Laboratory Response
Network
Elizabeth A. Macias, Ph.D., D(ABMM)
Gatekeeper, Air Force LRN Laboratories
Air Force Institute for Operational Health
Epidemiological 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)
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
• Recognize, rule-out, and refer to Reference or
National laboratories for further testing
LRN Structure
Basic Sentinel
Clinical
Laboratory
Advanced Sentinel
Clinical Laboratory
Basic Sentinel
Clinical 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 Sentinel
Clinical 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 Sentinel
Clinical 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 Sentinel
Clinical 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 Sentinel
Clinical Laboratory
It is further highly recommended…
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
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
USAF LRN Basic
Sentinel Labs
(CCLM Classification)
Andersen
Aviano
Beale
Bolling
Brooks CB (Clinic)
Buckley
Cannon
Charleston
Columbus
Croughton
Edwards
Eielson
Ellsworth
Geilenkirchen
Goodfellow
Grand Forks
Hickam
Holloman
Hurlburt Field
Incirlik
Kirtland
Kunsan
Lajes
Laughlin
Los Angeles
Maxwell
McChord
Misawa
Peterson
Pope
Ramstein
Randolph
Schriever Clinic
Upwood
Vance
Whiteman
USAF LRN
Advanced Labs
(CCLM Classification)
Altus
Andrews
Barksdale
Bitburg (Spangdahlem)
Davis Monthan
Dover
Dyess
Eglin
Elmendorf
Fairchild
F.E. Warren
Hanscom
Hill
Kadena
Keesler
Lakenheath
Langley
Little Rock
Luke
MacDill
Malmstrom
McConnell
McGuire
Minot
Moody
Mountain Home
Nellis
Offutt
Osan
Patrick
Robins
Scott
Seymour Johnson
Shaw
Sheppard
Tinker
Travis
Tyndall
USAFA
Vandenburg
Wright-Patterson
Yokota
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 CDCendorsed 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 Gatekeeper
COL Dan Harms
US Army
Bill Nauschuetz
USAF
Elizabeth Macias
USN
CDR Sharon West
Summary of LRN
Benefits
What does the LRN offer to the Department of
Defense and to the Nation?
• 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.
Missions of LRN
BW agents
Non-BT Missions of LRN
• SARS Testing
• Vaccinia testing – for smallpox
vaccination adverse effects
• Monkeypox testing
• Avian Influenza
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: elizabeth.macias@brooks.af.mil