Book:The Laboratories of Our Lives: Labs, Labs Everywhere!/Labs by industry: Part 1/Clinical, public and private

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3.5 Clinical, public and private

Pathology Lab.png

To talk of clinical laboratories (serving the patient) and public health laboratories (serving the population) requires a broad look at those labs that serve in the direct analysis, treatment, and prevention of illness. From large third-party reference laboratories like Quest Diagnostics that handle laboratory analysis of patient samples for doctors to the tiny physician office laboratory (POL) performing CLIA-waived tests, from the local hospital lab to a state's public health laboratory, from the mobile diabetes testing unit to the national disease prevention lab, it's difficult not to bump into a clinical or public health lab of some sort. These labs are found in the private, government, and academic sectors and provide many different services, including (but not limited to):

Clinical

  • diagnostic analysis of patient samples[1]
  • identification of infectious agents[1]
  • assurance of the quality of blood for transfusions[1]
  • analysis, management, and storage of reproductive tissues and fluids[1]
  • provision of basic point-of-care testing[1]
  • screening or testing of employees for drugs of abuse[1]

Public health

  • prevention, control, and surveillance of diseases[2]
  • collection, monitoring, and analysis of laboratory data submitted to national databases[2]
  • analysis and specialized testing of patient samples[2]
  • detection and analysis of toxic contaminants in environmental and food samples[2]
  • development and promotion of laboratory improvement programs as well as state and federal policy[2]

But how do clinical and public health laboratories intersect the average person's life on a daily basis?

As the debate about whether healthcare access should be universal[3] or is a human right[4] wages on, many people still receive medical care but some do not. While it's bad for the "have nots," can you imagine a different world, one where it's not a fight for the have nots but a fight for most everyone to survive? Try, if you will, to imagine a universe where laboratory medicine never existed. Without laboratorians diagnosing and researching, today's healthy population would be significantly smaller. Clinical and public laboratories have brought us advances in antibiotics, which without many more people would die from surgical site infections post-surgery.[5] These laboratories have helped bring medical diagnostics to more people more conveniently and efficiently, and they are at the forefront of most people's health care.[6]

3.5.1 Client types

Private - Private clinical (or sometimes referred to as reference) labs usually appear in either stand-alone facilities that outpatients go to or in a medical facility such as a physicians group, hospital, or some other form of care facility. Occasionally, you may find private clinical labs in manufacturing facilities to handle mandated drug testing or even in a mobile environment.

Examples include:

Government - You'll find public health labs almost exclusively on the government side, managing disease outbreaks, monitoring public health, and acting as a third-party analysis option for clinical labs struggling to identify or characterize a sample.

Examples include:

Academic - The laboratories found in the academic sphere are often multi-purpose, serving as teaching facilities for students while at the same time providing vital in-house testing to the academic facility's affiliated medical center. However, some may be stand-alone teaching labs designed to provide hands-on education in a lab outside a medical facility.

Examples include:

3.5.2 Functions

What are the most common functions? analytical, QA/QC, research/design, and teaching

What materials, technologies, and/or aspects are being analyzed, researched, and quality controlled? biological specimens, cadavers, whole organs

What sciences are being applied in these labs? clinical chemistry, clinical microbiology, cytopathology, epidemiology, genetics, hematology, histopathology, immunohematology, immunology, molecular biology, oncology, parasitology, pathophysiology, reproductive biology, surgical pathology, toxicology, virology

What are some examples of test types and equipment?

Common test types include:

Absorption, Alcohol level, Allergy, Amino acid analysis, Antimicrobial, Antigen, Bioaccumulation, Blood culture, Blood gases, Biocompatibility, Biomolecular, Biophysical profile, Blood typing, Calorimetry, Clinical diagnostic, Chronic toxicity, Colorimetric, Complete blood count, Compliance/Conformance, Composition, Cytopathology, Detection, Dietary exposure, Efficiency, Electrolyte and mineral panel, Electrophoresis, Endurance, Genetic, Genotype, Hematotoxicity, Hematocrit, Hemoglobin, Identification, Immunoassay, Immunofluorescence, Immunohistochemistry, Kidney function, Infectious disease, Lipid profile, Liver function, Medical toxicology, Metabolic, Mold - fungal - mycotoxin, Neurotoxicity, Nutritional, Osmolality, Osmolarity, Pathogen, pH, Proficiency, Radiochemical, Red blood cell count, Refractive index, Sensitization, Solubility, Specific gravity, Sports performance, Stress, Subchronic toxicity, Temperature, Thermal, Thyroid function, Urine culture, Validation, Verification

Industry-related lab equipment may include:

autoclave, balance, biohazard container, biosafety cabinet, centrifuge, chromatographic, clinical chemistry analyzer, colorimeter, desiccator, dissolved oxygen meter, dry bath, fume hood, homogenizer, hotplate, incubator, magnetic stirrer, microcentrifuge tube, microplate reader, microscope, multi-well plate, orbital shaker, PCR machine, personal protective equipment, pH meter, Petri dish, pipettor, powered air purifying respirators, refractometer, spectrophotometer, syringes, test tube and rack, thermometer, urinalysis device, water bath

What else, if anything, is unique about the labs in the clinical and public health industry?

At least in the United States, clinical labs are some of the most prevalent labs in the country; as of June 2022 there was approximately one CLIA-regulated clinical laboratory for every 1,049 people.[7][8] While many of the diagnostic techniques and laboratory instruments specific to clinical diagnostic laboratories can also be found in the clinical research setting, clinical research labs tend to be a somewhat different beast. As such, we cover those labs separately, in the next chapter.

3.5.3 Informatics in the clinical industry

From nursing to clinical care, from dentistry to occupational therapy, health informatics (or clinical informatics) is helping clinicians manage data and knowledge. In turn, clinicians collaborate with other health care and information technology professionals to develop health informatics tools that promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable. Health informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and health informatics tools to[9]:

  • assess the information and knowledge needs of health care professionals and patients;
  • characterize, evaluate, and refine clinical processes;
  • develop, implement, and refine clinical decision support systems; and
  • lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.

Finally, with the unfortunate emergence and lingering of the COVID-19 pandemic, the necessity for quality health informatics solutions inside and outside the laboratory setting has been highlighted further. This importance has become more evident with the need for more timely and accurate public health data, better tracking of COVID patient statuses, and better mining of data in order to better understand the impact of the virus.[10][11][12]

3.5.4 LIMSwiki resources and further reading

LIMSwiki resources - Clinical

LIMSwiki resources - Public health

Further reading


References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Douglas, S. (5 July 2014). "02. Types of Clinical Labs". Introduction to Clinical Laboratory Informatics – LII 006. Laboratory Informatics Institute, Inc. Archived from the original on 26 May 2017. https://web.archive.org/web/20170526212033/https://www.limsforum.com/lessons/02-types-of-clinical-labs/. Retrieved 28 June 2022. 
  2. 2.0 2.1 2.2 2.3 2.4 Witt-Kushner, J.; Astles, J.R.; Ridderhof, J.C. et al. (20 September 2002). "Core Functions and Capabilities of State Public Health Laboratories". Morbidity and Mortality Weekly Report 51 (RR14): 1–8. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a1.htm. Retrieved 28 June 2022. 
  3. Evans, D.B.; Hsu, J.; Boerma, T. (2013). "Universal health coverage and universal access". Bulletin of the World Health Organization 91: 546–546A. doi:10.2471/BLT.13.125450. 
  4. "Is Healthcare A Right?". PBS Newshour Extra: Student Voices. NewsHour Productions LLC. 30 September 2013. https://www.pbs.org/newshour/classroom/2013/09/debating-health-care-right-america/. Retrieved 28 June 2022. 
  5. Dall, C. (3 November 2016). "WHO guidance says no routine post-surgery antibiotics". CIDRAP. Regents of the University of Minnesota. https://www.cidrap.umn.edu/news-perspective/2016/11/who-guidance-says-no-routine-post-surgery-antibiotics. Retrieved 28 June 2022. 
  6. Shirts, B.H.; Jackson, B.R.; Baird, G.S. et al. (2015). "Clinical laboratory analytics: Challenges and promise for an emerging discipline". Journal of Pathology Informatics 6: 9. doi:10.4103/2153-3539.151919. PMC PMC4355825. PMID 25774320. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355825. 
  7. Centers for Medicare and Medicaid Services, Division of Laboratory Services (June 2022). "Laboratories by type of facility" (PDF). https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/factype.pdf. Retrieved 28 June 2022. 
  8. "U.S. and World Population Clock". United States Census Bureau. U.S. Department of Commerce. https://www.census.gov/popclock/. Retrieved 28 June 2022. "Used population value from June 1, 2022" 
  9. Gardner, R.M.; Overhage J.M.; Steen, E.B. et al. (2009). "Core content for the subspecialty of clinical informatics". Journal of the American Medical Informatics Association 16 (2): 153–7. doi:10.1197/jamia.M3045. PMC 2649328. PMID 19074296. https://www.ncbi.nlm.nih.gov/pmc/articles/2649328. 
  10. Zalon, M.L. (20 April 2024). "Health Informatics in the Time of COVID-19". University of Scranton. https://elearning.scranton.edu/resources/article/health-informatics-covid/. Retrieved 06 July 2022. 
  11. Bakken, Suzanne (1 June 2020). "Informatics is a critical strategy in combating the COVID-19 pandemic" (in en). Journal of the American Medical Informatics Association 27 (6): 843–844. doi:10.1093/jamia/ocaa101. ISSN 1527-974X. PMC PMC7313991. PMID 32501484. https://academic.oup.com/jamia/article/27/6/843/5851687. 
  12. Ganjali, Raheleh; Eslami, Saeid; Samimi, Tahereh; Sargolzaei, Mahdi; Firouraghi, Neda; MohammadEbrahimi, Shahab; khoshrounejad, Farnaz; Kheirdoust, Azam (2022). "Clinical informatics solutions in COVID-19 pandemic: Scoping literature review" (in en). Informatics in Medicine Unlocked 30: 100929. doi:10.1016/j.imu.2022.100929. PMC PMC8949656. PMID 35350124. https://linkinghub.elsevier.com/retrieve/pii/S2352914822000776.