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LAO PEOPLE’S DEMOCRATIC REPUBLIC

Peace Independence Democracy Unity Prosperity

****************

Ministry of Health

Department of Communicable Disease Control

National Center for Laboratory and Epidemiology

OPERATIONAL GUIDELINES

For Health Laboratory Networking in Lao PDR

Version 1

Vientiane Capital

2015

European Union

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Lao People’s Democratic Republic

Peace Independence Democracy Unity Prosperity ****************

Ministry of Health No: 787 /MOH

Vientiane Capital, Date 9 April 2015

Minister of health’s agreement

on Operational Guidelines for Health Laboratory Networking in Lao PDR

- In reference to the Prime minister Decree No. 178/PM dated on 05th April

2012 on the organization and activities of the Ministry of Health

- In reference to National Policy for Health Laboratories No. 1322 / MoH dated

on 10 August 2015 and National Strategic Plan for Health Laboratories No

908/MoH dated on 10 June 2013

- In reference to the request letter of Department of Communicable Diseases

Control No. 109/DCDC dated 10 February 2015

- In reference to the revision and recommendation of the Cabinet, Ministry of

Health

Minister of Health agreed:

Article 1 : Endorse the application of Operational Guidelines for Health

Laboratory Networking in Lao PDR

Article 2 : Delegate Department of Communicable Diseases Control (DCDC) and

the National Center for Laboratory and Epidemiology (NCLE) to coordinate with

related sections at central and local levels to effectively implement this policy

Article 3: The Cabinet, Departments, Institutes, University, Hospitals, Centers,

Vientiane Capital Health Departments, Provincial Health Department, District

Health Offices and other Related Sections to recognize, cooperate and effectively

implement in accordance to this Decree

Article 4: This decree is effectively entered in to force from the signed date

onward.

Minister of Health

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Table of content

Abbreviation ......................................................................... Error! Bookmark not defined.

1. Introduction and Justification ..................................................................................... 4 1.1. Preface ................................................................................................................................................ 4

1.2. Justification ......................................................................................................................................... 4

2. Purpose of the guideline ............................................................................................... 5

3. Target and Scope ........................................................................................................... 5 3.1. Target audience ................................................................................................................................... 5

3.2. Scope .................................................................................................................................................. 6

4. Terms of reference of the network .............................................................................. 6

5. Structure of the national laboratory network ............................................................ 6

6. Terms of reference of each level of the network ........................................................ 8 6.1. National reference laboratories ........................................................................................................... 8

6.2. Central level laboratories ...................................................................................................................12

6.3. Regional level laboratories ................................................................................................................13

6.4. Provincial level laboratories ..............................................................................................................14

6.5. District level laboratories ...................................................................................................................16

6.6. Health centers laboratories ................................................................................................................17

7. Coordination of the laboratory network ................................................................... 18 7.1. Laboratory network coordination at national level ............................................................................18

7.2. Terms of reference of the networking committee ..............................................................................18

8. National laboratory network activities ..................................................................... 19 8.1. Continuous training and technology transfer .....................................................................................19

8.2. Supervision of laboratory staff ..........................................................................................................20

8.3. Quality management within the network ...........................................................................................20

8.4. Specimen referral system ................................................................... Error! Bookmark not defined.

8.5. Biosafety ............................................................................................................................................21

8.6. Laboratory Data management ............................................................................................................21

8.7. Communication of the network .........................................................................................................22

9. Network activities implementation ............................................................................ 22 9.1. Actions plan .......................................................................................................................................22

9.2. Network activities financing ..............................................................................................................23

Annex .................................................................................... Error! Bookmark not defined.

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Aviation

ADB Asian Development Bank

BSC Biological Safety Cabinet

CAREID Canada-Asia Regional Emerging Infectious

Disease (CAREID)

CMPE Centre for Malaria, Parasitology and

Entomology

EU European Union

GOL Government of Lao PDR

IHR International Health Regulations

IPL Institute Pasteur Lao

IT Information technology

LIMS Laboratory Information Management System

LOMWRU Lao-Oxford Mahosot Wellcome Trust

Research Unit

NCLE National Center for Laboratory and

Epidemiology

PPE Personal Protective Equipment

RRT Rapid Response Teams

SOP Standard Operation Procedure

USAID United States Agency for International

Development

WHO World Health Organization

NTB Center National Tuberculosis Center

EQA External Quality Assurance

CICML Centre d'Infectiologie Christophe Mérieux du

Laos

1. Introduction and Justification

1.1. Preface

The diagnostic laboratory is a key component of the health system. Testing must be valid,

accurate, timely and reliable in order to contribute to Public Health decision making

(Public Health Laboratory) and to provide support for clinical treatment (Clinical

Laboratory) that is efficient and effective. The Laboratory also supports medical research

to provide earlier detection and identification of pathogens. The National Strategic Plan

for the Health Laboratories of Lao PDR 2013 – 2020 was developed to provide a

structure for implementing priority activities to strengthen laboratories as mandated in the

National Policy for the Health Laboratories of Lao PDR.

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1.2. Justification

The public health care system in Lao PDR is structured into five hierarchical levels of

care: health center, district, provincial, regional (sub-national) and central levels. There

are 4 levels of service provided: basic level, intermediate level, advanced level and high

level. The health center (also called ‘small hospital’) provides basic services while the

higher levels provide more specialized services including laboratory diagnostics. For

example, a health center may perform a rapid test or basic laboratory testing as specified

in the National Laboratory Norms and Standards Guidelines (2015). Improving and

enhancing laboratory capacity requires investment in infrastructure and human resources

which are difficult to provide in environments where resources are limited.

An effective laboratory network combined with sample referral system will improve

services in the following ways:

Accessibility of services

Reduced cost of services

Improve quality of services ; reliability and timeliness

Information sharing

Support public health including International Health Regulations (IHR)

2. Purpose of the guideline

The purpose of this guideline is to:

Define the components of Lao PDR Laboratory network

Describe the coordination and functioning of the laboratory network

Provide general guidance for the implementation of the laboratory network

Promote linkages with WHO collaborating centers, other international

laboratories and specific disease program partners.

3. Target and Scope

3.1. Target audience

This document is intended as the guideline for managing and coordinating relationships

between the health laboratories in Lao PDR.

The target audience includes public health centers: central hospitals, regional (sub-

national), provincial hospitals, district hospitals, health centers, military and police

hospitals, clinics, private hospitals and also includes the National Animal Health

Laboratory (NAHL), Food and Drug Laboratory and Environmental Health Laboratory

(WASH), that work with the MOH to prevent and control disease and to promote health

of the Lao population.

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3.2. Scope

This guide will be disseminated to health facilities and development partners at all levels

in order to support and strengthen identification, confirmation, response, prevention and

control of priority infectious diseases. The guide will also promote stronger collaboration

and coordination including mechanisms for information sharing with the animal health

sector, especially in the area of zoonotic diseases.

4. Terms of reference of the network

The tasks of the national laboratory network are as listed below:

- Establish, maintain and expand collaborative links between all laboratories that

perform diagnostic testing for infectious agents including veterinary, food and

water laboratories and other laboratories that have functions related to public

health.

- Promote best practices in all areas of health laboratory services including setting

quality standards, establishing and promoting internal and external quality

assessment schemes.

- Assure laboratory personnel continuing education through regular training and

supervision.

- Improve nationwide access to quality laboratory services for confirmation of

communicable diseases.

- Work collaboratively with the National Center for Laboratory and Epidemiology

(NCLE), MoH Department of Communicable Disease control, WHO and partners

to ensure optimal use of laboratory-based information for communicable diseases

surveillance including outbreak investigations and control efforts.

- Build on existing laboratory capacity to respond to existing and emerging

infectious diseases.

- Establish a sufficient budget for implementation of laboratory networks.

- Create and maintain a database of national laboratory services.

5. Structure of the national laboratory network

The national laboratory network is composed of laboratories at each level of the health

system that are committed to the proper diagnosis of priority infectious diseases for

public health decision making.

The laboratory network structure will be in line with the overall five-tiered organization

of the national health care system in Laos PDR: central, regional, provincial, district and

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health centers and also include NCLE, Institut Pasteur du Laos, Christophe Merieux

Center, Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Center for

Malaria Parasitology and Entomology (CMPE), TB Center, Dermatology Center, central

hospital laboratories, regional hospital laboratories, provincial hospital laboratories,

district hospital laboratories and health center laboratories.

The network also includes the Food and Drugs laboratory, National Animal Health

Laboratory, National Blood Transfusion Center , 103 hospital laboratory, 5 mesa hospital

laboratory, National Environmental Health and Water Supply Center laboratory and

private laboratories.

The terms of reference for each level describe their roles and responsibilities within the

network. Additional guidance will be provided for specific network activities.

Figure 1. National Laboratory Network structure

Reference Laboratories:

- LOMWRU

- CICML

- IPL

- CMPE

- NTB

- Dermatology Center

Central hospital

laboratories

NCLE

- National Animal Health

Laboratory

- Food and Drug Laboratory

- Environment and Wash

Laboratory

- National Blood

Transfusion Center

- Military Hospital

Laboratories (103)

- Police Hospital

Laboratories (5 Mesa)

- Private laboratories

Health Care Department DCDC

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6. Terms of reference of each level of the network

6.1. National reference laboratories

National reference laboratories are designated by the Ministry of Health. In order to

qualify for designation, a laboratory should fulfil the following criteria and conditions.

The status of NRLs will be subject to review every 5 years. To apply for NRL status

laboratories will present documentation demonstrating technical expertise in the areas

listed below. Applications should be submitted to NCLE, the secretariat of the National

Laboratory Committee (NLC). NCLE will present the application to the National

Laboratory Committee. In order to promote a sustainable system, the status of designated

NRLs and their areas of expertise and missions should be considered by the Government

of Lao/MoH and donors when funding is allocated or becomes available.

Exemplary expertise and knowledge, applied appropriately and according to

international standards and practices.

Figure 2. National Laboratory Network structure

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Adequate equipment, materials, reagents, consumables and resources to perform

required task.

Appropriate infrastructure (including containment facilities and biosafety and waste

management systems) to support activities.

Qualified staff with sufficient training and experience to ensure competency to carry

out the assigned tasks.

Sufficient funding to support and guarantee continuous high quality work including

(1) Laboratory participation in international EQA programs.

(2) Laboratory participation in international laboratory networking.

Terms of reference

The roles and missions of National Reference Laboratories cover 6 main areas:

1. Reference diagnostics provision

- Utilize scientifically validated lab methods for specific pathogens or disease

characterization or diagnosis.

- Timely laboratory confirmatory testing for disease pathogens to support clinical and

surveillance activities.

- Investigate novel pathogens (emerging infectious diseases).

2. Monitoring, alert and response

- Reference laboratories should provide laboratory data to the National Focal Point

(NCLE) (see information flow chart).

- Provide advice and technical support in outbreak investigations

- Provide early warnings in case of unusual occurrences: detection of changes in

incidence, virulence, drug resistance, emergence of a possibly infectious disease of

unknown etiology

3. Reference material provision

- Develop, maintain and/or have access to relevant source reference materials: reference

laboratory strains and cultures, clinical isolates, sera, genetic materials, etc.

- Provide and/or facilitate access to reference material for relevant laboratories and

organizations.

4. Scientific support

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- Provide scientific advice and recommendations to public health authorities. Provide

technical support for policy development, e.g. vaccine issues, outbreak response

management and preparedness planning.

- Provide advice and support to laboratories (i.e. including activities such as conducting

workshops and other training activities based on needs, but also for the implementation of

new methods/technologies).

5. Collaboration and research

- Participation in regional/international laboratory networks.

- Participation in regional or internationally relevant projects and initiatives, including

research and development activities.

- Participation in, and contribute to surveillance for infectious diseases to achieve and

maintain core capacities under IHR.

6. Education / training

Contribute and participate in improving the quality of medical and technical education at

the University of Health Sciences including development of programs, training and

funding) training and mentoring of employees selected from among laboratories of the

Ministry of Health.

Figure 2. Specimen Referral and Laboratory Data flow

National Animal

Health Laboratory

Food and Drug

Laboratory

Environmental and

WASH laboratory

National Blood Center

laboratory

Military Hospital

Laboratories (103)

Police Hospital

Laboratories (5 Mesa)

103 Hospital

laboratory

5 mesa hospital

laboratory

International

Reference Labs

Other Reference Laboratories:

LOMWRU

CICML

IPL

CMPE

National Tuberculosis Center

Dermatology Center

NCLE

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Provincial health department

Central hospital laboratories

Health center laboratories

District health department

Sub national/Regional laboratories

Provincial hospital laboratories

Districts health laboratories

Lab data flow

Specimen referral flow

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6.2. Central level laboratories

The Central level laboratories are the laboratories located in national/central hospitals.

They fulfil the minimum standards defined in the National Laboratory Norms and

Standards guidelines. Central level laboratories support treatment, rehabilitation and

supervise catchment provinces.

Terms of reference

The roles and missions of central laboratories are as listed below:

Provide technical support to their catchment regions.

Collect samples from referred patients from the catchment area and where

necessary refer specimens to reference laboratories.

Perform supportive supervision and recommend remedial actions.

Participate in responses to epidemics, outbreaks and emergency situations.

Maintain records and manage laboratory health information and provide monthly

and annual reports to NCLE.

Participate in laboratory Biosafety program.

Participate in laboratory quality management programs including External QA

and Internal QA Schemes.

Participate in surveillance activities (diseases under surveillance).

Their specific missions in the control and surveillance of communicable diseases include:

1. Sample Collection and management

Organize training, provide sampling guideline and procedures to health workers

(physicians, nurses, lab technicians, etc).

Collect and store specimens according to sampling guideline until transport or

additional testing.

Transport specimens to national reference laboratories as needed according to

national sampling guidelines.

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2. Disease Confirmation

Perform laboratory tests for confirmation as appropriate: culture, isolation,

serogroup/type identification, antimicrobial susceptibility, serology, molecular

biology etc… as appropriate.

Store representative isolates from the outbreaks as needed for verification.

Observe, evaluate and report changes in trends of diseases during routine analysis

of laboratory results.

3. Data management and report

Record laboratory results as appropriate.

Provide results to clinical staff and patients.

Report notifiable disease results to provincial health office and to NCLE as

directed by national reporting requirements.

Report observed changes in trends during routine analysis of laboratory results to

NCLE.

6.3. Regional level laboratories

The regional level laboratories are those laboratories located in regional hospitals. They

fulfil the minimum standards as defined in the National Laboratory Norms and Standards

guidelines. Regional level laboratories support treatment, rehabilitation and supervise

catchment provinces.

Terms of reference

The roles and missions of regional laboratories are as listed below:

Perform laboratory tests according to national standards.

Provide technical support to their respective provinces.

Conduct supportive supervision to provincial hospitals.

Attend referred patients and specimens from the provincial hospitals and other

smaller health facilities do not capable to perform testing and if necessary refer

specimens to higher levels.

Keep records and manage laboratory health information and provide monthly

and annual report hospital director, provincial health offices and NCLE.

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Participate in RRT teams.

Participate in External QA Schemes and proficiency testing.

Their specific missions in the control and surveillance of communicable diseases

include:


Communicate sampling guideline and procedures to health workers (physicians,

nurses, lab technicians, etc).

Store specimens according to sampling guideline until transport or additional

testing.




Perform laboratory studies for confirmation as appropriate: culture, isolation,

serogroup/type identification, antimicrobial susceptibility, serology.

Store representative isolates from the surveillance or outbreak as needed.

Observe, evaluate and report the changes in trends of diseases during routine

analysis of laboratory results.


Record laboratory results.


Report notifiable disease results to provincial health office and to NCLE.


Provincial health office and NCLE.

6.4. Provincial level laboratories

The provincial level laboratories are those laboratories located in provincial hospitals.

They fulfill the minimum standards defined in the National Laboratory Norms and

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Standards Guidelines. In addition, the provincial laboratories have to provide guidance

and supportive technical assistance to district laboratory in the catchment area

The roles and missions of provincial level laboratories are as listed below:


Provide technical support to their respective districts.

Conduct supportive supervision to districts laboratories.

Attend referred patients and specimens from the districts hospitals, health centers

and other health facilities ( if necessary refer specimens) to higher levels.

Keep records and manage laboratory health information and provide monthly and

annual report to hospital director, provincial health offices and NCLE.

Participate in RRT teams.

Participate in External QA and IQA Schemes and Biosafety program.


include:


Communicate sampling guideline and procedures to health workers (physicians,

nurses, lab technicians, etc).

Store specimens according to sampling guideline until transport or additional

testing.




Perform laboratory studies for confirmation as appropriate: culture, isolation,

serogroup/type identification, antimicrobial susceptibility, serology.

Store representative isolates from the outbreak as needed.

Observe, evaluate and report changes in trends during routine analysis of

laboratory results.

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Report notifiable disease results to provincial health office and to NCLE.


Provincial health office and NCLE.

6.5. District level laboratories

The district level laboratories are those laboratories located in district hospitals. They

fulfill the minimum standards defined in the National Laboratory Norms and Standards

guidelines. Each district hospital laboratory provides support to the health centers within

its geographical area.

Terms of reference:

The roles and missions of district laboratories are:

Provide technical support to the health center laboratories.


Conduct supportive supervision to health centres laboratories.

Attend referred specimens to province or higher level ( if applicable).

Keep records and manage laboratory health information and provide monthly and

annual reports to Hospital director, district health offices and NCLE.

Participate in External QA Schemes if available.


include:

1. Sample Collection and management Disease Confirmation

Perform laboratory studies for confirmation as appropriate: microscopy, staining

and rapid diagnostic tests (RDT).

Use standard case definitions to indicate specimen collection.

Observe changes in trends of diseases/syndromes that cause outbreaks by

conducting routine analysis of laboratory results.

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Keep record information as require.

Report notifiable disease results to district health office and to NCLE.

Observed changes in trends during routine analysis of laboratory results to district

health office and NCLE.

6.6. Health center laboratories

The health center laboratories are those laboratories located in health centers and

performing basic laboratory tests like RDT and microscopy. They fulfill the minimum

standards defined in the National Laboratory Norms and Standards Guidelines.

The roles and missions of health center laboratories are:

Perform basic essential laboratory tests according to the national standard.

Refer specimens to the higher levels.

Keep records and manage laboratory health information and provide quarterly

and annual reports.

Participate in external QA schemes if available.


include:


Use standardized case definitions to determine initiation of specimen collection

process.

Collect specimens according to approved guidelines.

Document specimens with patients’ complete clinical history and description.

Transport specimens to referral laboratory according to approved guidelines.


Use standardized case definitions to initiate confirmation process as part of an

outbreak investigation.

Handle specimens within approved guidelines, information control and report

information of samples and patients.

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7. Coordination of the laboratory network

7.1. Laboratory network coordination at national level

The national laboratory network is coordinated by a National Networking Committee

composed as follow:

Chair: Deputy Director of NCLE

Secretariat: Laboratory chief of NCLE

Members:

- Chiefs of central hospitals laboratories

- Chief of Food and drugs center

- Chief of laboratory, National Animal Health center laboratory

- Chief of laboratory, CMPE

- Chief of laboratory, TB center

- Chief of Laboratory, Dermatology center

- Chief of laboratory, Environmental and water supply center

- Deputy chief of laboratory, CHAS

- Representative of Pasteur Institute

- Representative of Merieux center

- Representative of Wellcome Trust

- Representative of University of Health Science

- Chief of laboratory, National Blood Transfusion Center

7.2. Terms of reference of the Laboratory networking committee

- Advocate for the network implementation (funds and technical support)

- Plan the national laboratory network activities (work plan)

- Coordinate the implementation of the network activities

- Set up working groups for specific tasks

- Provide feedback information to all laboratories

- Assess and monitor the implementation of the national laboratory network work plan 1

to 2 times per year.

- Set up quarterly meeting or any time as necessary.

- Require project or technical human resource to assist, if necessary.

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8. National laboratory network activities

8.1. Continuous training and technology transfer

To strengthen the skills of laboratory personnel and promote excellence in laboratory

practice, the network will provide continuous training as budget is available and carried

out according to the following steps:

- Training needs assessment and identification of training topics.

- Elaboration/update of training modules.

- Identification and eventually strengthening of training center(s) for practical workshops.

- Establishment of training plan/program annually. (annual? biennial? triennial....)

- Implementation of training courses.

The training modules will cover all laboratory areas and training will be provided through

seminars and hands-on laboratory workshops. After the completion of every training

course/module, participants will be provided with a certificate of attendance and as this

program is developed, Continuing Professional Development (CPD) points will be

awarded and tracked

Laboratories chiefs and the national networking committee through NCLE will maintain

a data base of all staff trained and courses attended. All staff must be encouraged to share

information from training programs with their colleagues.(require training to staff)

examples of continuing training modules for staff may include require:

Lab management training.

Sampling training.

Stock management training.

Equipment maintenance training.

Sterilization, disinfection, cleaning, disinfectant preparation and control.

Specific technical training on disease diagnostics or laboratory methods.

Biosafety training.

Basic laboratory quality management systems training.

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8.2. Supervision of laboratory staff

Regular supervision of all laboratories is recommended. However, due to lack of funding

resources, the national networking committee will plan supportive review for all

laboratories twice a year. The main purpose of supportive review is to make a direct

assessment of a laboratory under normal working conditions in order to check that it is

operating in accordance with standards.

The review will be supportive, checking for and helping to solve problems. It will also

serve as a means of continuing education since during training some details may not have

been well understood and supervision can help to filling up the gaps. Therefore, the

supervisions will be carried out by experienced and skilled personnel from a higher level

laboratory.

Where human resources are available the supportive review process will be in line with

the tiered structure of the network: NCLE & central level laboratories will supervise

regional laboratories, regional laboratories will supervise provincial labs, provincial labs

will supervise districts labs and finally district labs will supervise health center labs.

The supervisors, using a standardized check-list will mainly assess performance in

technical activities, compliance with SOPs, Biosafety guidelines, the quality and

reporting of results, record keeping, internal quality controls, instrument performance,

availability and quality of reagents, and management of consumables.

The supervision practical implementation will follow the steps:

- Preparation and planning meeting.

- Check-list preparation and validation.

- On-site supervision.

- Report and feed-back.

8.3. Quality management within the network

The network will promote good laboratory practices through the following activities:

- Training on laboratory quality management.

- Provision of quality management documents: SOP’s, Generic quality manual to be

adapted by each laboratory, technical guidelines, etc..

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- The promotion of internal quality controls (provision of control samples) and

participation in EQA programs.

8.4. Specimen referral system

An effective specimen referral system will promote accessibility and affordability of

health care. This will ensure timely diagnosis and clinical treatment as well as support

public health interventions (epidemic investigations, etc...)

For this, a system to transfer patient specimens to higher level laboratories will be

implemented.

A national guideline for sampling and specimen transportation will be developed. and

that will include the following components

8.5. Biosafety

The national network will promote biosafety practices through support for biosafety

officers, training and provision of guidance about personal protective equipment (PPE)

and containment equipment (Bio safety cabinet use, etc..).

A national biosafety guideline will be adapted and distributed to all laboratories.

8.6. Laboratory Data management

The network will improve data management capacities of laboratories through the

following activities:

- Development of standardized laboratory logbook templates specifying the information

to be recorded.

- Provision of laboratories with IT equipment (computers, LIMS= software) and internet

connection as budget and software become available.

- Training on laboratory data management.

The data to be shared within the network will include:

- Laboratories contacts (heads, specialist...)

- Laboratories testing capabilities (tests performed, or at least specialized tests performed)

- Specific laboratory training needs

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- Laboratory tests and data for notifiable diseases (laboratory case definitions as

developed).

- Standardized SOPs.

- Standardized tools and forms for data collection will be developed and distributed to

laboratories.

-The data will be collected quarterly using postal mail (Bus, Airplane), fax, or E-mail.

8.7. Communication of the network

The laboratory network will establish communication channels with participating

laboratories, other relevant department of the Ministry of health (e.g DCDC, Department

of Health Care) and international laboratory network partners such as the WHO & WHO

collaborating centers, US-CDC, US-PACOM, Thai NIH, NIID Japan etc...

The purposes of the communication will include:

- Emergency case notifications,

- Information exchange: technical, scientific, training opportunities, update on

laboratories (contacts, testing capacities, etc…)

The communication will use the following formats:

- Office phone list

- E- mailing list

- Periodic newsletter issued annually (or 2x per year)

The creation of a professional association for laboratory technologists and a Biosafety

association will be promoted.

9. Network activities implementation

9.1. Action plan

A three year action plan will be established for the initial implementation of the network

activities.

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9.2. Network activities financing

NCLE will be request a budget from MoH and donors to support the implementation of

the laboratory network activities. An advocacy meeting will be conducted with MoH and

technical partners to promote support from within and outside of the country.

Annex

The different reference activities and laboratories

Disease/pathogen Testing Reference

laboratorie*

Reference

laboratorie1**

Reference

laboratorie 2***

Bacteria

Intestinal disease / pathogen

Watery Diarrhea

Vibrio Cholerae

- Culture and Biochemical

testing

- Serotyping/serogrouping

O1/O139,Serogrouping

monovalent Inaba/Ogawa

- Antibiotic testing

NCLE

LOMWRU,

Mahosoth

hospital

Vibrio Parahaemolyticus

Culture and Biochemical testing NCLE

LOMWRU,

Mahosoth

hospital

Food and Drug

Antibiotic testing NCLE

LOMWRU,

Mahosoth

hospital

Bloody diarrhea

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Shigella

- Stool culture, Blood culture

and Biochemical testing,

- Sero-grouping (core tests

- Antibiotic testing NCLE

LOMWRU,

Mahosoth

hospital

Food and Drug

Serotyping NCLE

Typhoid/ Salmonellosis

Salmonella - Stool culture, Blood culture

an d Biochemical testing,

- Sero-grouping (core tests)


NCLE

LOMWRU,

Mahosoth

hospital

Food and Drug

Serotyping NCLE

Diarrhea

Pathogenic E.coli

- Stool culture and Biochemical

testing

- Antibiotic testing NCLE

LOMWRU,

Mahosoth

hospital

Identification by PCR

NCLE

Campylobacter


testing

- Antibiotic testing NCLE NAHL

Identification by PCR NCLE

Plesiomonas Shigelloides


testing


NCLE LOMWRU,

Mahosoth

hospital

NAHL

Respiratory disease/

Pathogen

Pneumonia

Streptococcus pneumoniae

CSF culture, from blood and

Biochemical testing,

Serotyping/Serogrouping by

group

NCLE LOMWRU,

Mahosoth

hospital

Laboratory,

Mithapab

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Minimum Inhibitor

Concentration (MIC)

LOMWRU,

Mahosoth

hospital

NAHL

Appropriate antibiotic

susceptibility testing (MIC)

LOMWRU,

Mahosoth

hospital

NAHL

Identification by PCR LOMWRU,

Mahosoth

hospital

CICML

Legionella pneumophila

-Urine culture and Biochemical

testing

- Enzyme Immuno Assay (EIA)

- PCR testing

CICML

Pseudomonas aeroginosa

- Stool culture, pus, sputum

and Biochemical testing


NCLE Laboratory,

Mitapab

hospital

Anthrax

Bacillus anthraces

- Polychrome methylene blue

stain for capsule (M’Fadyean

reaction),

- - Malachite green / Modified

ZiehlNeelsen stain for spores,

- -Culture and Biochemical testing

- PCR testing

NCLE NAHL 5 Mesa hospital

laboratory

Leptospirosis

Lebtospira interrogans

Ab by RDT Mittaphab Lab


testing

LOMWRU,

Mahosoth

hospital

Ab IgM by Elisa NCLE

Identification by PCR

LOMWRU,

Mahosoth

hospital

Enchephalitis

Neisseria Meningitis


Testing


NCLE

LOMWRU,

Mahosoth

hospital

Mittaphab Lab

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Diphtheria

Corynebacterium

diphtheroides


Testing


NCLE

LOMWRU,

Mahosoth

hospital

Toxin detection

NCLE

Pertussis

Bordetella pertussis

Ab IgA, IgM by Elisa

NCLE

Melioidosis

Burkholderia Pseudomallei


Testing


NCLE

LOMWRU,

Mahosoth

hospital

Brucellosis

Brucella


Testing


NCLE

Syphilis

Treponema Pallidum

Find Cardiolipin by Rapid

Plasma Reagin (RPR) NCLE

103 hospital

laboratory Mahosot hospital

Laboratory

Ab by Treponema Pallidum

Hemagglutination Assay (TPHA) NCLE

Virology

Respiratory disease

/phatogen

Influenza virus

Culture NCLE NAHL

Real time RT-PCR NCLE IPL CICML

- Ab (When need) IPL NAHL

Sequencing NCLE

27/30

Fever and Rash

Dengue

Dengue virus

- Ab IgG/IgM and NS1 Ag by Real-time RT PCR

- RNA by Real-time RT PCR NCLE

LOMWRU,

Mahosoth

hospital

IPL

Chikungunya Real-time RT PCR NCLE IPL

Chikungunya virus

PCR assays (Reverse

transcription PCR, real Time

PCR)

NCLE IPL

Measles/Rubella

Measles/Rubella virus

Ab IgM by ELISA NCLE

Ab IgG by ELISA NCLE IPL

PCR LOMWRU,

Mahosoth

hospital

IPL

Diarrhea ( Children <5

years)

Rotavirus

Ag by RDT NCLE

Ag by Elisa NCLE LOMWRU,

Mahosoth

hospital

Encephalitis

Japanese Encephalitis

Ab IgM by Elisa NCLE

LOMWRU,

Mahosoth

hospital

Real time RT-PCR LOMWRU,

Mahosoth

hospital

IPL

AIDS

HIV

Ab by RDT NCLE

Mittaphab

hospital

Laboratory

Institute Military

of Disease

Prevention

Ab or Ag by Elisa NCLE

Viral load CICML

CD4/CD8 Mahosot

hospital

laboratory

Sethathirat

hospital

laboratory

28/30

- PCR

- Genotyping CICML

Hepatitis NCLE

HAV Ab IgM by Elisa

NCLE Mahosot hospital

Laboratory

HBV

Ab Anti HBs Ag by ELISA Mother and

Child hospital

laboratory

Mahosot hospital

Laboratory Mahosot Lab

clinical

HBsAg by Elisa Mittaphab

hospital

Laboratory

Mother and Child

hospital

laboratory CICML

HCV Ab LgM by Elisa Mittaphab

hospital

Laboratory

Mother and Child

hospital

laboratory

Mahosot hospital

laboratory

HEV Ab IgM by Elisa Mittaphab

hospital

Laboratory

Mother and Child

hospital

laboratory

HBV and HCV Viral load CICML

Enterovirus disease

Enterovirus

Real time RT-PCR

CICML

LOMWRU,

Mahosoth

hospital

Rabies

Rabies virus

Real time RT-PCR LOMWRU,

Mahosoth

hospital

Immuno Fluorescent Assay (IFA) NAHL

Mouse Inoculation NAHL

Other

Rickettsia (Spotted

fever, Murine and Scrub

typhus)

Ab by Slide and test tube Mittaphab

hospital

laboratory and

Sethathirath

hospital

laboratory

103 hospital

laboratory

5 Mesa hospital

laboratory

- Ab Typhus and Scrub Typhus

by Elisa

- Spotted ferver, Typhus and

LOMWRU,

Mahosoth

hospital

29/30

Scrub Typhus by PCR

- IFA

- Rickettsia

LOMWRU,

Mahosoth

hospital

TB

Mycobacterium tuberculosis

(MTB

MTB by Ziehl Nielsen

NTB Sethathirat

hospital

laboratory

LOMWRU,

Mahosoth

hospital and Institute Military

of Disease

Prevention

Culture

NTB CICML Mahosot

Microbiology/LO

MWRU

Leptospirosis

Leprosis microscopy (Ziehl Neelsen)

Dermatology center

Blood Parasites

Malaria

RDT CMPE

Institute Military

of Disease

Prevention

Microscopy CMPE

Institute Military

of Disease

Prevention

Mahosot hospital

laboratory

Filaria

RDT CMPE

Microscopy CMPE

103 hospital

laboratory

Stool Parasite

Ameobic dysentry Microscopy

NCLE Mittaphab

hospital

laboratory

Institute Military

of Disease

Prevention

Giardiasis Microscopy

NCLE Mittaphab

hospital

laboratory

Institute Military

of Disease

Prevention

Giardiasis DNA/PCR PCR CICML

Opisthorchis viverini Microscopy

CMPE

30/30

Schistosoma Microscopy

CMPE IPL NAHL

Cryptosporidium spp.

Ag by Latex Agglutination Settathirat

hospital

laboratory

Mahosot

hospital

laboratory

Cryptosporidium spp.

isolate DNA/PCR

PCR CICML

Taenia solium-

(Cysticercosis)

CICML

Trichinella ELISA CICML

MRSA Methycillin resistance by PCR

(mecA gene)

LOMWRU,

Mahosoth

hospital

Gonorrhoea

Neisseria gonorrhoeae

Gonococcal

Culture

NCLE

LOMWRU,

Mahosoth

hospital

Mittaphab

hospital

Laboratory

Antibiotic Susceptibility testing

NCLE

LOMWRU,

Mahosoth

hospital

Mittaphab

hospital

Laboratory

Remark:

This is the ability to analyze the current and updated every 1

* Reference laboratory is the reference laboratory diagnosis must be considered in the

test sample the first

** Reference laboratory 1 is the reference laboratory diagnosis option 1 in case

laboratory reference attached or more over sample.

*** Reference laboratory 2 is the reference laboratory diagnostic option 2 in case

reference laboratory 1 attached or more over sample.

Minister of Health

operational guidelines for health laboratory networking in ... · operational guidelines for health...

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