Located at Wright Patterson Air Force Base, OH, the U.S. Air Force School of Aerospace Medicine's (USAFSAM) Epidemiology Laboratory (Epi Lab) is the sole reference lab for the U.S. Air Force.
That means the lab’s staff does a lot of testing: 2 million tests per year through a menu of 130 assays. In addition to reference lab duties, the Epi Lab also provides infectious disease testing, which includes both SARS-CoV-2 and HIV testing.
Customer service
The laboratory’s customer service endeavors in 2020 often focused on the pandemic, completing 13 percent of the Department of Defense’s (DOD) SARS-CoV-2 polymerase chain reaction (PCR) tests. Up through the COVID-19 surge over the summer, Epi Lab completed 34 percent of the department’s tests.
To meet that demand, the lab’s turnaround time (TAT) for SARS-CoV-2 PCR tests averaged 16 hours, which far exceeded its initial goal of 48 hours. The only exception occurred during a single week in July, when a surge in demand corresponded with supply shortages.
Epi Lab took many steps to achieve that TAT. For example, it validated 11 different viral/universal transport media and seven specimen types. The lab also acquired bulk quantities of standardized phosphate buffered saline (PBS) and transport tubes. Using those supplies, the lab’s staff made more than 30,000 aliquots of PBS and shipped them throughout the DOD’s healthcare system.
Productivity
To keep up with testing demand for SARS-CoV-2 and all other diagnostic assays, Epi Lab has a vast array of analyzers, which it is continually upgrading to increase productivity. For example, the instruments used for immunodiagnostic testing were upgraded, allowing the lab to return results to providers 66 percent faster.
Teamwork
The pandemic taxed Epi Lab’s ability to maintain its non-COVID-19 testing services, and it put 25 percent of the test menu (lower volume tests) on hold from the end of May until September.
To resume all testing services, the lab hired staff, growing from 90 employees working on two shifts to 126 employees working on three shifts. The lab also shifted to a 24/7 operation, with active-duty staff covering evenings and nights on 12-hour shifts.
Epi Lab not only added staff, but also trained 15 techs from microbiology and immunology in molecular processes.
As a result of the efforts in teamwork, productivity and other areas, the staff won many awards. The lab was named the U.S. Air Force School of Aerospace Medicine’s Collaboration Team of the Second Quarter, the Public Health Collaboration Team of the Year, and the Biomedical Services Team of the Year for the 711th Human Performance Wing. In addition, 47 team members were awarded the Air Force Achievement Medal and 62 were awarded the Armed Forces Service Medal.
Education and training
To keep up with continuing education, Epi Lab’s managers hosted 26 webinars in conference rooms where staff could practice social distancing. If available, electronic links were also sent out, so staff members could sign in using a computer or mobile device.
Strategic outlook
One focus of Epi Lab’s strategic planning process involves bringing tests routinely sent to civilian reference labs back in to the military system.
In 2021, Epi Lab plans to add carbohydrate deficiency transferase (CDT) testing to its in-house roster, saving a projected $9 million dollars annually on 629,000 samples. In addition, Epi Lab plans to shift HbA1c testing from an immunoassay to an electrophoretic assay. This change will allow Epi Lab to provide information about hemoglobin variants to providers and patients.
A second focus of Epi Lab’s strategic planning is to move from manual to automated testing processes. For example, the lab plans to update Lyme disease testing a using a two-tier testing algorithm from the CDC. The updated algorithm utilizes an enzyme immunoassay in place of the western immunoblot assay. The lab has also ordered a new analyzer to automate the 11,000 thousand rapid plasmin reagin (RPR) tests it performs each year.
Lab inspections
The laboratory is accredited by the College of American Pathologists and the Clinical Laboratory Improvement Program (CLIP is the Military equivalent of CLIA). To prepare for its next inspection in 2021, the lab completed 135 proficiency testing surveys in 2020, maintaining a 99 percent average.
In 2019, CAP inspected the lab, and only noted one deficiency. “This is an amazing accomplishment for the lab, considering the large turnover in military staff that takes place,” said Peter Wasik, Maj., USAF, BSC, Branch Chief for Microbiology at Epi Lab.
