ASCLS Today Volume 32 Number 1

Jessica McMahon, Maeve Montesi, Sara Downie

As three University of Delaware Medical Laboratory Sciences students, we had no idea what to expect at our first ASCLS Legislative Symposium in Washington, D.C. We were unfamiliar with what lobbying was, how it was done, or the extreme importance of the issues for which we were lobbying. Although well versed in the sciences of the career, we were not familiar with the political issues surrounding it. Essentially, we arrived at the hotel the day before the Legislative Symposium, often referred to as ‘Leg Day,’ with no idea what to expect or how much we would learn. 

To our surprise, medical laboratory scientists (MLS) came to Leg Day from forty-three states! It was amazing to see professionals come together to discuss the impact of these issues on not only everyone in the room, but other communities outside of our own. There was a large sense of unity among the members, especially those who had previously attended the ASCLS Legislative Symposium. With a good mixture of new and returning participants, everyone could add to the conversation, allowing for a dialogue about the various legislations. 

The presentations on Monday opened our eyes to many issues with which we were unfamiliar, the Protection of Access to Medicare Act (PAMA) bill being the most pressing and concerning. ASCLS Executive Vice President, Jim Flanigan, opened the day with several jokes and set the stage for a day of sitting, learning, and conversation between professionals. 

We greatly appreciated Patrick Cooney, Matt McMarty, and Matt Schultz’s quick introductory lesson on the U.S. government and how things run at the Capitol, senate, and congressional buildings, more commonly referred to as “The Hill.” As science students, we definitely needed the political background. 

The panel conversations that constituted the remainder of the day were incredibly helpful. The panelists were well spoken and insightful. Specifically, Julie Allen, from National Independent Laboratory Association, did an excellent job of explaining the complicated issue of PAMA in terms we could understand and to which we could relate. She was able to explain the potential far-reaching impacts of the bill and used phrasing that we could reiterate to our congressional members. As newcomers to the conference, we greatly appreciated having some scripted verbiage. 

The workforce discussion and panel were also particularly informative and relatable for us. Finding clinical rotation laboratories for University of Delaware students with experienced professionals and the capacity to take them is becoming increasingly difficult. We appreciated the presentations and research done on the topic and were able to use some of the statistics and research from the panel to substantiate and personalize our presentations to the Delaware senators and congresswoman. In addition, Jim Flanigan did a wonderful job organizing the presentations and guiding our questions throughout the long day. After the Monday lectures, we felt more than comfortable explaining the issues to our government’s congressional members. 

Overall, Leg Day offered incredible insight into many issues unbeknownst to us. During our quick lunch break, we were fortunate to sit with returning Leg Day participants. We learned best and worst ways to approach congressional members. The best part about Leg Day was talking to the other laboratory scientists and hearing their views and how these issues have impacted them. It is incredible that several students who, before March 20th, had no knowledge of these issues could relate and sympathize with laboratory scientists who had worked in the field for years. 

We were very lucky, thanks to Dr. Mary Ann McLane, to have appointments at the offices of Delaware’s two senators, Chris Coons and Tom Carper, and Delaware’s congresswoman, Lisa Blunt Rochester. In all three appointments, we had the privilege of talking to the healthcare staff member for fifteen to twenty minutes. We were never rushed or pushed out of the office.

We actually got a photo with Senator Carper! For the most part, we felt that the staff members did an excellent job of listening and understanding our cause and taking note of our issues. We felt incredibly prepared after Leg Day and could talk professionally and cordially about PAMA, the MLS workforce and laboratory developed tests while expressing the urgency of the topics. Being on “The Hill” in Washington, D.C. was an incredible experience and an amazing opportunity. We highly recommend that any professor in medical laboratory sciences bring as many students to Leg Day as possible! It showcases a side of the profession that cannot be taught in the classroom and provides a whole other realm of appreciation for not only the profession but the individuals who work so hard in it. 

As future medical lab scientists, Leg Day and lobbying offered us the chance to problem solve outside of the lab. It enabled us to get involved with our future and work to help steer it in the right direction. We hope to see everyone again next year!

We gratefully acknowledge the funding support of the University of Delaware Honors Program, the university crowdfunding effort, and the Department of Medical Laboratory Sciences. It truly would not have been possible without their help.

Halcyon St. Hill, Ed.D., M.S., MLS(ASCP)^CM, FASAHP, ASCLS Diversity Advisory Council Member

Diversity and inclusiveness are not just buzz words; they are terms that address the uniqueness of each individual and extend beyond our perceptions of each person. Perceptions are deeply rooted in our beliefs, values, and life experiences, and may lead to unprecedented judgements. Diversity, inclusiveness, and tolerance can only be fully understood by each of us when we discover the diversity first in ourselves and proceed to embrace the diversity of others. This article will address the meaning and importance of diversity and inclusiveness in the clinical laboratory.

Diversity can be broadly defined as the many ways that make each person different. Diversity is not simply based on physiognomies often marked by skin color, eye color, or race. Instead, it is a unification of age, height, race, gender, sexual orientation, acquired characteristics including beliefs, values, education level, and language that make each of us unique; diversity also incorporates national origin, religion, and one’s life experiences. 

Inclusiveness embraces diversity by valuing the uniqueness of individuals and groups of individuals. For instance, in clinical laboratory practice, each person in the workplace is unique, as is every patient. None-the-less, as laboratorians we hold common professional beliefs and values, some of which are common to healthcare such as, ethical responsibilities and patient-centered care. We must, however, examine our beliefs, and as laboratorians, think about why another profession may have a perspective that we do not fully support. It is important for each and all of us to try to understand such differences, and reassess our position before solidifying our judgments.

A great and historic example is the initiation of rapid testing for HIV that allowed people who were not clinical laboratory technicians or scientists to perform that specific test. Initially, it seemed unprecedented to have persons perform HIV screening tests when they lacked the depth and breadth of education and practice experiences that clinical laboratory scientists and technicians held. The value of having HIV screenings done by others and confirmatory tests done by the qualified laboratorians was overshadowed. The latter example highlights the importance of examining professional values that focus on the greater good for patients/clients’ benefits, along with the appropriateness of overseeing procedures that are relevant to laboratory standards of practice. It also raises the importance of knowing and recognizing one’s own diversity, recognizing each other’s diversity, and using that knowledge to become conscious of our biases and more inclusive and accepting of the diversity among others – i.e. each of us must be “tuned in.” Typically, we do not recognize some of our major biases. Inclusiveness requires us to step back and look at situations and people from a broader and more comprehensive perspective for the greater good. Inclusiveness results in a more unified and productive environment and workplace. When everyone senses being heard and valued for her/his uniqueness, there is more open and often robust communication that leads to better solutions for any given problem or issue, and hence “tuning in” occurs. 

It is imperative to understand ourselves, our biases, and how to embrace diversity by personifying inclusiveness among ourselves as professionals. It is also important to “tune in” to our clients’ diversity to provide quality cost-effective services. Diversity in the workplace requires us to determine and address institutional biases and acknowledge the richness and value of inclusiveness. This will result in a stronger work ethic, higher productivity, and better-quality laboratory services. A secret to success is embracing diversity and practicing inclusiveness, because “tuning in” is the understanding that “reciprocal relationships between human behavior and social environments are basic to human interaction among peoples of the world."

Judy Moore, B.S.

Current blood banking policies in the United States require screening blood donors for behaviors that might increase their risk of infectious disease and then deferring them if necessary. Donor blood is also screened by serological and nucleic acid tests for various known transfusion-transmissible diseases to ensure safety and protect the transfusion recipients. The present tests required in the United States are for detection of HBV, HCV, HIV-1/2, HTLV-I/II, Syphilis, WNV, and Chagas disease.¹ However, these are just a few of the possible transfusion-transmissible diseases and deciding whether to screen or test for a disease can be difficult and includes many factors. 

AIDS serves as an example of the challenge of meeting an emerging threat. When AIDS was first recognized in the United States in 1981, the causative agent was unknown, as well as how it was transmitted. There was also disagreement in the medical and governing agencies about how to respond. This uncertainty and lack of consensus delayed strong action to protect the nation’s blood supply in the immediate years following AIDS discovery.² As a result, many people contracted AIDS from transfusion of blood products. Exact numbers during this time are not available, but a 1991 study estimated that over 2000 recipients were infected by HIV-1 from 1978 to 1984 at one San Francisco blood bank alone.³

To avoid this outcome in the future when responding to emerging infectious diseases (EIDs), retrospective analyses showed how the process could be improved. Committees were formed and recommendations given to develop a more systematic approach of defining and prioritizing EIDs and determining the appropriate response or interventions.⁴ 

In 2009, the Transfusion Transmitted Diseases Committee from AABB, published a supplement that identified and characterized 68 EIDs that posed varying degrees of risk to transfusion safety and of which current interventions are inadequate.^5,6 Since that time, six more EIDs were added along with fourteen updates.⁷ The AABB’s goal was to provide a set of tools for the blood bank industry which in the United States has more than 70 blood suppliers.⁸ The supplement defines EIDs as infectious diseases with increasing incidence in the last 20 years or have the potential to increase. They can emerge as new human infections perhaps from crossover zoonotic infections or they can be known agents which have expanded into new areas. They can also be existing human pathogens that have recently been recognized or agents that are re-emerging in areas once controlled. They pose a potential threat to transfusion safety if they have an asymptomatic blood-borne phase, if they can persist in stored blood products, and if they can infect intravenously.⁶

The supplement also describes a priority or ranking system of red, orange, yellow, or white to help assess the risk of each of the EIDs. The ranking is based on scientific and epidemiologic evidence of risk to blood safety and public perceptions and concerns regarding the risk. Protecting the blood supply depends not only on the underlying science but also on the more subjective expectations of society. High public perception of risk tends to lead to a public demand for action to reduce the risk.⁶ A recent example of this is Zika virus in which the FDA in 2016 advised that all blood products should be screened for Zika using investigational tests for the time being. Dr. Susan Stramer of the American Red Cross suggests this policy is likely prompted more by media attention and public fears than by data.⁸

Although the rankings have a degree of subjectivity and a different set of reviewers might come to different conclusions, it provides a framework to compare. The red category represents EIDs with the highest priority. They have low to high scientific or epidemiologic evidence and have varying levels of public perception but may cause severe clinical disease. Human variant Creutzfeldt-Jakob disease (vCJD), Dengue viruses (DENV), and Babesia species are in this category. Interestingly, these three diseases are all caused by different types of agents: prion, virus, and protozoa. This demonstrates the variability of EIDs and the challenge of protecting the blood supply from agents with differing biology and life cycles. 

Part 2 of this article will appear in the next issue and will continue the discussion of high-priority EIDs mentioned above.

REFERENCES
1. Testing requirements for relevant transfusion-transmitted infections. 21 CFR §610.40.
2. Glynn SA, Busch MP, Dodd RY, et al. Emerging infectious agents and the nation’s blood supply: responding to potential threats in the 21st century. Transfusion 2013;53:438-54. 
3. Busch MP, Young MJ, Samson SM, et al. Risk of human immunodeficiency virus (HIV) transmission by blood transfusions before the implementation of HIV-1 antibody screening. Transfusion 1991;31:4-11.
4. Leveton LB, Sox HC, Stoto MA. HIV and the blood supply: an analysis of crisis decisionmaking. Transfusion 1996;36:919-27.
5. Atrey C, Nakhasi H, Mied P, et al. FDA workshop on emerging infectious diseases: evaluating emerging infectious diseases (EIDs) for transfusion safety. Transfusion 2011;51:1855-71.
6. Stramer SL, Hollinger FB, Katz LM, et al. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion 2009;49:1S-29S.
7. Stramer SL. Current perspectives in transfusion-transmitted infectious diseases: emerging and re-emerging infections. ISBT Science Series 2014;9:30-6.
8. Fusco L. Maintaining the safety of the blood supply against the threat of emerging transfusion-transmitted diseases. AABB News 2017;19:012-7.

Susan Naka MT(ASCP)^CM, MS, ASCLS-Hawaii Past President
Kristen Croom, MLS(ASCP)^CM, MB(ASCP)^CM, ASCLS-Hawaii Past President

The ASCLS-Hawaii society decided to take a different approach to activities for the 2015-2016 year. At an annual board meeting in early 2015, some members said the biggest issue in Hawaii was members and prospective members not seeing the “value of ASCLS membership.” The few people that can attend the national ASCLS meeting are board members as per our by-laws and that doesn’t appear to impact the majority of the Hawaii membership. At this meeting the membership voted to allocate $100 per member to “give back” to the ASCLS-HI members. The board asked for a special committee to look at what could be done that wouldn’t jeopardize our non-profit status and would work best for most of our members. When Kristen Croom was installed as the 2015-2016 Society President she asked the Board to support more activities aimed at showing the membership the value of ASCLS. Kristen had learned through the ASCLS Leadership Academy that this issue was not unique to Hawaii, but common throughout the country.

ASCLS-Hawaii “Road Show”
The board realized how invigorated we all felt after the national meetings. We also realized the huge value in the continuing education sessions available at the national meeting. The special committee and the Board had the idea to see if we could present recordings from the national ASCLS meeting for continuing education credit. The $100 per member would be used for food and drinks for the individuals that would attend the sessions. We wanted to share these recordings at individual laboratories throughout the state and take ASCLS to members’ and potential members’ work sites. We named it the “ASCLS-Hawaii Road Show.” ASCLS National had agreed to offer Professional Acknowledgment for Continuing Education (P.A.C.E.®) credits to those that attended the recordings. 

Our first ASCLS-Hawaii Road Show was at the largest laboratory company in the state, Diagnostic Laboratory Services (DLS). A well-known microbiologist, Dr. Matt Bankowski, was their medical director, so we chose a microbiology topic and asked him to be the onsite expert to answer any questions after the session. We chose the topic of Dengue fever and, by coincidence, there was a Dengue fever outbreak on Hawaii Island within a couple of weeks. About 20 people attended this conference with good feedback. 

Our next road show event took place at Tripler Army Medical Center. We were able to show two recordings back-to-back, allowing day shift and evening shift employees to attend. We had a great turn out and a positive response from the group.

We hope to continue the ASCLS-Hawaii Road Show this year. We feel this is one way of giving back to our members directly at their workplaces by offering P.A.C.E.® approved programs. 

Hawaii Clinical Laboratory Conference (HCLC)
The Hawaii Clinical Laboratory Conference is the largest annual conference held in Hawaii and attended by over 200 clinical laboratory professionals. It has been co-sponsored by ASCLS-Hawaii and the Clinical Laboratory Management Association Aloha Chapter for over 10 years. For the 2016 meeting, the board decided to give members a $25 rebate on their registration when they stopped at our booth during this conference. It was one of the busiest booths at the meeting and generated a lot of interest from non-members. In the past we had a $100 difference between member and non-member rates, but the 2016 HCLC planning committee decided to offer one price regardless of membership status to boost attendance. Although we did not get a bump in our membership numbers like we had in the past, the Board felt the face-to-face interaction with our members was worth it. Members were able to meet the ASCLS-Hawaii Board members in person. We also collected over $600 for ASCLS/PAC. 

This is just one more example of what Kristen had learned at the Leadership Academy - the value of face to face contact with our members. It’s easy to send an e-mail or post a message on Facebook that can be deleted, but meeting members in person is much more enduring and satisfying.