WRIGHT-PATTERSON AIR FORCE BASE, Ohio – The 711th Human Performance Wing’s United States Air Force School of Aerospace Medicine Public Health and Epidemiology Laboratory Service, also known as the ‘Epi Lab,’ is a Department of Defense reference laboratory offering clinical diagnostic, public health, and force health screening testing and sustainment of DOD’s beneficiary population.
Since the inception of the Epi Lab in 1990, its focus has been on serving as a public health testing and force health screening laboratory for the United States Air Force. Currently, the lab supports Tri-service testing with approximately 224 customers world-wide, supporting 9.4 million beneficiaries.
As the Air Force Clinical Reference Lab, the Epi Lab provides force health screening, as well as clinical diagnostic testing for its customers, and according to staff members, the laboratory prides itself on providing the best testing methodologies to protect the force. In the last year, the lab has added several different tests to its missions and continues to be a leader in influenza testing, partnering with other Services and the CDC. Altogether, the lab performs about 2.1 million tests a year for active duty service members, dependents, beneficiaries, reservists and National Guard members.
As part of the Defense Health Agency’s Global Influenza program, “We grow and isolate Flu A/B, parainfluenzas, adenovirus and the Respiratory Syncytial Virus, or RSV,” said Senior Airman Brittany Mitchell, Medical Laboratory Apprentice. “The data we get from isolating and sequencing the flu is provided to the Centers for Disease Control and Prevention for use in future influenza vaccine development.”
“For Chlamydia and Gonorrhoeae testing, we recently switched testing platforms which allows us to test for other pathogens such as Clostridium difficile, which is a gastrointestinal bacteria, and Herpes virus, providing more specific diagnostic information to providers to help treat their patients,” Mitchell said.
One of the other areas that the laboratory provides DOD testing support is with testing of the Human Immunodeficiency Virus, commonly referred to as HIV.
“In October 2016 the Epi Lab switched to 4th-generation HIV testing, which enabled the lab to detect an HIV infection two weeks sooner after an exposure than with the previous generation of testing. Decreasing the window to detection allows patients to receive counseling and treatment much sooner,” said 1st Lt. Cedric Walters, operations chief of the lab’s Immunodiagnostics branch.
The force health testing conducted at the lab has a major impact upon the medical readiness picture of Airmen who may be called to deploy at any time. In January 2017 all treatment facilities received guidance that states that before Airmen can deploy, they must have the Mumps vaccination and/or show laboratory results of a titer.
“Under the new guidance, a lot of people were unable to deploy until they either received the vaccination or got their blood drawn to show evidence of immunity. We saw about a four-to-five times increase over a few months in terms of volume and we were still able to produce those test results within 24 hours,” Walters said.
In addition to providing testing to support to beneficiaries, protecting the public is also a crucial mission to the Epi Lab. During the days after September 11, 2001, when the Epi Lab was located in San Antonio, Texas, assigned personnel played a vital role in testing suspicious samples. The Epi Lab continues that important mission today.
“We also have a unique capability with our Biosafety Level 3 lab. Most hospitals and clinics don’t have this capability. We’re that reference site people can come to when they have things they can’t figure out – or when people have things they can’t test at their location,” said Walters.
Tech. Sgt. Ashley Iovieno, NCOIC of the lab’s microbiology branch, discussed some of the safety features provided by the Biosafety Level 3 lab. “We can test for organisms [bacteria, fungi, and viruses] that need extra precautionary measures such as double layers of personal protective equipment, negative airflow within the chambers of the lab supported by entry and exit points that are secure so that personnel have to go in one door and close it in order to go in the next door,” Iovieno said. “In addition, we use specialized air handling to protect our staff from organisms such as tuberculosis, or different fungi,” she said.
The Epi Lab is also a Laboratory Response Network Reference Laboratory, and can assist in response efforts involving situations involving biological threat agents. According to Iovieno, if the LRN were to be activated, the lab would work with the Ohio Department of Public Health in identifying high level biological threats.
The Epi Lab recently responded to a Department of Health Agency initiative to look at streamlining testing and foster cost savings by increasing testing capabilities.
“Our eventual goal is to be DOD’s reference lab,” said Walters.
Walters, who has been assigned with the lab since May 2016, said the long term strategy of the reference lab is to be able to offer testing that many hospitals and clinics are unable to perform themselves.
With the workload increases, the laboratory has many opportunities to optimize its processes. For instance, six days a week, FedEx arrives in the morning with 100-150 boxes. In those boxes are foams packed with samples – tubes of blood or containers of stool, urine, or viral and/or respiratory samples. They all come either frozen on dry ice, refrigerated with ice packs, or at room temperature. Central Operations team members receive these boxes, unpack each one, compare each specimen against the provided shipping list and log the information into the laboratory information system, which is called the Composite Health Care System, or CHCS. Every single sample is manually logged into the system, and each day brings another 5,000 – 8,000 samples, with each sample being relabeled with the lab’s internal label. Central Operations personnel are known as the “face” of the lab because of their interaction with customers. They are experts in how different types of specimens must be shipped to the lab to preserve the integrity of the samples.
To help prevent injuries to lab employees from repetitive motions involved with these processes, the lab anticipates receiving an automation system in the coming months that will take the initial sample, send it to the correct department in the lab, take the cap off the sample, send it on to the analyzer for testing, take it back when finished testing, recap it and scan it for where it needs to go, and prep it for storage.
The Epi Lab is the DOD’s only clinical reference laboratory, staffed with 95 professionals, including military, DOD civilians, and contractor personnel that will continue to provide its customers with top notch medical testing. The staff of the Epi Lab continue to use innovative technologies to support the medical readiness of Airmen and their families, enabling them to take the fight forward when called upon.