Canadian Public Health Laboratory Network. Core Functions of Canadian Public Health Laboratories

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1 Canadian Public Health Laboratory Network Core Functions of Canadian Public Health Laboratories

2 Canadian Public Health Laboratory Network The CPHLN Core Functions of Canadian Public Health Laboratories document is based on the white paper, Core Functions and Capabilities of State Public Health Laboratories, published by the Association of Public Health Laboratories (APHL), as well as core functions material produced by the British Columbia Centre for Disease Control, Cadham Provincial Laboratory in Manitoba and the Provincial Laboratory in Saskatchewan. The CPHLN gratefully acknowledges the contribution of the above organizations in the preparation of this document. What is a core function? A core function is a role fundamental to a laboratory s mandate that identifies the minimum functions that must be supported by adequate capabilities and resources to ensure sufficient capacity or output of services.

3 Background What functions should, and do, Canadian, public health laboratories perform? What capabilities should, and do, they have? What is, and should be, their unique role in safeguarding the public's health? Canada's public health laboratories are an integral component of Canada's public health system. Critically linked to all sectors of the public health infrastructure (e.g. disease control and prevention, environmental health, epidemiology, emergency preparedness and response), public health laboratories provide early detection of health risks associated with infectious agents, compile data in support of outbreak investigations and identify causes of disease to aid in treatment and prevention. As providers of essential services and leadership in the development of programs and policies, Canada's public health laboratories offer the science and resources needed to promote and protect the health of Canadians. In defining the core functions of public health laboratories in Canada, it is important to understand the scope of responsibilities of today's public health laboratory. Far beyond their traditional role of laboratory testing, public health laboratories are now engaged in the broader challenge of disease recognition, prevention and control as well as health improvement. The CPHLN forges a critical partnership that draws together public health laboratories to create a national program-based approach to disease control. CPHLN partnerships are integral components of the "health team." A core function is a role fundamental to a laboratory's mandate. The term capability refers to a specific activity that ensures the laboratory's success in implementing the core function. Each organization also has capacity or, in the case of public health laboratories, output of testing or services provided over a defined period. The Core Functions of Canadian Public Health Laboratories document identifies the minimum core functions of Canadian public health laboratories, which must be supported by adequate capabilities and resources to ensure sufficient capacity or output of services. The CPLHN recognizes that the core functions and capabilities of Canada's public health laboratories reflect the needs, priorities and resources of their respective constituencies, and thus may differ somewhat from region to region. As such, the core functions and capabilities outlined in this document are intended to serve as a frame-work for future evaluation activities as well as investment and policy decisions involving Canada's public health laboratories. The ability of the public health system to respond to emerging public health challenges, such as the advent or outbreak of new diseases, depends on the efficacy of Canada's public health laboratories. To ensure the performance of the public health system in meeting these challenges and protecting the well being of Canadian communities, the functions, capabilities and responsibilities of public health laboratories must be evaluated and updated on an ongoing basis. collaboration Core Functions of Canadian Public Health Laboratories 2

4 Core Functions and Capabilities The following are ten core functions and capabilities basic to the Canadian public health laboratory system. The CPHLN considers these to be a minimum requirement for the provision of optimal service on behalf of communities throughout Canada. 1. Communicable disease surveillance, prevention and control; 2. Outbreak and emergency response to communicable diseases; 3. Environmental health and food safety; 4. Reference testing, specialized screening and diagnostic testing; 5. Biosafety, containment, and biohazard spill response programs; 6. Integrated communicable disease data management; 7. Public health policy development and evaluation; 8. Laboratory improvement and regulation (Quality Assurance); 9. Training and education of health care and public health workers; and 10. Public health related research and development. Communicable Disease Surveillance, Prevention and Control A public health laboratory in Canada should have the ability to serve as a first line of defence in the rapid recognition and prevention of the spread of communicable diseases by: Examining specimens and analyzing test results for the identification of disease outbreaks; Isolating and identifing causative agents of communicable diseases; Determining the source of infection through analysis of outbreak organisms using molecular epidemiological tools; Working in a consulting and advisory capacity with Medical Officers of Health and their public health staff; Identifying infectious carriers through laboratory testing; Locating sources of infection in the environment; and Working as a key counterpart to communicable disease control and epidemiology units in the above services. A Canadian public health laboratory should have the ability to provide population surveillance for infections of importance to public health communities, including: Testing for environmental contaminants (e.g. food and water); Determining patients' or communities' immune status to communicable diseases; Studying antibiotic resistance; and Providing enhanced laboratory surveillance using state-of-the-art information technology. 3 Core Functions of Canadian Public Health Laboratories

5 A Canadian public health laboratory should have the ability to serve as a centre of expertise for the detection and identification of micro-organisms and transmissible conditions of importance in human disease, including ensuring access to reference as well as diagnostic laboratory expertise and capabilities in the areas of: bacteriology; virology, including HIV services; mycobacteriology; parasitology; serology; molecular laboratory epidemiology; mycology; and metabolic and genetic screening programs. A Canadian public health laboratory should have the ability to provide specialized investigations of low-incidence infections or high-risk diseases such as tuberculosis and botulism, including: Testing for suspect cases of tuberculosis (M. tuberculosis) to identify infections and determine effective antibiotic treatment (e.g. antibiotic susceptibility testing); Testing influenza specimens, as directed by national and international surveillance efforts, to identify viral strains and control influenza; and Assisting public and private health care providers in the investigation and control of unusual communicable or environmental diseases (e.g. emerging and re-emerging pathogens, bioterror events). A Canadian public health laboratory should have the ability to perform tests to meet specific program needs of public health agencies. Core Functions of Canadian Public Health Laboratories 4

6 Outbreak and Emergency Response to Communicable Diseases A public health laboratory in Canada should have the ability to serve as a centre to: Provide infection control and laboratory support for the investigation of outbreaks of antibiotic-resistant organisms; Provide laboratory support as part of provincial and national disaster preparedness plans for environmental or health emergencies; Support investigative analysis of biological agents regardless of the source of exposure (e.g. accidental, bioterrorist or natural disaster); and Assist in the co-ordination and development of capacity to quickly and accurately handle a large volume of tests in a public health emergency situation. Environmental Health and Food Safety A Canadian public health laboratory should have the ability to serve as a centre to: Conduct analysis of environmental specimens (e.g. food and water) to identify and monitor potential microbiological threats to human health; Conduct analysis of environmental specimens to ensure compliance with environmental regulations; Provide services that support the Quality Assurance aspects of networks for water microbiology; Provide leadership in the certification of laboratories that carry out drinking water testing for public health purposes; Conduct scientific studies or laboratory analysis of environmental specimens (e.g. food and water) to determine the relationship between environmental hazards and human health; Test specimens implicated in food borne illness to identify causes and sources, including assays to detect organisms such as E. coli 0157, Campylobacter, Staphylococcus, Salmonella, Shigella, Vibrio, Listeria, Clostridium botulinum and Clostridium perfringens; Analyse agents of foodborne or waterborne illness using molecular epidemiological (e.g. DNA fingerprinting) tools; and Provide public health services through the integrated network of Canada's public health laboratories. 5 Core Functions of Canadian Public Health Laboratories

7 Reference Testing, Specialized Screening and Diagnostic Testing A public health laboratory in Canada should have the ability to serve as a reference microbiology laboratory to: Provide services with national and inter-jurisdictional links; Test for unusual or rare pathogens (e.g. emerging and re-emerging pathogens); Provide nucleic acid amplification testing and molecular epidemiology services; Confirm atypical laboratory test results and verify results of other laboratory testing involving infections of public health importance; and Provide reference diagnostic testing to laboratories that may not have the capability to fully identify disease agents of clinical public health importance. Biosafety, Containment and Biohazard Spill Response Programs A Canadian public health laboratory should have the ability to serve as a resource for laboratory biosafety including: Maintaining high quality biosafety programming for laboratory staff (e.g., Transportation of Dangerous Goods, WHMIS); Providing leadership and training opportunities in biosafety at a regional, provincial/territorial, national and international level; Acting as a link with other national and international biosafety programs; and Working with other jurisdictions to ensure an integrated response to Risk Group 4 organisms (e.g., Medical Microbiologist 24/7 On Call Service, Emergency Assistance Plans (ERAP) etc.). Core Functions of Canadian Public Health Laboratories 6

8 Integrated Communicable Disease Data Management A public health laboratory in Canada should have the ability to serve as a central repository for analysis and dissemination of information in support of public health programs, including: Collecting laboratory data essential for public health decision making; Ensuring the maintenance and communication of laboratory data using standardized data formats; Ensuring rapid dissemination of laboratory information to assist in the identification, understanding and control of disease outbreaks; Providing primary data to support the development and implementation of policies and plans; Participating in nation-wide disease reporting network with centralized facilities for the receipt, storage, retrieval and analysis of data; Participating as a key link in Canadian and, where appropriate, international database systems to collect, monitor and analyze laboratory data; and Serving as the primary data link for the surveillance of diseases of national and global concern. Public Health Policy Development and Evaluation A Canadian public health laboratory should have the ability to serve as a resource to: Provide medical and scientific leadership in the development of public health policy and integration of public health laboratory science into practice; and Participate in the development of standards for health related laboratories, including food, environmental, clinical and research standards. 7 Core Functions of Canadian Public Health Laboratories

9 Laboratory Improvement and Regulation A Canadian public health laboratory should have the ability to serve as a central resource for laboratory Quality Assurance and set the standard for local laboratory performance, including: Maintaining College of American Pathologists or ISO accreditation with distinction; Supporting the development of Quality Assurance programming for clinical and environmental laboratories through the provision of training, consultation and proficiency testing; Developing and managing program delivery to ensure the reliability of laboratory data used for communicable disease environmental monitoring; and Providing testing in support of provincial/territorial and federal environmental regulations. Training and Education of Health Care and Public Health Workers A public health laboratory in Canada should have the ability to serve as an academic centre in areas related to public health, including: Provision of training to improve the scientific and technical skills of public health laboratory staff, including cross-training to meet surge response requirements; Participation in training of technologists, under-graduate and post-graduate medical and non-medical trainees; and Assistance with training and education of infection control personnel. Public Health Related Research and Development A Canadian public health laboratory should have the ability to evaluate and implement new technologies and analytical methodologies to ensure the provision of state-of-the-art, cost-effective and timely analytical and diagnostic services in support of the nation's public health and health care communities to: Identify the need for new laboratory methodologies for communicable disease detection and prevention; Conduct research to improve laboratory tests for communicable disease surveillance; Collaborate with academic and private sector researchers and other government agencies to adapt, test and evaluate emerging technologies for public health laboratories; Conduct applied studies into new analytical methods and services necessary to meet changing public health surveillance and regulatory requirements; and Conduct public health research. Core Functions of Canadian Public Health Laboratories 8

10 Core Functions Fulfillment To support the development of the ten core functions and capabilities identified by the CPHLN, Canadian public health laboratories are encouraged to: Build and strengthen partnerships with provincial/territorial, regional and national public health leaders and private industry; Maintain communication with medical health officers, epidemiologists and infectious disease experts, as well as environment departments, public health nurses, agriculture departments, and policy makers; Address legislative and regulatory responsibilities with laboratory stakeholders; Participate in strategic planning and policy development processes; Explore ways to optimize resources in a fiscally challenging environment; and Develop accountabilities within a framework of evaluation for the optimal delivery of public health and reference services. facilitate 9 Core Functions of Canadian Public Health Laboratories

11 leadership Dialogue surrounding core functions and capabilities should not be limited to local public health laboratories. Comprising an integral component of the broader network of Canadian public health, public health laboratories have an opportunity to contribute to the development of a national framework for the delivery of improved public health. Collaboration among federal, provincial, and territorial participants is necessary to balance the strengths and weaknesses in Canada's public health laboratory system and ensure a cohesive response in outbreak and emergency situations. Core Functions of Canadian Public Health Laboratories 10

12 Canadian Public Health Laboratory Network Contact Us Canadian Public Health Laboratory Network 1015 Arlington Street Winnipeg, MB R3E 3R2 Canada Tel: Fax: Visit the CPHLN at Canada in Printed The Canadian Public Health Laboratory Network (CPHLN) is funded through the National Microbiology Laboratory (NML). CPHLN consists of medical or scientific directors from the public health laboratories in each province. Federal stakeholders are the National Microbiology Laboratory, Centre for Infectious Disease Prevention and Control (CIDPC), Laboratory for Foodborne Zoonoses (LFZ), National HIV and Retrovirology Laboratories, Centre for Emergency Preparedness and Response (CEPR), Defence Research and Development Canada (DRDC), and Canadian Food Inspection Agency (CFIA). Other CPHLN members include Canadian Blood Services (CBS), Héma Québec and Council of Chief Medical Officers of Health (CCMOH). The CPHLN Secretariat reports to the CPHLN chair and is administered by the Scientific Director General of the NML. CPHLN supports the Water and Food Safety Subcommittee, Bioterrorism Response Subcommittee, and Laboratory Standardization Subcommittee.

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