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Cost-effective Management of Influenza-Like Illness in the Neuraminidase Inhibitor Era
Wallace H. Greene, Ph.D.,- Milton S. Hershey Medical Center

Our first speaker for the day was Dr. Wallace Green, Ph.D., Assistant Professor of Pathology and Director of Clinical Virology at the Hershey Medical Center.   Dr. Green spoke on the Cost-effective Management of Influenza-Like Illness in the Neuraminidase Inhibitor Era.  Dr. Wallace’s presentation will be made available to all members on the Keypocc Web page.  Some highlights of Dr. Wallace’s presentation include:

• On average there are 20 million cases of Influenza in the US per year attributing to a cost of 10 billion dollars a year to treat.
• Influenza therapy can be effective if it is given in time.
• Ineffective or late therapy can attribute to resistant organisms
• Nursing homes have an influenza rate of 60%
• Diagnosis of Influenza is based on Clinical judgment, culture, or by utilizing rapid assays.
• Diagnosis determined by clinical judgment: 72% of cases were confirmed by culture, 79% confirmed with RT-PCR.
• Diagnosis determined by Culture:
• Higher Complexity testing
• 10-14 days before can call negative
• Hemadsorption and DFA confirmation recommended
• Sample handling and transport plays and important role in culture sensitivity.
• Decreased accuracy when sending to Reference Laboratory due to transport. – Not Recommended
• Diagnosis determined by Rapid Antigen Detection kits
• Specificity good during outbreaks
• Sensitivity poor for some kits
• Several kits and methodologies were discussed.
• Do not need viable viruses
• Widely available
• Easy
• Moderate to Waived complexity
• Subjective read
• After testing is complete there is no viable isolates for further characterizations

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Management of Streptococcal Pharyngitis: Role of the Laboratory and POC Testing
Arthur E. Crist Jr, Ph.D. - Wellspan Health System, York Hospital

Our next speaker was Dr. Arthur E Crist, Jr.,Ph.D., Clinical Director of Clinical Microbiology at Wellspan Health System, York Hospital, Department of Laboratories, Division of Clinical Microbiology.  Dr. Crist gave a presentation on the Management of Streptococcal Pharyngitis: Role of the Laboratory and POC Testing.  Dr. Crist’s presentation will also be made available on the Keypocc Web page.  Some highlights of Dr. Crist’s presentation include:

• It is important to diagnose and treat streptococcal phyaryngitis because treatment prevents sequelae. (Rheumatic Fever, Scarlet Fever, Glomerulonephritits, Invasive Streptococcal Disease)

• Sore throat is caused by Group A streptococcus, S. pyogenes, Group C S. dysgalactiae, Group G dysgalactiae

• Clinical Diagnosis of Streptococcal Pharyngitis:

• Based on signs and symptoms

• Not very accurate

• 50% of those treated are not infected with Group A

• 30% of those not treated will be infected with Group A

• Laboratory Diagnosis of Streptococcal Phyaryngitis (culture)

• Specimen Collection problems (10% of false negatives can be attributed to improper specimen collection techniques)

• Considered the Gold Standard

• Selective vs. Non selective media

• 1 to 2 day incubation

• Broth enhancement

• Rapid Antigen Test used in the diagnosis of Streptococcal Phyaryngitis

• Methods extract cell wall antigen from organism on throat swab

• Extracted antigen detected by: latex agglutination, enzyme immunoassay, or optical immunoassay.

• Many kits available, 24 are waived.

• Good sensitivity and specificity

• Culture if rapid antigen results are negativ

•  Molecular methods (PCR) may equal or exceed sensitivity provided by culture.

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Provider-Performed Microscopy Testing:
The Wet, the Wild and the Wiggly 
Robert L. Sautter, Ph.D. - PinnacleHealth System

Our third speaker for the day was Dr. Robert Sautter, Ph.D., System Microbiologist and Medical Director, Outpatient Point-of-Care at Pinnacle Health System.  As with our other 2 speakers, Dr. Sautter’s presentation on Provider –Performed Microscopy will be available for members to view on the Keypocc Web page.  Highlights of Dr. Sautter’s presentation include:

• PPMP is a CLIA classification

• Regulated by CAP, JCAHO, and the PA State Department of Health

• Examinations must be performed by a physician, a mid level practioner or a Dentist.

• All three regulating agencies have different requirements for personnel, physician training, and physician competency.  Differences can also be seen in procedure requirements, quality improvement programs and how a POC program verifies the accuracy of the results for PPMP.

• At Pinnacle Health System, the physicians and residents receive training and yearly competencies.  Support from the laboratories Medical Director is instrumental in guaranteeing physician cooperation and compliance.

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PPMP Compliance - One Organization's Approach to a Complex Issue
Peter Gawron, B.S. , MT(ASCP) - Milton S. Hershey Medical Center

Following lunch, Peter Gawron discussed ways that Hershey Medical Center had tackled some of their complex issues in relation to PPMP Compliance.  Peter is going to make his procedures and forms used for this purpose available to the group via the Keypocc Web page.

During the Business Meeting the following items were discussed:

Officers for 2003 were announced, they are:

• President: Peter Gawron

• Vice-President: Jennifer Mixel

• Treasurer: Beverly McAllister

• Secretary: Wendy Van Dyke

Proposed changes to the By-laws and Constitution were discussed.  The proposal allowing Corporate Members/Vendors to serve as officers of the board was approved.

Several Audio conferences sponsored by Abbott will be available on the Abbott web site.  Role of Troponinis in Diagnosis Fending and Therapeutic Decision Making, Feb 20 and Feb 27.

March 2003 meeting plans were discussed.  Karen Espey and Melody Botterbusch are the hosts for the meetings.  Several ideas such as PPMP and  strep screen testing were discussed.

Marcy Anderson discussed that the AACC will be meeting in Philadelphia this year and there will be a POC Forum.  The meeting will be held on July 24, 2003.  Marcy asked that Keypocc consider “hosting” the meeting.  As of now the format is unknown.  She is asking that Keypocc prepare and present a Storyboard of our organization for the meeting.  A decision was made to attend the AACC meeting in lei of holding our regular summer Keypocc meeting.  The group also decided that we would form a subgroup to work on the storyboard.

Chris Fetters discussed that AACC, POCT division has formed a distance learning committee.  There will be 3 20-minute PowerPoint presentations available for all to view at no cost.

The evaluation of the meeting was extremely positive!  With no other business the meeting was adjourned.

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Speakers

Wallace H. Greene, Ph.D.
Assistant Professor of Pathology and Director of Clinical Virology, Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

Wallace H Greene, Ph.D., is a Diplomate, the American Board of Medical Microbiology and is Certified in Medical and Public Health Virology. He was granted a patent  in 1989 for a vaccine against infectious bovine keratoconjunctivitis. Dr. Greene is active in many professional organizations including the American Society for Microbiology, the Infectious Diseases Society of America, the Clinical Laboratory Management Association and  the Pennsylvania Strategic Medical Action Response Team. He is also the current president of the Central Pennsylvania Microbiology Association.

Arthur E. Crist, Jr., Ph.D.
Clinical Microbiologist/Technical Director of Clinical Microbiology, Wellspan Health System, York Hospital, Department of Laboratories, Division of Clinical Microbiology

Arthur E. Crist. Jr.,Ph.D., currently serves on the Infection Control Committee and the Counter-Terrorism Task Force at York Hospital. He is a member of York Laboratory Associates and the faculty of the School of Medical technology at York Hospital.  Dr. Crist is a current member of the American Society for Microbiology, the Anaerobe Society of the Americas and the American Society of Clinical Pathologists. He has served in the past as both vice president and president of the Central Pennsylvania Microbiology Association.

Robert L. Sautter, Ph.D.
System Microbiologist and Medical Director, Outpatient Point-of-Care, PinnacleHealth System