Community Garden Project 2017 2

Fire Safety 2

2017 Sentinel Laboratory Bioterrorism Exercise Results 3

Fish Contamination Monitoring Program—A Year in Review and The Future of Fish Analysis 5

Page 2

In 2011, the Bureau of Laboratories, “Healthy Living” Vision Priority Team 6 created a

volunteer-based annual community vegetable garden in order to provide healthy food

options for local individuals with limited access to fresh produce.

Since inception, our small community garden has been able to produce approximately

1000 pounds of a variety of vegetables for donation to the Greater Lansing and the

Holt Community Food Banks.

We thank our laboratory gardeners and the building facilities crew from the

Department of Management and Budget for their support toward this healthy initiative.

Thank you to Michigan State University Horticulture Department for the donation of

the vegetable plants for our 2017 garden.

The BOL Community Garden Project is one way the laboratory forms local community

partnerships in order to help strengthen public health efforts in Michigan.

Community Garden Project 2017

In preparation for National Fire Safety Week, the Bureau of Laboratories Health

and Safety Officer, Judy Smith, assembled laboratory employees to participate in

fire extinguisher refresher training.

DeLau Fire Services provided equipment, fire, and technical expertise about fire

safety and use of dry chemical extinguishers in the work environment.

While all employees were successful with extinguishing a small contained outdoor

fire, the employees gained respect for the importance of fire safety and

professional fire fighters.

Fire Safety

2017 Sentinel Laboratory Bioterrorism Exercise Results expected to perform notification to MDHHS BOL of a potential select agent.

Automated identification systems, including MALDI-TOF and Vitek, are not

recommended for identification of organisms where aerosol generation is

a safety concern. Additionally, rapid identification systems commonly misidentify

select agents. The American Society for Microbiology (ASM), “Recognize/ Rule

Out / Refer,” guidelines provide accurate and safe steps for identification of

isolates which cannot be ruled out as select agents.

ASM Sentinel Clinical Laboratory protocols for Suspected Biological Threat

Agents: http://www.asm.org/index.php/guidelines/sentinel-guidelines

Exercise Scenario/Clinical History:

A 67-year-old male with diabetes mellitus presented to the emergency department with

a leg wound that was not healing and appeared to be getting worse. He stated that the

antibiotics his family physician prescribed had run out. The patient had no recent travel

history, but during his work-up, it was discovered he had fought in the Vietnam War.

Swabs were collected from the leg wound and submitted to the laboratory for culture

testing.

Exercise Result:

Participants should not have been able to rule out Burkholderia pseudomallei. The

patient history was helpful by learning that the patient had fought in the Vietnam War.

Burkholderia pseudomallei is sometimes referred to as the “Vietnam time bomb”

because the disease can reactivate in returning Vietnam veterans after many years in

latency. The organism sent was Burkholderia thailandensis, that mimics Burkholderia

pseudomallei biochemically. The initial culture result worksheet sent with the sample

did not list Burkholderia pseudomallei as a rule out option, however, a new result

worksheet was emailed to participants and the due date was extended.

Important Note: Once a laboratory has isolated a suspected select agent, it is

Important for facilities to immediately contact their designated Laboratory Response

Network (LRN) reference laboratory. The LRN reference laboratory for Michigan

is the Michigan Department of Health & Human Services, Bureau of Laboratories

(MDHHS BOL). Do not attempt full identification and susceptibility testing in your

facility. The LRN provides guidance recommendations for retaining samples and

submission for confirmatory testing. As part of this exercise, laboratories were

Page 3

Test Name Expected Result for Burkholderia thailandensis

Colony Morphology

Creamy, Grey, Convex, non-hemolytic and may have non-violet pigment on blood agar

Many laboratories neglected to report their findings on Mac-Conkey agar

An important feature of this organism is the ability to grow on MacConkey agar in comparison to some other select agents that do not

Gram Stain Gram negative rods/bacilli, bipolar staining

Catalase Positive

Oxidase Positive

Indole Negative

Motility Motile or Positive

Additional tests

Growth at 42°; Resistant to Penicillin; Amoxicillin/Clavunate-susceptible; Polymixin B or colistin-no zone

Growth on B. cepacia selective agar; No pigment on Mueller Hinton agar

Continued on page 4

Page 4

Sentinel Lab Results:

The exercise sample was shipped to seventy three sentinel laboratories in Michigan.

Nine out of the seventy three laboratories no longer perform microbiology testing.

Laboratory Exercise Statistics

Number of Facilities

Percent Response

Laboratory Performance

62/64 97 Performs Microbiology testing and responded to the exercise.

48/62 77 Contacted the LRN laboratory

62/62 100 Reported results by the exercise due date, June 23, 2017.

61/64 95.3 Have at least 2 staff members trained and certified for Category A packaging and shipping.

48/62 77.4

Could not rule out Burkholderia pseudomallei, or ruled out all select agents using the initial worksheet that excluded Burkholderia pseudomallei. 37/66 Unable to rule out Burkholderia pseudomallei

11/66 Ruled out all select agents using initial worksheet that excluded Burkholderia pseudomallei

4/62 6.5 Incorrectly ruled out all select agents using the updated form that included Burkholderia pseudomallei.

6/62 9.7 Incorrectly identified the isolate as Yersinia pestis.

2/62 3.2 Incorrectly identified the isolate as Brucella species.

2/62 3.2 Incorrectly identified the isolate as Francisella tularensis.

2017 Sentinel Laboratory Bioterrorism Exercise Results

Continued from page 3 MDHHS BOL would like to thank all facilities who participated in the 2017 BT

Sentinel Laboratory Exercise. This preparedness exercise is one way to ensure

that Sentinel Laboratories are able to meet the ASM guidelines of, “Recognize /

Rule-out / Refer, Suspected Biological Threat Agent specimens. The Centers for

Disease Control and Prevention recommendation is to have at least two staff

members in your facility certified to package and ship Category A samples.

MDHHS BOL offers free packaging and shipping certification classes throughout

the State of Michigan. New classes will be offered in the spring and fall of 2018.

If you are interested in hosting a class at your facility, please contact Shannon

Sharp, BT Coordinator at sharps1@michigan.gov or (517)335-9653.

Burkholderia pseudomallei

After 48° on Blood Agar Plate After 48° on Chocolate Agar Plate

Gram Stain

Page 5

Fish Contamination Monitoring Program -

A Year in Review and the Future of Fish Analysis

Since the 1980s, the State of Michigan has collected and analyzed fish from our

state’s waterbodies. During the course of our involvement in the program, the

Analytical Chemistry section has provided analytical results to the Michigan

Department of Environmental Quality (DEQ) and the MDHHS Division of

Environmental Health from fish samples processed, extracted, and analyzed by

staff here at MDHHS BOL. In a typical year, fish analysis consists of the extraction

and analysis of 500-700 samples, predominantly for persistent organic pollutants

(POPs) including polychlorinated biphenyls (PCBs), chlorinated pesticides, and

mercury. The data provided by the laboratory is used at the DEQ for temporal trend

studies and ecological site assessments. The edible fillet results are used by the

Division of Environmental Health for the public “Eat Safe Fish Guides.”

In the past year, the Analytical Chemistry section (AC section) analyzed

approximately 520 samples as part of the 2017 advisory year. Several things

transpired this past year that set 2017 apart from years past. In 2017, the laboratory

offered more analytical tests with more targeted analytes than ever before. In

addition to PCBs, pesticides, and mercury, the AC section reported results for

Perfluorinated Compounds/Perfluoroalkylated Substances (PFCs/PFAS), Dioxins,

Furans, coplanar PCBs, Polycyclic Aromatic Hydrocarbons (PAHs), Toxaphenes,

lead, nickel, vanadium, arsenic, and chromium. In total, the AC section reported

results for 187 analytes across more than 11 methods which amounted to over

1600 analyzed samples, totaling over 72,000 individual test results. This year also

marked a transition in technology being used by the laboratory. Traditionally, the

bulk of the fish analyses were performed using gas chromatographs with electron

capture detectors (GC-ECD), and direct mercury analyzers. Over the past few

years and especially in 2017, the AC section has incorporated newer and more

sophisticated technologies for fish analysis including: Liquid Chromatograph

Tandem Mass Spectrometry (LC-MS/MS), Gas Chromatograph Mass Spectrometry

(GC-MS), Gas Chromatograph Tandem Mass Spectrometry (GC-MS/MS), Gas

Chromatograph High Resolution Mass Spectrometry (GC-HR-MS), Inductively

Coupled Plasma Mass Spectrometry (ICP-MS), and Inductively Coupled Plasma

Atomic Emission Systems (ICP-AES), in addition to our traditional analytical

techniques.

Bureau of Laboratories, Analytical Chemistry Section, UPLC MS/MS

Continued on page 6

The AC section has invested heavily in embracing technological advancements to

improve the accuracy and efficiency of fish testing. Over the past several years this

section has increased testing capacities with the addition of one GC-MS/MS, three

Ultra Pressure Liquid Chromatograph Tandem Mass Spectrometers (UPLC-MS/MS)

instruments,

several ICP-MS instruments, and a new mercury analyzer. The laboratory intends to

expand on the advances made in 2017 to further utilize modern technologies including

GC-MS/MS and LC-MS/MS instrumentation and improve sample preparation

techniques to keep pace with the ever changing landscape of trace analytical testing. It

is our goal to be prepared for whatever emerging contaminant issues our partners wish

to address. 2017 was an exciting year for the fish program and it is expected that a

busy 2018 will bring even more new challenges. The lab is currently developing

methods for PFC analysis in additional matrices such as venison, serum, and water. In

addition, we have already received, analyzed, and reported priority samples for the

analysis of PFCs and mercury in fish from water bodies affected by the ever growing

PFC contamination concern that has made news not only in Michigan, but nationally as

well. In the next couple of years, the annual sample volume for PFC analysis in fish

could potentially increase to approximately 800 samples for PFCs alone.

Page 6

LabLink is published quarterly by the Michigan Department of Health and Human Services, Bureau of Laboratories, to provide laboratory information to Michigan health professionals

and the public health community.

MDHHS is an Equal Opportunity Employer, Services and Programs Provider.

Editor: Teresa Miller

Fish Contamination Monitoring Program -

A Year in Review and the Future of Fish Analysis

Continued from page 5

Thermo Triple Quadrupole

Mass Spectrometer

Bureau of Laboratories

Analytical Chemistry Section

Inductively Coupled Plasma

Mass Spectrometry

Bureau of Laboratories

Analytical Chemistry Section