Surge Capacity for Response to Bioterrorism in Hospital Clinical Microbiology Laboratories

Abstract

Surge capacity is the ability to rapidly mobilize to meet an increased demand. While large amounts of federal funding have been allocated to public health laboratories, little federal funding has been allocated to hospital microbiology laboratories. There are concerns that hospital laboratories may have inadequate surge capacities to deal with a significant bioterrorism incident. A workflow analysis of a clinical microbiology laboratory that serves an urban medical center was performed to identify barriers to surge capacity in the setting of a bioterrorism event and to identify solutions to these problems. Barriers include a national shortage of trained medical technologists, the inability of clinical laboratories to deal with a dramatic increase in the number of blood cultures, a delay while manufacturers increase production of critical products and then transport and deliver these products to clinical laboratories, and a shortage of class II biological safety cabinets. Federal funding could remedy staffing shortages by making the salaries of medical technologists comparable to those of similarly educated health care professionals and by providing financial incentives for students to enroll in clinical laboratory science programs. Blood culture bottles, and possibly continuous-monitoring blood culture instruments, should be added to the national antibiotic stockpile. Federal support must ensure that companies that manufacture essential laboratory supplies are capable of rapidly scaling up production. Hospitals must provide increased numbers of biological safety cabinets and amounts of space dedicated to clinical microbiology laboratories. Laboratories should undertake limited cross-training of technologists, ensure that adequate packaging supplies are available, and be able to move to a 4-day blood culture protocol.Surge capacity, the ability to rapidly respond to a sudden and dramatic increase in needs, has historically been addressed in the military as one component of readiness and in the civilian emergency preparedness setting to meet the needs of the population in response to natural disasters. The provision of medical services in the setting of a terrorist event is another scenario in which surge capacity must be adequate.In the setting of a bioterrorism (BT) event, plans in place have increased the surge capacity of the public health and emergency medical system to deal with the diverse needs of the population. These plans include increasing the ability of the United States to rapidly deliver large quantities of antibiotics, vaccines, antitoxins, and ventilators from the national antibiotic stockpile and manufacturing sufficient smallpox vaccine to vaccinate the U.S. population. Plans to enable first responders and emergency departments to mobilize in a timely manner to deal with a tremendous increase in the demand for their services are also in place. There are significant costs associated with the maintenance of surge capacity.Although large amounts of federal funding have been allocated to laboratorie...

Barriers to surge capacity of an overcrowded emergency department for a serious foodborne disease outbreak

“…Occasionally they are indicated to screen for specific pathogens or for public health and criminal investigations 30. Inadequate surge capacities with FBDO, especially a bioterrorism attack, could be caused by a shortage of hospital clinical laboratory capacity and special treatment capability 31. Hospitals should have a surge plan to increase the capacity of clinical microbiology tests.…”

Biological weapons

“…providing ventilatory support; communications) might be maintained if utility supplies (e.g. electricity, fuel) were compromised [76,77]. Modelling estimates for pandemic influenza in the United States suggest that, although many patients could be cared for at home, if the pandemic was severe, and numbers affected paralleled those of the 1918 pandemic, at the peak, hospitals would need 191% of available non-intensive care beds; 461% of available intensive care beds; and 198% of available ventilators for influenza alone [65,78].…”

The Challenge of the Hospitals and Health Care Systems in Preparation for Biological and Chemical Terrorism Attack

“…There is concern that hospital laboratories might have inadequate surge capacity to deal with a significant bioterrorism incident. A workflow analysis of a clinical microbiology laboratory that serves major medical centers was performed by Shapiro [15] to identify a solution to this problem. Their conclusion was that hospitals must provide an increased number of biological safety cabinets and the amount of space that they give to the clinical laboratory, should cross-train more technologists and should give better training to most of the staff.…”