Diagnostic Labs Could Be Overwhelmed with Swine Flu Tests

A sudden increase in the number of swine flu cases in the United States could cause problems in diagnostic labs, which are already suffering from a shortage of workers.

Laboratory professionals affiliated with the American Society for Clinical Pathology have expressed concern that a large spike in swine flu screenings could slow down testing for other diseases, potentially putting some patients at risk.

There are several tests for H1N1, the virus that causes swine flu, ranging from rapid influenza diagnostic tests, which can detect influenza viral nucleoprotein antigen in as little as 30 minutes, to more sophisticated polymerase chain reaction (PCR) assays. All require lab personnel to administer and review results.

According to Dr. Michael Laposata, chief of pathology at Vanderbilt University Hospital (Nashville, TN, USA), a staff of roughly 300 lab technologists and other workers already has been processing an average of 150 to 200 flu tests--for both swine and regular flu--a day, most of them from the hospital's pediatric emergency room. If there is a significant surge in H1N1 swine flu tests, overtime budgets could be stretched at many hospitals, especially small ones.

At New York University Langone Medical Center (Bronx, NY, USA) lab workers handled an increase of as many as 300 swine flu tests a week during the initial epidemic in the spring and early summer, according to Irina Lutinger, the medical center's senior administrative director of clinical laboratories. If swine flu becomes a full-fledged epidemic this fall and winter, her staff of 45 in the lab's microbiology department could be forced to handle thousands of H1N1 tests per week, she said.

A number of hospitals are coping with the potential surge in swine flu tests by drafting contingency plans. For example, during a serious outbreak, all medical tests would be reviewed and prioritized, and excess tests would be sent to outside labs for analysis. There is also a growing trend among medical professionals and local health departments to recommend H1N1 flu tests only for the sickest patients or for particular surveillance studies.

Emergency room staffers at Montefiore Medical Center (New York, NY, USA) for example, generally reserve swine flu testing for patients who clearly need hospitalization or have serious underlying health problems. Patients who are younger and otherwise healthy are treated and then encouraged to stay home, said Michael Levi, director of clinical microbiology services at the hospital.

Much of the concern among lab directors is due to the fact that since at least the 1990s, fewer people are choosing lab work as a career. Even if they do, fewer training programs are around to serve students, experts say. The American Society for Clinical Pathology said that according to federal statistics, 138,000 new laboratory professionals will be needed nationwide by 2012, but fewer than 50,000 will be trained.

Related Links:
Vanderbilt University Hospital
New York University Langone Medical Center
Montefiore Medical Center