Role of the hospital-based microbiology laboratory in preparation for and response to a bioterrorism event.

Many hospital-based clinical microbiology laboratories were called upon by local first responders (law enforcement, hazardous-material teams, and emergency medicine service personnel) to perform testing on powdery and miscellaneous environmental substances during the anthrax outbreak of September and October 2001. The post-September 11 anthrax outbreak was the first definitive challenge to the integrated laboratory system known as the Laboratory Response Network (LRN). The LRN strongly recommends that hospital-based laboratories restrict testing to human specimens and use only diagnostic test protocols developed in partnership with subject matter experts from the American Society for Microbiology (ASM), Centers for Disease Control and Prevention (CDC), and the Association of Public Health Laboratories. Only public health laboratories should analyze environmental and animal specimens. During the initial anthrax scare, the submission of powdery substances and other suspicious nonhuman specimens to hospital-based clinical microbiology laboratories was prompted by public panic, pressure from law enforcement to obtain an immediate answer regarding the presence or absence of anthrax spores, the unfamiliarity of first responders with the LRN, and pressure placed on laboratories to provide a public service. However, many laboratories were unfamiliar with or did not understand their role in the LRN. As a result of the anthrax experience, one of the major questions being asked by microbiologists is “what is or what should be the role of the hospital-based clinical microbiology laboratory when confronted with biothreats, biocrimes, or bioterrorism?” The laboratory’s standard roles of detection, recovery, characterization, identification, and determining the etiological agent’s susceptibility to antibiotics will continue, with additional emphasis being given to biothreat-associated agents. This role also involves an active role in surveillance and epidemiology. The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to “raise suspicion” when a targeted agent is suspected in a human specimen. To be successful in this role, laboratory personnel, including the laboratory director, in conjunction with infection control and administrative personnel, should develop both laboratory and institution-wide response plans. These plans must include the following: (i) criteria for distinguishing the type of bioterrorism event; (ii) information regarding access to and utilization of the LRN, including diagnostic testing protocols; (iii) safety guidelines; (iv) communication and notification protocols; (v) criteria for the safe packaging and transport of infectious substances; and (vi) measures to increase laboratory security.