, it sure does seem that there are more women in the laboratory profession. However, we have come a long way and are seeing an increase in women being honored for their education, professional achievements, and advancements in the field. Every single lead technologist and laboratory manager at our institution as well as the CEO of our health system currently is female. Interestingly, more than HALF of the 40 Under Forty Honorees this year are highly educated women with advanced degrees!

We all know full well that more than 70% of critical medical decisions are based on laboratory results. Therefore, if the field of laboratory professionals is made up of mostly women, it appears that our attention to detail is instrumental in making some major decisions. Yes, there still may be gender gaps when comparing men to women in academia however, what once was a field dominated by the male PhDs and MDs, appears to be shifting majorly as more and more women are making their presence known in Pathology and Laboratory Science.

I applaud everyone who was honored this year as one of ASCPs 40 Under Forty. Women are the past, present, and the future of laboratory science and medicine and it brings a little extra smile to my face to know that so many well deserving women are being recognized by ASCP this year.

2015 ASCP 40 Under Forty Top Five: Amanda Wehler, Tiffany Channer, Jennifer Dawson, LeAnne Noll, and Kimberly Russell

-LeAnne Noll, BS, MB(ASCP)^CM is a molecular technologist at Children’s Hospital of Wisconsin and was recognized as one of ASCP’s Top Five from the 40 Under Forty Program in 2015.

Dilutions: How Are You Doing Yours?

If you ask someone to dilute a sample in half, pretty much everyone will do it the same way – add an equal volume of sample to an equal volume of diluent, whether that’s 1 mL to 1 mL or 100 µL to 100 µL. But if you ask people to do a 1 to 2 dilution, you may be surprised to get different results. That’s because I’ve found that the convention for writing dilutions is taught differently at different Medical Laboratory Science (MLS) schools.

A 1 to 2 dilution should be written as ½. It means to dilute something in half. But many times it will be written as 1:2. These two forms are actually not equal, despite the fact that they are used interchangeably in the laboratory. One is a dilution and the other is a ratio. In the scientific literature, if you see “1:2”, it means to add 1part to 2 parts. That will be 1 mL added to 2 mL, for a total of 3 mL, or a 1/3 dilution.

Unfortunately, this problem is prevalent in the laboratory. I’ve seen 1 to 10 dilutions written both as 1/10 and 1:10. It’s very important to know how the technologists in the lab are performing that 1 to 10 dilution. Are they doing a true 1/10 (1 mL sample plus 9 mL diluent) or are they actually doing a 1 to 11 dilution (1 mL sample plus 10 mL diluent)? Your patient results may be different depending on who does the dilution!

Coming into this field from a scientific background rather than an MLS background, I prefer the convention of writing a dilution as 1 over something, ½, 1/10, rather than as a ratio, 1:2, 1:10. However, perhaps the majority of medical laboratory scientists are taught the ratio. Either convention works fine as long as it is clear to everyone in the lab what dilution they are actually performing and being asked to perform. You might want to just check your own MLS and see how they do their dilutions.

-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

Confirmed Case of Ebola Diagnosed in the United States

CNN is reporting that a patient in Dallas, Texas is the first person diagnosed with Ebola Virus in the United States.

According to the CDC, the patient traveled to the United States from Liberia on 9/19-9/20. The patient exhibited symptoms on 9/24, sought care on 9/26, and was admitted to the hospital on 9/28. Today, the CDC received and tested samples from the patient and confirmed the presence of the Ebola Virus by PCR methodologies.

The CDC and the Dallas County Health and Human Services will conduct contact interviews to determine if the patient may have had contact with anyone while infectious. If any contacts are identified, they will be quarantined and monitored for 21 days (the longest known incubation period for the virus).

CDC director Tom Frieden, MD, MPH says, “I have no doubt in my mind that we will stop it here.”

Be that as it may, it doesn’t hurt to be prepared. Lab professionals and pathologists should be familiar with the CDC’s Ebola information page.

Pandora’s Box

Archived in the ever-rich and exotic mythologies of the Greeks is the story of Pandora’s Box. It was actually a “jar”—which is strangely close to a “test tube” in my opinion. Pandora was given a wedding gift, a beautiful jar, with instructions not to open it under any circumstances. Curiosity killed the cat, so to speak, and she finally couldn’t resist. When she opened it, all the evil contained in the jar escaped and spread over the earth. She tried to close it but too late—the contents had already escaped. Only one thing remained in the jar at the very bottom—the Spirit of Hope.

I’m not sure the World Health Organization would agree with me, but “Pandemic” is very close to “Pandora.” In a world where international travel is commonplace the spread of contagious disease is a major concern. Rats on ships carrying plague may be a thing of the past, but viral-loaded passengers on an international flight happen every hour of every day. Think of all the headlines in the past decade that have highlighted international health risk issues. It seems that Pandora has unleashed a few additional mutated “evils,” and I doubt we’re through with all her mischief.

As laboratory professionals, we are essential to solving the public health issues confronting our world today. Rapid diagnosis, evidence-based research, viral load monitoring, susceptibility and pharmacological validation, managing toxicity—familiar territory for us, and just think of how much relies on our expertise? We are called on daily to be the platform and framework for “pandemic control” measures. Sitting in our clean, efficient, well-lit, safe and busy laboratories throughout our country it’s easy to forget there are bacterial and viral war zones not far from our shores…all it takes is a small rat on a creaky ship (or a young child on a red-eye international flight) to initiate a modern day plague world-wide.

Next time you hear “pandemic”, remember Pandora. Wash your hands, put on a mask, and peer inside that jar of hers and shake out some Spirit of Hope. Sprinkle it liberally around our laboratories and colleagues, and let’s roll up our lab coat sleeves—we have a lot of work to do!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Is Your Lab Ready to Give Results to Patients?

In February I wrote about the Department of Health and Human Services regulation that amends the Clinical Laboratory Improvement Amendments of 1988 and the Health Insurance Portability and Accountability Act of 1996 in regards to reporting of patient results. The deadline for implementation is fast approaching–9/27/2014–and so I’m curious as to how prepared laboratories are for this change.

Is your lab ready? What sort of changes have you made, if any? And do you see this as a way for pathologists and laboratory professionals to become a bigger part of the healthcare team? Or is it simply going to make everyone’s life harder?

–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Part of the Healthcare Team

The laboratory is often considered a separate entity from the healthcare team. We are the “black box” that provides information and so some equate us with the healthcare IT department. Instead of being isolated with our instruments and microscopes while we crank out data like a big computer, we should be an integrated member of the team and involved in patient care. Imagine the benefits to the patient if a laboratory professional were included in patient rounds. Questions such as: “Can we test for that? Is that test performed on-site? What kind of sample do they need?” would have immediate answers. Laboratory professionals could also provide guidance in test selection and differential diagnoses.

Laboratory professionals and pathologists should work toward this level of involvement. And it doesn’t need to start by leaping into the middle of someone’s rounds. It can start as simply as expanding on an answered question. For example: the transplant team requests a STAT tacrolimus level, but tacrolimus is only performed once a day by tandem MS. Asking to speak with the transplant about tacrolimus testing can actually open many doors. Not only does everyone on the team now understand how tacrolimus testing works, the session also introduces the laboratory professional to a variety of healthcare providers. These providers now have a face to put with a name and a laboratory contact to call in the future when new questions arise. This initial contact could lead to cooperative efforts on other fronts. A rope bridge has been started, and it can become a freeway. All that’s required is to recognize opportunities, and get the laboratory professionals out of the lab and into the healthcare team.

This increase in visibility could feasibly become vital to the survival of the laboratory in the future. As healthcare dollars shrink, it’s incredibly important that the public and our healthcare colleagues understand just how much of their care is predicated by information the laboratory provides. It’s our job as laboratory professionals to help them understand. The doctors of pharmacology (PharmDs) led the way with this type of paradigm shift; now it’s time for laboratory professionals to follow suit. The laboratory can become one of the many faces of medicine rather than its most hidden profession.

Laboratory Professional’s Role in Electronic Health Records

Electronic Health Records (EHRs) will play a large role in the future healthcare landscape; it’s imperative these systems display laboratory data accurately and efficiently. The Center for Surveillance, Epidemiology, and Laboratory Services at the Centers for Disease Control recently published a paper about the role Laboratory Professionals can play in the development of electronic health records.

The paper concludes, in part, that “Laboratory professionals and organizations can support the future vision and help improve the overall quality of healthcare for individual patients and the national population.”

If you’d like to read the announcement and the paper in full, it’s here.