Public health lab earns national certification

The National Public Health Reference Laboratory yesterday became the seventh laboratory to be certified by the Guyana National Bureau of Standards (GNBS).

But while the institution has added a number of new tests since it opened its doors in 2008, some cases will still have to be referred overseas, according to Minister of Health Dr Leslie Ramsammy, who said investment in certain testing “doesn’t make any sense. This lab adds to the menu of things we can do in Guyana and reduces significantly the number of things we send abroad but it does not eliminate the need to send things to CAREC [the Caribbean Epidemiology Centre] and does not eliminate the need to send things beyond CAREC. There are certain things that would continue, deliberately so, on reliance to external agencies.”

Ramsammy stressed that it did not make sense to invest in equipment and personnel as there would not be justification for certain testing, and he cited anthrax as an example. He said should the development be done to provide this test, the equipment would sit as a “white elephant” and noted that there are other tests that Guyana may do once a year and external assistance would be sought.

He stressed that the reference laboratory must be one that maintains accreditation and quality as it is the lead lab in the country. “But with pride and achievement comes burden… and we have to maintain [the high quality]. But if all we want to do is maintain the accreditation, I don’t think it fits our ambition because our ambition is to be the best and we have to work hard,” he said. He said Guyana is happy to be part of the US President’s Emergency Plan For Aids Relief (PEPFAR), which is seeking to develop standards for laboratories throughout the world and especially in those countries where the initiative has been deployed.

According to Ramsammy, the lab has grown from a staff of 13 persons to more than 30 persons and important areas such as microbiology and molecular biology had been added to the lab’s testing. He boasted that there is no other laboratory in the region that can test for molecular biology—the study of life at a molecular level which overlaps with other areas of biology and chemistry, particularly genetics and biochemistry. “It is a major, it is a signal achievement that we now have the capacity for PCR (Polymerase Chain Reaction) DNA… laboratory testing, which we do now routinely at the lab here. Viral load testing is done routinely now and we are glad that we no longer have to rely on sending our specimen to South Africa through CDC for testing so that we can know the HIV status of all newborn children. It is done right in this building that we are located in so now we can know within a short period of time,” he said.

Next year, Ramsammy explained, the lab would introduce testing for the human papillomavirus (HPV), which would be administered to young women. He said that since last year the lab has been testing for the Chagas disease and soon this test will be done across the country in the public health institutions.

Additionally, the lab would determine which of the more than 30 rapid tests done for malaria is more reliable. He noted that many of the malaria tests that are considered unreliable by the US Centers for Disease Control (CDC) are being conducted by private institutions but the results are unreliable and contribute to sustaining the malaria epidemic in the country.   The minister said training is continuing at the lab to ensure that the high standards are maintained.

Meanwhile, Head of the GNBS’ Conformity Assess-ment Department Candelle Walcott-Bostwick said, “You can see this as step one towards accreditation; an accreditation will provide you with that international recognition and mark of competence for the type of testing that you are doing at this laboratory.” She said Guyana’s national standard is “almost as good as the international requirements because we would address most of the requirements that are required by the international standard.” However, she added, “what I want to tell you is that you have now started the journey, this is the beginning of it because you have to consistently implement the systems and also improve on it and aim towards the accreditation standard and beyond… Now the hard work begins because what the bureau would normally do, we will come unannounced to conduct surveillance visits where we are going to come to see how you are implementing your systems….”

Walcott-Bostwick pointed out that other laboratories would be looking towards the national lab for reference and will use it as their benchmark. According to her, the lab has been showing that it has the ability to implement the requirements of the international standards and also to provide accurate and reliable test results.

The certification covers area such as personnel competence; to ensure that the lab is using equipment that are calibrated and maintained; that the lab has the adequate facilities to do the testing; and it also demonstrates that the lab has a system in place to prevent samples from being mixed up and providing inaccurate results. The lab’s quality control system allows it to ensure that there is accuracy and reliability in the test.

The reference lab became the second lab under the public health system to be certified by the bureau while there are five other laboratories that have been certified.

Walcott-Bostwick pointed out that it is a requirement under the Health Facilities Act that all laboratories become certified and she encouraged all laboratories to work towards being certified.

In brief comments, Dr Barbara Allen, Country Director of the US CDC, said it was important to have a laboratory that can give high quality test results, while noting that mistreatment of a patient may occur from inaccurate or untimely lab results. She told the employees that the hard work continues, since they cannot simply sit back and wait for two years to be re-inspected in order to be re-certified. Allen stressed that everyday would require due diligence.

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