I'm really excited about being able to spend a little bit
of time with you this evening to talk about the Wisconsin
State Lab of Hygiene. It really is your public health
and environmental lab here in Wisconsin.
We do a lot more than bioterrorism and emerging
infections. But as I go through,
I'll emphasize a few of those areas, as well.
I'd like to share with you a little history of
the State Lab of Hygiene. We'll do almost a virtual tour
of some of our areas, and then discuss some of the current
roles that the State Lab of Hygiene fulfills here at
the University and in Wisconsin. We had some very early
beginnings here at the University of Wisconsin.
Back in 1903, the legislature passed a law and appropriated
the big sum of $1,500 to establish a laboratory
known as the Hygienic Laboratory on the campus of the University
of Wisconsin. The laboratory was first opened
in October of 1903, in the basement of what is now Ag Hall
just up the street from this building.
It was a very modest one-room laboratory that primarily
focused on bacteriological analysis of water and
a little later on, some bacteriological testing for
a number of infectious diseases. The laboratory was founded on
what's often being referred to as the "Wisconsin Idea."
Back around 1902, Governor Robert LaFollette and
the UW President, President Van Hise, got together
and they came up with something known as the "Wisconsin Idea."
And in short, what the Wisconsin Idea means is a way to
take the resources, the knowledge of the University of
Wisconsin to the corners of the state, to benefit state
government, local government, and really all the citizens of
our state. I might point out that this is
the year when the School of Medicine at this University is
celebrating their 100th anniversary, and not to be
outdone, but the State Lab of Hygiene has actually been
around a little bit longer than the School of Medicine.
The State Lab of Hygiene specifically attached to the
University, which is somewhat unique for laboratories like
ours, many of the public health and environmental laboratories
are really attached to a state executive like the Department
of Health or the Department of Natural Resources
or Environment. But in Wisconsin, the decision
was made very early on to place this laboratory at the
University of Wisconsin and give it the challenge of meeting
part of a scientific mission of the university, participate in
teaching, participate in research, and above all, to
promote public health throughout the state.
Some early shots from our laboratory.
This is the first laboratory. The second laboratory
was actually moved from the Agriculture building over to
South Hall, which is up on Bascom Hill.
That laboratory actually expanded.
They hired a few more people. They expanded the scope of
testing. They primarily focus on water
quality, a little bit of air quality, and that's where they
really began testing for contagious and communicable
diseases, shortly after the turn of the century.
From there, in 1928, the lab was moved down to what was
then called Wisconsin General Hospital, which is the old
University Hospital, right behind where we are.
And again the mission of the laboratory expanded, and we
became the laboratory to support the Department of Health
and Family Services, and the laboratory to support the
Department of Natural Resources here in Wisconsin.
We're actually established in the statutes.
The Wisconsin Statutes, among other things, indicate that the
Wisconsin State Lab of Hygiene should be a facility for
teaching in the fields of public health
and environmental protection. And I think today, as I look at
laboratories like ours around the country, I'm one of the few
people who have actually directed three other
laboratories similar to ours. I can honestly say that here
in Wisconsin, we've taken that mission very seriously and
have done a lot more with that than what many of the other
states have. For example, Dean Bardeen,
back in 1914, the Dean of the Medical School, he had a
joint appointment as Director of the State Lab of Hygiene.
Later on, Dr. Al Evans was named director the laboratory.
At the time, he was also chair of the Department of
Preventative Medicine. And more recently, in my time,
and in fact I might mention that I started my public health
career in the building and laboratory that I now direct.
And Dr. Stan Inhorn was instrumental in convincing me
that I really ought to go back to graduate school.
And little did I think after going back to graduate school,
and going to the CDC, and out west for a number of years
that I would have this opportunity to come back
to the University of Wisconsin. But Dr. Inhorn was chair of
the Department of Pathology and also director of the laboratory.
More recently, up until 2006, Dr. Ronald Laessig was director
of the lab and also a professor of Pathology and in
Population Health Sciences. The statutes that created
the State Laboratory of Hygiene also indicated that there
would be an autonomous or independent board to provide
direction to the laboratory. That board consists of the
Chancellor of the University or his designee and the
secretaries of the three agencies that we support.
And those are the Department of Heath and Family Services,
the DNR and the Department of Ag, Trade
and Consumer Protection. Each of those secretaries
can identify an individual to sit on our board.
In addition to that, the Governor appoints a physician to
represent clinical laboratories, a person from the environmental
laboratory industry, someone from the occupational
health lab industry, a person from local
the health department, and then three public members,
one of whom must be a coroner or medical examiner
here in Wisconsin. We support and serve a lot
of people throughout Wisconsin by providing clinical
and environmental testing. More recently, we expanded
our laboratory to provide occupational health testing
and industrial hygiene testing. I'll say a little bit more
about that a little later. But the people who use our
laboratories are physicians, hospitals and clinics,
as well as a number of federal agencies that rely on the work
that we do next door. We work very closely with the
Center for Disease Control, the EPA, with OSHA,
with the USGS, and a number of public health environmental
projects that impact many of us here in Wisconsin.
We also like to think that we are the laboratory that
supports the local health department infrastructure
throughout the state. We support them, as well as the
Tribal Health Centers here in Wisconsin.
We also have an academic mission.
And we are always looking out for other places on campus
where we could link up with other researchers
to provide laboratory support to projects that
they are already undertaking. Our staff are actively involved
in a number of professional and research associations
such as the American Waterworks Association,
the American Professional Hygiene Association, and the
Association of Public Health Laboratories.
Although we are not a private laboratory like you would see
elsewhere in the state, we do do some work directly
for the citizens upon request. Usually these requests
are funneled through the Department of Health
or through the Department of Natural Resources.
And one of the other things that we have become since the
late 1980s, has been the primary bio and chemical terrorism
laboratory to support emergency responses
here in Wisconsin. And we do that by being a part
of the National Environmental Response Network.
So what do we do? If we look at the scope
of everything that we do in our laboratory, we're primarily
a reference testing laboratory for clinical specimens.
We're involved in the teaching mission at the university.
We have an active research program, and a very active
outreach program, looking for ways to take our services
throughout the entire state. We do that from two main
locations here in Madison. The first is the building
next door, 465 Henry Mall. That's the building that
was built specifically for the State Lab of Hygiene
in 1953. And that building today
houses our communicable disease division,
the disease prevention division, and our laboratory
improvement division, and the management offices
for our laboratory. That's about
a 100 square foot building. In addition to that, in 1999,
we dedicated a building out on the East Side of Madison
out near the Department of Agriculture.
And that's where we house our environmental health division,
where we have a large environmental sciences
laboratory, an occupational or industrial
hygiene laboratory, as well as our forensic
toxicology laboratory is housed in that building, which
is about 72,000 square feet. That, for some reason,
shrank down. You can probably see it a whole
lot better on your handout. I apologize for that.
This is sort of the organizational structure of
our laboratory. And I don't want to really
go into that, in much detail. I guess I would rather talk
about the staff that we have at our laboratory.
We currently have about 340-350 staff.
About 25 of those are either faculty or academic staff.
We've got a little over 300 classified staff, mostly
microbiologists, chemists, medical technologists
in the laboratory. And then we always have a number
of students who are coming in for various types of training
at the lab. If you look at kind of
the budget of our operation, we're about a $40 million a year
laboratory. And of that amount, we are
required to raise funding for three-quarters,
or about $30 million. We do that by charging fees
for some of the testing, by entering in to agreements
with other governmental agencies to do special work for them,
and by soliciting research proposals, grants and contracts
to support our operation. Only about a quarter of the
resources that we use in the laboratory come from
the state GPR and state tax dollars.
Of that one-quarter, we spend two-thirds of that
basically providing laboratory services to the Department of
Health and Family Services and to DNR.
Only about a third of that amount, or something
less than $2 million to support the academic mission
of our laboratory. Our lab has some very
well defined strategic goals. I won't go into those in a lot
of detail, but I just want to highlight a couple key areas.
We believe that the future, for us to be successful
in the future, we really need to network with a number of
laboratories around the state. So we've developed fairly
sophisticated networks of these laboratories, both clinical
laboratories and environmental laboratories, that could help us
in the event we ever encountered some type of a severe
public health or environmental disaster, including things
like biochemical, or biological, or radiological emergencies.
One of our other goals is to implement and integrate
new technologies throughout the laboratory.
Some of these are emerging technologies that we work
mostly with others on campus to develop.
And we're constantly looking for ways to implement,
for example, molecular assays not just in a clinical
laboratory, but in our environmental laboratory,
our newborn screening lab, as well as other cytogenetic
lab services. One of the most difficult
things, I think, today about directing a laboratory
is finding qualified people to fill the positions
that we have. It's getting more and more
difficult all the time to attract people to your lab
and then also to keep people in our laboratory.
We see people come in, and they spend a couple years.
They retrain them. The next thing you know
they're going across town or they're doing what I did,
and get out of the state because of better
professional opportunities. One of our major goals is to
focus on workforce development in an effort to hire the best
and keep the rest. Our fourth goal is one that
builds upon what we see as one of those key goals
of the laboratory. And that is as a collector
and distributor of laboratory information.
We're actively involved in collecting information from
clinical labs and we're working on the environmental laboratory
sector as well, so we can collect that information
as part of a statewide surveillance network.
And we can report that to either the DNR or to the Department
of Health to support their surveillance activities.
The next few slides deal with our communicable
disease division. We have a very highly respected
and well-equipped, and well-trained bioterrorism
laboratory next door. This laboratory is registered
as a select agent laboratory with the Center for Disease
Control, which basically means they're registered to handle
some of the most dangerous biological pathogens.
We have BSL-3 laboratory capability, which means that
many of these pathogens, things like the organisms
that cause Anthrax, Tularemia, and others, can be safely
handled within our laboratory. The communicable disease lab
supports outbreak responses throughout the state by working
closely with local health departments
and the Department of Health. And we've really become
quite good at being, or priding ourselves on the fact
that we, on several occasions, have been the first lab
in the country to identify a multi-state outbreak
of a disease, and to characterize the organism or
the cause of the disease, and to submit that and share that
information with CDC and other states.
We're actively involved in a program called pulse-net,
which is a technology that allows us to take an organism
that might be isolated from food, and an organism that
comes from somebody who might have been ill,
or some other source; and can not only identify them
as the same genus and species, but to say that genetically
they are identical strains. And that capability has been
a real boon to us in public health, because we now have
a tool that allows us to track definitively
associations, where before we just couldn't.
"Well it's the same organism, but so what?"
There's a lot of people in the community that may have
the same organism. Now we can go to a subspecies
level and identify whether it's actually the same strain.
That's been very helpful in these multi-state outbreaks
of E. coli 0157 on spinach and lettuce, and outbreaks
of Salmonella in various types of food recently.
The communicable disease lab provides reference testing
for a whole host of infectious diseases.
We do very little primary testing, meaning we don't look
at a lot of clinical specimens. They go to a clinical
laboratory first. The clinical lab identifies
something that needs further work up, and that organism
comes into our lab, so we can do the definitive testing
on diseases like Tuberculosis, Rabies, HIV, Measles,
and a whole host of other infectious diseases.
( inaudible ) >> In the case of bioterrorism,
if there was a powder that somebody really thought
contained a bioterrorism agent, that would come to us directly
from law enforcement. We've set up very good
working relationships with law enforcement and those
who would be on-scene to initiate those investigations.
They would bring those types of samples directly to our lab.
But in a clinical sense, if someone was exposed to
one of these agents, and after an incubation period
they developed Tularemia, or they developed Anthrax,
and the clinical lab isolates the organism
from blood culture, or from another clinical specimen--
When they have worked that up sufficiently to suspect that
this could possibly be Anthrax, at that point, they will
package that and get it in to us, and we will do additional
definitive testing on those organisms to support any kind
of an outbreak. >> Is it safe that they bring
samples to you, instead of you going and picking up the samples
and holding them with proper procedure?
It's probably safer to have people bring that sample to us.
Now the people who would be bringing that sample to us,
we have actually trained on the safe handling practices,
how to safely collect the sample, how to package that,
how to ensure that nothing is going to leak, and there's
not going to be any hazard associated with them bringing
a sample into our lab. Once it gets into our lab, then
we put it into containment and handle that so that none
of our people would be exposed. ( inaudible )
We have a network of people primarily in law enforcement
and emergency responders who would likely
maybe be out on the scene. We have those people trained.
We've also trained laboratorians in about 135 labs around the
state, so if they see a specimen that is suspicious for one of
these organisms, that they will then safely package that
and ship that in to us in a safe and rapid manner.
( inaudible ) That's a little bit hard
to define but we are-- >> Could you repeat
the question? >> Yes, how many cases
do we get in a year? I'm really not sure
how I can answer that. I'm just not sure how
to give you an exact number. If you were talking about
something like tuberculosis, you know, how many samples
would we get to support that? ( inaudible )
Most of the things that come into our lab come in
by courier or they are shipped through another means.
On any given day, we probably receive in the neighborhood
of five to 500 or 1,000 samples to be worked up.
Does that give you some idea? I mentioned earlier this ability
to differentiate between organisms of the same strain.
We do that by a technology known as PFGE or
Postfield Gel Electrophoresis. Basically that's a molecular
typing assay. Our laboratory is probably
one of the more advanced in the country
in developing and using these types of tools.
We also have a diagnostic virology lab.
One of our main focuses there is influenza.
And the laboratory is also involved in doing tests
for rabies. Whenever there is a potential
rabies exposure, someone gets bit by a bat, and the bat is
captured, that comes in and we'll test the animal for rabies
in an effort to minimize the need for prophylaxis
of people who may be exposed. I mentioned tuberculosis.
Yes? ( inaudible )
Everything gets autoclaved. Then we have a commercial
company that will come by and pick up all of that material.
Then I believe it's either incinerated or landfilled.
( inaudible ) What do we use that for?
( inaudible ) We use Postfield Gel to take
DNA, make the fragments, and then compare the fragments
from one organism to the fragments we get from another
organism from another source. Basically, if we get a similar
distribution of the fragments, we can say
they are the same strain. ( inaudible )
Yes. Did you have a question?
Do you do anything that would be resistant to autoclaving...?
( inaudible ) >> We do not in our laboratory.
I think there's maybe another lab on campus that may
handle something like that. Yes?
Do you do anything with all of the hospitals
in the United States and the incidence of Staph infections,
MRSA, or others like it? >> The question was do we do
anything with the hospitals and look for unusual or maybe
drug resistant organisms. And we do.
We work with the hospitals, not in the United States
so much, but particularly here. >> Where's here?
On campus. It is a nationwide problem,
but we work with the hospitals here.
If we isolate an organism like MRSA, VRSA or a highly
drug-resistant organism, we can identify that.
We will then share that organism with colleagues at
the Center for Disease Control in Atlanta, where they can
then do additional typing and susceptibility on that
organism. But in most cases, the clinical
labs would refer that organism to us initially.
I mentioned tuberculosis is a disease here in Wisconsin
that we thought we would get rid of, but it just
hasn't quite happened. In our lab, it's primarily the
tuberculosis lab for the state. We not only isolate the
organism, but we determine the drug susceptibilities
to that. And with newer technology,
it no longer takes six to eight weeks to identify
the organism. We can actually do it
in about 24-48 hours. We've got new technologies for
working with influenza virus. Primarily, this will
allow us to determine drug susceptibilities of some
of the newer anti-viral agents. And this is very important,
because some of the more common strains of influenza,
about 80% of them have recently been shown to be resistant
to some of the drugs that we have been using
for a number of years. We've got the ability to do
a variety of influenza testing to support any kind
of surveillance. Dr. Pete Shult
and Carol Kirk in our lab have developed a national
reputation, a national leader in providing that information
to other labs around the country on an annual basis.
They've established a network of hospital laboratories
to submit clinical specimens to us, and have also identified
several hundred positions in clinics that are using
rapid tests with influenza. So when they get a positive
with that, they send not only that positive in,
but the clinical specimen in for us to attempt
to isolate that virus. One of the other successful
things that we have done in our communicable disease lab
is to participate in the National Laboratory
Response Network. The Lab Response Network
is a large group of diverse laboratories that have agreed
to standardize procedures for how we would respond
to a bioterrorism attack or other significant
public health event. This includes sentinel
laboratories, which is a kind of clinical labs,
reference laboratories, which we are a state reference
and kind of a national reference lab, and then
those few laboratories at the top of this pyramid,
laboratories like the CDC in Atlanta, and others,
that have the ultimate BSL-4 Laboratory Safety
capabilities, serve as the definitive lab
for this network. This is a network that
has evolved since about 1990, when CDC, the FBI
and the Association of Public Health Laboratories
formed a partnership and have been working on this ever since.
We often criticize government, particularly federal government
for not doing things correctly, or not doing it right.
But I've got to say that this was a true partnership that
took some very enlightened leadership at the federal level
to bring CDC, the FBI, and all of the state public health
labs together to sit down and identify what do we really
need to have as a nation to respond appropriately
to a bioterrorism attack. Not only did they work out
the methods and the details, standardize a lot of that,
but the Department of Health and Human Services went to bat
to Congress to obtain funding that funded not only the federal
component of this, but they recognized the need
to have these labs established around the country.
So they put money in there to support laboratories
in all 50 states to develop this capability
and to support this network. The slide that shows
the laboratories that have been established.
I think there are about 170 or so, now.
Every state has at least one LRN lab.
We followed that national model here in Wisconsin.
Dr. Pete Shult and others were instrumental to developing
what we refer to as the Wisconsin Lab Response Network.
We've got about 135 hospitals and clinical labs that
participate in this network. As part of that they receive
training, consultation, and reference testing to support
their local activities. If it wasn't for this network,
we would never identify a number of the outbreaks
that you read about in the newspaper.
Outbreaks like the contaminated spinach that
occurred in the Fall of '06. The reason that we were able
to be the first in the nation to identify there was this
outbreak, was the fact that some of these local labs
identified the organism, shipped it in to us.
And all of a sudden, we're getting the same organism
from three different areas of the state.
And something like that should lead one to wonder,
there is a common source. Why are we seeing this?
Is it a new strain? Is there something unusual
about it? Because of the way that we have
established this network of labs in the state, they're
well-primed to quickly ship these specimens to us
so that we can follow up and make those associations.
Yes? ( inaudible)
What do they do? Do they actually take samples
from the patient? How do they know that what
they're isolating is something that's important?
Well, the microtechnologists or the microbiologists
in the hospital laboratory, they have been trained.
And most of them understand that they can work up a sample
to identify an organism. And if that organism is one
that causes a recordable disease here in Wisconsin, a Salmonella,
a Shagella, you know, something like that, then that
organism would be sent to us. Now for clinical management
purposes, simply knowing what the organism is, and probably
more importantly, knowing what drugs it's susceptible to,
that testing can be done at the local level.
But when it comes time to making associations between
a person who is sick in Monroe, and one in Deerfield,
and three in Madison, someone on a larger scale
needs to get those organisms, bring them into the lab and
do that epidemiological typing that helps us out
in Public Health. >> They have a clinical sample.
They identify it. They type it
so they know what it is? >> They could do that, yes.
What are their requirements? >> To report the disease.
With laboratories, there is a strong recommendation
that those isolates be submitted to the State Lab of Hygiene.
There is not a hard and fast requirement that the organism
be sent. In some states there is.
Samples like that from several diverse places, do you
have staff of epidemiologists or people who do the quick work
to rule out and find out where the factory is
that produced...? >> We have two epidemiologists
on staff. But we refer that information
to the Department of Health, the Division of Public Health.
They then work closely with the local health departments
to track down possible sources, to go out and bring in
additional samples that will help us further track
these things down. I'd like to move on to another
area of our lab. And that's
our disease prevention area. Many of you have probably heard
of newborn screening. I want to highlight this one
because in my mind, this is the most effective
public health program that I can think of.
Every child born in Wisconsin, shortly after birth, has
somebody prick them in the heel and take five drops of blood
and put in on a piece of filter paper.
That filter paper is then sent into our laboratory, where we
test it for about 47 different metabolic, endocrine,
or immunologic diseases. We're testing about 70,000
newborns in Wisconsin every year, and we test them
for things like PKU, which is a metabolic disease that results
when the body cannot break down an amino acid, and so it builds
up in the body and then has some very serious developmental
effects on the child at a very early age if it's not detected.
All states perform newborn screening.
Some states only test for about 12 of these conditions.
Other states test for 60-65 of these conditions.
We're currently testing for about 47 of them
here in Wisconsin. And even though these children
are quite rare, depending on the condition we may find
20 children a year, we may find five, or we may not
find any in any given year. They're that rare.
But the things that we screen for, are things that
if identified, there is an intervention,
or there is a treatment, or there is a special diet
that will result in that child having a much better life.
Without screening, many of these children would end up
in state institutions, many would not live beyond
their first year of life. So this is really a very
successful public health program that the laboratory supports.
I want to mention just one of these you'll probably be
reading more about in the next few days.
And that's Severe Combined Immunodeficiency.
This is the "bubble baby syndrome"
where a child is born without any immune system.
They don't have the cells to produce an immune response.
We're not sure how frequent that is in Wisconsin.
Some of our early studies have shown that maybe
we might see one a year. We're aware of about 15 children
at the present time who are from Wisconsin
who have had that condition. The reason we're going to
begin screening for that, one is we have developed
a technology in the last year that we are
very comfortable with. If we can identify these
children shortly after birth, these children can undergo
a bone marrow transplant and completely turn this around.
So by having this transplant they can develop a
fairly normal immune system. And we believe they'll live
a normal life. Without it, six months,
maybe a year, and that would be all.
We're quite excited about this. It's been one of the major
research efforts this past year. And just today we have been
working with the Department of Health to put in place
an emergency rule to actually add this
to the newborn screening panel here in Wisconsin.
We also have, in our laboratory a school of cytotechnology
that trains people primarily to do pap smears and others.
We have a laboratory that does cytogenetics.
Some of the people in our lab have been pioneers
in the development of some of these assays.
They're rapidly involved in teaching both the medical
genetics and in research to develop new methods for
identifying, at the molecular level, a number of
these types of diseases. ( inaudible )
What cytogenetics is? Oh, what that is.
What those are, that's chromosomes.
And I've got one-- There's something that's
abnormal. And I don't see exactly--
It's chromosome 11. I'll do this.
It's chromosome 11. You see?
They should be identical when you look at them.
Now the fact that they're curved is just the way
that they're isolated from the cell itself.
But if you look at 11 and 13, what's actually happened here
is a piece of 13 is missing. It attached to 11.
We do that type of chromosome analysis
in our cytogenetics lab. And depending on the
rearrangement, the abnormality of the chromosome, some of those
things are associated with clinical conditions.
So we do this looking at, in some cases, prenatal tests.
In some cases, we'll run this on infants that may be born
with a condition that might be of chromosome or genetic origin.
( inaudible ) There are 21 pair
of chromosomes here. And these would be chromosomes
from a single cell and a single person.
We basically process the specimen and isolate
the chromosomes and then analyze them under a microscope.
( inaudible ) Bone marrow donors are,
in many cases, a sibling, another child if there is one.
It could be a parent, would be a pretty close match.
And the fact that there's a transfusion that
occurs early in life, there are fewer rejection problems
in the child themselves. The treatment has been
very successful in most cases. Yes?
With all this information we have, has anyone looked at...
( inaudible ) >> We are beginning to do some
of that in our cytogenetics lab where we know certain types
of cancers are associated with certain abnormalities
in chromosomes. And probably about a third
of the work in cytogenetics is cancer patients.
We're trying to associate abnormalities in the
chromosomes with the type of cancer that they have.
Yes? ( inaudible )
There are requirements about who can be a donor.
If they have some type of known genetic condition,
if they have various types of other things, they don't
use them for a donor. We're running low on time.
I would like to just mention a little bit about
our environmental health lab. We analyze local drinking water
to determine if there are contaminates in drinking water,
either microorganisms or various chemicals that
might be present in the water. That's been one of the things
that the public health lab has been doing
for over 100 years. An example of someone in
our radiochemistry laboratory looking for radioactive material
that might be present in primarily surface water.
Our laboratory does a lot of outdoor air quality
measurement to support DNR. A lot of this is research
testing, looking for very, very low levels of contaminants
in the air. We do some of this
in cooperation with colleagues in civil and environmental
engineering who have a number of research projects underway.
In order to test air samples and look for say, metals at
a very low level, you have to do that at a lab
that is virtually metal free. This is an example of our
ultra-low trace element laboratory.
If you look in there, the hoods here,
a lot of the counterwork, wherever we can, we've taken
the metal out of the lab and replaced that with plastics
and other types of materials, so we're not contaminating
the testing that we do. In our OSHA laboratory,
industrial hygiene lab. That's a fairly large operation,
it's about $3.5 million a year, that we get from OSHA
to be one of only two labs in the country that provide
regulatory testing for OSHA. We currently have agreements
in place with 40 states that will send their work to us
here in Madison. We do a lot of work with DNR
to identify sources of pollution and monitor on an ongoing basis
the environment. Numbers of samples, we have
a whole host of things that we can test the samples for,
anything from endocrine disrupters, or we'll look for
non-specific things or chemicals in water samples
that might impact organisms or fish.
And then we can actually use this chemical analysis
for a number of things. This is an example of one
of our chemists in our environmental toxicology lab.
We actually have little fish, little flathead minnows
in these tanks. Then we put the sample in there
and we look to see if they have a negative impact
on the fish themselves. It doesn't tell us what's
causing the toxic effect, but it will say there's
something there, keep looking. Other important areas
are forensic toxicology. If you are ever stopped in
Wisconsin for a DUI or OWI, we'll probably get a blood
into our lab, we'll test it to see how much alcohol
you have on board, if you've got any illegal
drugs or prescription drugs at a very high level
that might cause impairment in your ability to drive
an automobile, snowmobile, motorcycle, boat.
If you're ever arrested on those charges, that work
will come into our laboratory. We receive about 2,000 OWI cases
a month to work up in our lab. Part of that work up not only
includes the laboratory analysis of these, but the chemists
often have to go to court and testify on the lab findings.
This laboratory also supports work for the coroners and
medical examiners around the state.
We're not quite CSI, but we're getting close.
We've got capability here to identify several hundred
prescription drugs. And in some cases, the person
may have a prescription drug on board, and they should
only have this much, but when we get a sample from them
on part of an autopsy they've got this much.
There's a problem. In many cases, we've been able
to help the coroners and medical examiners identify
a possible cause of death by doing this type of analysis.
We have a lab improvement division.
I credit this to my predecessor, who set up a system
to send out unknown samples to other labs, have
the other labs do the test, and send the results back to us.
It's called proficiency testing. In all laboratory regulatory
programs, there's a requirement to participate in some kind
of proficiency testing. Where do you
get those samples? We saw that here in Wisconsin,
there's an opportunity to make a little money.
About $3.5 million a year. So we prepare these samples.
We package them. We say they're unknowns.
We sell that to, right now, about 5,000 laboratories
around the country, and about 100 or so laboratories overseas.
We're providing a very vital laboratory service and
capitalizing on the expertise that the staff in the lab
have developed over the years. This is what some of
the samples look like. And we now have about
200 different proficiency testing challenges
that we make available. These go out maybe once a year,
four times a year. The laboratory automatically
gets sent one of these. Then they do the test,
report the results to us, electronically now,
to save us from paperwork. Then we report that
on to the regulatory agency, if that's on the clinical side,
it's CMS, the Center for Medicaid Services.
On the environmental side, it may be EPA.
( inaudible ) We're very cautious and careful
about what organism we put in that unknown vial.
There have been some problems with proficiency testing
programs that have sent a virulent, but a pathogenic
sample, pathogenic to humans, and there have been
a few accidents with that. And you'll probably be hearing
about one of those within a week.
But fortunately, we select the organisms
we send out very carefully. They're generally the ones
that are not as highly pathogenic to humans, but
would be the type of organism that might be found
in a clinical specimen. We send very, very small
quantities of these things. On the chemistry side,
we end up sending, it's either a horse serum
or cow serum that's been spiked with a certain amount
of a chemical. So again, even though
there is something in there that could be bad,
quantities are minimal and we've been very fortunate
that there really have not been accidents
as a result of that. The last slide is the Health
Informatics and Surveillance. This is where we are developing
the capability to electronically share a lot
of laboratory information. We're developing Web portals
so this can all be done securely over the Web.
I'd like to end by saying that we are YOUR
Wisconsin State Lab of Hygiene. We take pride in the fact
that we support not only the university,
we support state agencies, we support local agencies,
but we really support the people of Wisconsin
in all that we do. Without us, there would be
no effective way to respond to disease outbreaks and
other public health emergencies. When I look at our staff,
I tell them frequently that they are really on the front lines
of protecting you and protecting our state's public health
and environmental health throughout the state.
That's all we've got up there. But if you have any questions,
I'll be happy to take them. Yes?
( inaudible ) Very good question.
I've had the pleasure or what, when I was State Epidemiologist
in Idaho, of closing the last TB Sanitarium that they had
in Idaho. We no longer isolate TB patients
like we did 50 years ago. We now can effectively treat
these patients with multiple drugs
over a long period of time. It may be three months,
six months, 12 months or more. We can basically render them
non-infectious, so that they can be treated effectively
in the community. And we do not need to put them
in a facility like they did in the '30s, and I think
into the early '40s, and maybe into the '60s
in some states. My understanding is that
Wisconsin had a TB Sanitarium on the north side of Lake Mendota.
Now it's converted into another, I think, Dane County
or Madison Health Department is using that health facility.
I remember those days well. But with today's therapy, and
the incidence of TB going down, we can find other effective ways
of dealing with that. Any other questions?
Yes. >> The lab has a lot going on,
various lines of work, some of them pretty large scale,
with large quantities of material for 340 staff.
How does the staffing level compare with other labs
that you've run? >> Given the amount and
the scope of the program here, the amount of laboratory work
that's performed, I think we're probably
a little bit on the low side. I think other labs that
don't have quite the scope that we have here
certainly have more people in it than we do.
We sort of pride ourselves on doing it a little better,
quicker and more automated than other places.
But from time to time, we find ourselves still struggling
to fill important key positions, and in some cases there
just are not enough laboratory scientists coming
out of our training programs around the country.
We have recognized that. And because of that, we're
participating in a couple fellowship programs, jointly
with CDC, where they have emerging infectious disease
fellows that will come in for two years.
We train them and do our best to keep them.
We have a fellowship in our lab to train cytogeneticists.
They go through our training program.
We do everything we can to make sure they stay with us
once they complete the fellowship.
So it's difficult, but we're hanging in there.
Yes? >> Do you have a backlog?
In most areas of the lab we do not have
a significant backlog. I can think of one area
where we have a backlog that I wish was a little bit shorter.
And that was in our toxicology area.
But generally there is not that much of a backlog
throughout our laboratory. Yes?
Politically, have there been problems with budgeting?
Did any people at the State Capitol decide that they want
to cut down on the budget and you're strapped for funds?
Is that a problem? >> Well, you know,
I've only been here a year. And I guess I want to say that
we had a very successful budget this last round, even though
the state budget was laid way out there much longer
than it should have been, that only impacts
about 25% of our budget. Ultimately, the state budget
was passed and we were able to obtain the state support
for our lab. But the bulk of it,
what we bring in to run the lab does not come from the state.
So it's one of the things I tell people that's one
of the great things about being in Wisconsin and being director
of this lab, versus a lab associated with the Health
Department in another state where you are really at
the mercy of the legislature. There are some risks that
can be associated with that. Yes?
I understand that a lot of people throw away their drugs
and decide not to use them. It goes into the water supply
eventually. And a lot of us older people
aren't taking benefit of the drugs, in other words,
it goes into urine and gets back into the water supply.
Are you testing for that? >> We are, but some of these
drugs, when they break down, are known as
endocrine disrupters. We've done an active research
program in that area. We're also working with some of
the sewer treatment facilities to help look for ways that
they can maybe change some of their processes
that would do a better job of inactivating some of these
materials that may end up in the sludge, before it can
get back into the water supply. That is an area that we're
actively conducting research in. Yes?
Where can we take leftover drugs?
I don't know. >> I have a sister who died.
I have a house full of drugs. I don't know
what to do with them. >> We do not take drugs.
But I understand that here in the Madison area
there is a program. I'm not exactly sure who
runs that, but if you've got my name and number,
send me a note. I'll look that up for you.
I think it may be the Madison Dane County Health
Department. Does anybody else know
who that is? >> I was told to bring all
unused medications to your pharmacist, and they know
how to take care of them. >> Some pharmacists, I think,
would do that, others might not.
( no audio ) >> The county, a couple months
ago, had a drug collection day where you could bring in
your unused drugs, and other cosmetics, and things like that
for disposal by them. So probably, the Dane County
Health Department or the City of Madison.
Yes, I remember something just recently.
I think they do this a couple of times a year,
where they will take those and properly dispose of them.
Yes? >> You're not supposed to
throw them down the toilet. >> Right, you're not supposed to
throw them down the toilet. Anything that goes down
the toilet goes into the sewer system.
And all that stuff may actually go all the way through.
Yes? >> The fact that you can't get
and hold scientists is a sorry reflection
about our own country. ( inaudible )
But I will ask you, do you seek scientists from overseas
to fill those positions? >> The short answer to that
is yes, we do. We look wherever we can
to find the scientific expertise that we really need.
We have a very diverse staff in the laboratory.
Prior to coming back to Wisconsin, I was at CDC
in Atlanta, and they are having a serious time identifying
scientists for their key positions.
And so they are actively recruiting in various countries
around the world. Yes?
Is it salary or benefits? If you go into high schools
or middle schools for outreach for microbiology,
it's the most fascinating thing there is these days.
I think it's a little bit of both, you know,
sometimes we have salary issues. We seem to do fairly well
when we're compared locally. But I think the more we can
get out and the more we can engage people in high school
to think about science. It's an exciting career,
There are a lot of things you can do.
I started out as a med-tech right next door.
I became an epidemiologist. I could share stories for hours
about some of the neat investigations, and some of
the opportunities that I've had here in this country
and overseas, because of the science background.
And I think that's a message that we need to get out
to young people today. ( inaudible )
In our lab, I would say about half of the people
who leave our lab probably go to an industrial setting.
In those cases, it's generally for quite a bit more money.
( inaudible ) We have an employee health
monitoring program in place, where if any of our employees
say, developed a fever, if they develop any kind
of symptoms, one of the things that they are trained to do
is to, if they become ill, and they see a physician,
they say you know, "I work at the State Lab
of Hygiene. I work with Tularemia.
And maybe you ought to check that out."
We really have a very, very good record in terms of
not having accidents in the lab where exposures occur, and
somebody actually becomes infected with something.
But we do have kind of a monitoring program where we
watch the employees for things that they may be exposed to.
You're in a building that's old...
( inaudible ) Will the new building
be on this campus? >> We're in a building that's
over 50 years old right next door.
Mechanical systems in the building after 50 years
have never been upgraded. They're failing.
In fact, some of the ventilation systems,
the ducts in there are starting to fall apart.
They're held together with duct tape.
( inaudible ) We've engaged an architectural
firm to develop a plan for a new lab.
As part of that, one of the sites that is being considered
is out by the other lab on the east side of Madison.
I think this will benefit the state in the heart of campus,
to stay here on campus with that laboratory.
In order to interact with students, to fulfill
our research mission, our teaching mission
I think it's important that we have that presence.
So there are other options we're also pursuing.
One may be to move off, renovate the building
and then move back. That's about
a $20 million project. A new building is way up here.
But we're actively exploring a number of different options
to address the facilities that we have.
( inaudible ) For some of you, the Wisconsin
Vet Diagnostic Lab is a lab that's similar to ours.
It's a little bit smaller, but it's a brand new,
very nice facility just down the road.
It used to be out on Mineral Point Road somewhere,
but was recently moved back on campus when they built
a dedicated a new lab. I think they've been there
about a year. That lab actually came back
onto campus. And is administratively
very similar to our lab. They have
the same statutory basis. They have a board
that's operated very similarly to our lab.
But there focus is primarily on animal diseases.
That lab was funded primarily by the state, a little
bit of University money, and a little bit of revenue money
went into that building. That building is probably
about a third of the size of our operation.
One more. >> Do you have anything
to do with Radon? >> Our laboratory
can test for Radon. And for those of you who
may not be familiar, Radon is a radioactive gas
that is naturally released in various types
of geological formations. I think granite is one of them.
And in some locations, Radon can seep through
the floors of the homes and buildings, and accumulate
to levels that are thought to be harmful.
We can do Radon testing, although I think most of the
Radon testing here goes to private labs in the area.
Another one. ( inaudible )
That's a difficult question for me to answer,
because I'm really not that familiar with that.
But the one area that I can think of where some of our work
butts up against that is where I was talking about
newborn screening. A couple of those conditions
that we screen for, for example PKU, could cause
very severe mental illness in a child at a very early age.
If you can identify the child, you can provide them
with a restrictive diet. They come right around and they
can lead a fairly normal, healthy life.
That's the only one area where our work
really bumps against that. >> For the state of Wisconsin,
is there anything that's even a little bit comparable
to what you describe for physical...
( inaudible) >> Not that I'm aware of.
But I know there is something like that.
The Department of Health and Family Services have some
mental health capabilities and facilities.
I just really don't know much about that.
Okay? Thank you very much.
( applause )