Testing guidelines established by the Centers for Disease Control and Prevention (CDC) recommend that laboratories prepare flourescent smears to identify acid-fast bacilli (Mycobacteria) and to report these test results within one calendar day from receipt of the specimen. Although all positive smears identified by the Public Health Laboratory (PHL) are immediately communicated to the provider, the goal is to report all staining results within this timeframe. Unfortunately, variables inherent to laboratory operations create barriers that can prevent the laboratory from achieving the goal of reporting 100% of results within one calendar day. These variables include the availability of staffing, laboratory work schedules and hours of operation, receipt date and volume of specimens received, and constraints of the laboratory information management system. A recent CDC study of mean laboratory testing turnaround times noted that a performance target of 92% of smear results reported within one calendar day is a goal that laboratories can realistically achieve. In the study, participating laboratories met this target 89% of the time. Further breakdown of the Conn. PHL Q1 2016 data reveals that for this indicator 87.2% were reported within 2 calendar days; 95.6% within 3 calendar days (a more realistic indicator of overall performance given the barriers to testing) and 100% within 4 calendar days. The CTDPH laboratory evaluates testing efficiency on an ongoing basis to identify and incorporate processes to improve on this goal.

The DPH Laboratory partners with local health departments and health care providers, with activities coordinated by the DPH Tuberculosis Control Program. Other partners include the CT Department of Corrections and the CDC. For more information, please visit the DPH Tuberculosis Control Program webpage at:

http://www.ct.gov/dph/cwp/view.asp?a=3136&q=388584&dphNav_GID=1601

Because timely laboratory screening is a critical first step in identifying suspect cases of tuberculosis, the capacity to perform laboratory testing is paramount. Maintaining adequate staffing levels and maintaining sufficient testing supplies are necessary to respond to both high daily volume and isolated surge events. To this end, the hiring and retention of qualified testing personnel, the cross-training of testing personnel across laboratory specialties, and securing funding for testing supplies assures the ability to maintain a high level of laboratory services. Communication among partners is equally important, led by a TB Elimination Advisory Committee that develops state-specific guidelines for tuberculosis treatment and prevention.

The PHL plays a crucial role in the timely and accurate detection and reporting of tuberculosis testing results. Acting as a reference laboratory, the PHL provides specialized services not generally available in Connecticut. Future fiscal constraints must be anticipated and new funding streams must be explored in the face of scarce public health resources. Actions include continued and improved communications among stakeholders and the further establishment of partnerships, both public and private, that share the agency's mission of assuring healthy people in healthy Connecticut communities. By working together, controlling the transmission of this treatable and preventable illness is within reach.