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Hardy MC, Stinnett RC, Kines KJ, Rivera-Nazario DM, Lowe DE, Mercante AM, Gonzalez Jimenez N, Cuevas Ruiz RI, Rivera Arbolay HI, Gonzalez Peña RL, Toro M, Trujillo AA, Pappas CL, Llewellyn AC, Candal F, Burgos Garay M, Gomez GA, Concepcion Acevedo J, Ansbro M, Moura H, Shaw MW, Muehlenbachs A, Romanoff LC, Sunshine BJ, Rose DA, Patel A, Shapiro CN, Luna-Pinto SC, Pillai SK, O'Neill E. Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria. Nat Commun 2019; 10:2720. [PMID: 31221973 PMCID: PMC6586791 DOI: 10.1038/s41467-019-10776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
Public Health Laboratories (PHLs) in Puerto Rico did not escape the devastation caused by Hurricane Maria. We implemented a quality management system (QMS) approach to systematically reestablish laboratory testing, after evaluating structural and functional damage. PHLs were inoperable immediately after the storm. Our QMS-based approach began in October 2017, ended in May 2018, and resulted in the reestablishment of 92% of baseline laboratory testing capacity. Here, we share lessons learned from the historic recovery of the largest United States’ jurisdiction to lose its PHL capacity, and provide broadly applicable tools for other jurisdictions to enhance preparedness for public health emergencies. Hurricane Maria hit Puerto Rico in 2017 and resulted in a complete loss of activity of the Public Health Laboratories. Here, the authors discuss the approach taken and tools developed to re-establish activity in these laboratories using a quality management system and the lessons learned in this process.
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Affiliation(s)
- Margaret C Hardy
- Laboratory Leadership Service Fellowship, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Division of Foodborne and Waterborne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Office of the Chief Regulatory Scientist, Australian Pesticides and Veterinary Medicines Authority, Armidale, New South Wales, 2350, Australia
| | - Rita C Stinnett
- Laboratory Leadership Service Fellowship, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Kristine J Kines
- Laboratory Leadership Service Fellowship, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Danisha M Rivera-Nazario
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - David E Lowe
- Laboratory Leadership Service Fellowship, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Alexandra M Mercante
- Division of Foodborne and Waterborne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Nathalie Gonzalez Jimenez
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Rosa I Cuevas Ruiz
- Public Health Laboratories, Puerto Rico Department of Health, San Juan, PR, 00936, USA
| | | | | | - Mayra Toro
- Public Health Laboratories, Puerto Rico Department of Health, San Juan, PR, 00936, USA
| | - Alma A Trujillo
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Claudia L Pappas
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Anna C Llewellyn
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Francisco Candal
- Office of Technology and Innovation, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - María Burgos Garay
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Gerardo A Gomez
- Division of Foodborne and Waterborne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jeniffer Concepcion Acevedo
- Division of Foodborne and Waterborne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Marisela Ansbro
- Division of Select Agents and Toxins, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Hercules Moura
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Michael W Shaw
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Atis Muehlenbachs
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Lovisa C Romanoff
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Brittany J Sunshine
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Dale A Rose
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, USA.,Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Anita Patel
- Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Craig N Shapiro
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, USA
| | - S Carolina Luna-Pinto
- Office of the Director, Center for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Satish K Pillai
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Eduardo O'Neill
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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