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Dearest Colleagues,

You may or may not be aware of the recently filed Senate and House bills in Florida that could have serious impacts to our Florida medical laboratory professional’s licensure laws. For reference, the bills can be found at the links below:

• Senate Bill 1108 (2024) - The Florida Senate (flsenate.gov)
• HB 1313 (2024) - Clinical Laboratory Personnel | Florida House of Representatives (myfloridahouse.gov)

FSCLS, as well as our ASCLS colleagues around the nation would like to address key provisions in these bills, in an effort to find common ground with the sponsors, as well as reiterate our patient-centric mission.

1. The bill seeks to abolish the requirement that ‘DOH conduct examinations for clinical laboratory licensure’. As you know, the state of Florida no longer offers a separate exam. However, the bill would also abolish the licensing board’s ability to deem a national certifying agency (such as ASCP or AMT). This would lead to the ability of uncertified personnel performing laboratory testing. The FSCLS Board strongly opposes this provision.
2. The bill also seeks to defer all personnel regulations to CLIA standards. When combined with the first provision, this deferral would potentially gut our current licensure practices in Florida, which will negatively impact patient safety. The FSCLS Board strongly opposes this provision. Future efforts of the FSCLS board will focus on crafting messages about the current inadequacies of CLIA personnel regulations.
3. The bill seeks to remove requirements that the DOH have oversight of training programs. Currently, a program can operate in Florida without NAACLS (or similar) accreditation as long as a biennial self-study reviewed by the Board of Certification. This gives the Board of Clinical Laboratory Personnel the power to shut down “degree mills” and further strengthens existing programs that provide quality education and training to laboratory science students. BOCLP oversight is imperative to preserving the quality of laboratory education and patient safety. Therefore, the FSCLS Board strongly opposes this provision.
4. The bill seeks to abolish the requirement for trainee registration. As you know, Florida MLT/MLS students are required to apply for and obtain a “trainee license”, which does not provide the student with any autonomy or ability to practice, nor does it act as a provisional license upon graduation. It is an unnecessary cost for students, and an administrative burden to program directors. The FSCLS Board approves this provision.

What is the status of the bill?

1. The bill is currently in several committees/subcommittees.
2. On February 1, the Healthcare Regulations Subcommittee voted 14-0 to approve the bill. As far as we know the only groups that testified to the subcommittee in support of the bill is LabCorp and Quest.
3. The companion bill in the Senate, SB1108, has had no movement.
4. The Florida Hospital Association and the Safety Net Hospital Alliance of Florida has not weighed in on the bill.
5. The sense right now is that these bills will not move forward in the 2024 legislative session.

 As always, our patients and their safety and well-being are the forefront of our mission. While we continue to monitor the status of these bills, FSCLS and ASCLS are focused on building a coalition to ensure that the negative aspects of these bills do not pass as they are currently written. We are reaching out to our colleagues at ASCP and AMT in an effort to come together to determine the best course of action, and welcome the Florida Hospital Association (and other invested organizations) to work with us on issues such as workforce shortage. We ask that members and non-members alike be prepared to participate in positive social media and letter-writing campaigns to make our position known and to continue to advocate for our profession and our patients.

Emilia Marrero-Greene, M Ed, M(ASCP)^CM, MT(AAB)        &             Kyle Riding, PhD, MLS (ASCP)^CM

FSCLS President                                                                                                ASCLS Secretary/Treasurer

Welcome to the new website for the Florida Society for Clinical Laboratory Science (FSCLS), aka ASCLS-Florida!

"Do It Scared: My Experience as a First-Time Speaker at JAM", by Jasmine Kendrick

Like most people, public speaking has always terrified me. I’ve never had the gift of being able to talk about any and everything on the spot while keeping an audience engaged. As I attended more lab related conferences and listened to different speakers, part of me wanted to be up there. No matter what department or field of study I am in, learning and sharing what I’ve learned has always been a passion of mine. A passion that was finally able to outweigh my fear of public speaking. Some of the best advice I’ve heard is “Do it scared”; even though something may scare you it is still worth giving it a try. That little quote from an Instagram post is what pushed me to apply as a presenter for the 2023 Joint Annual Meeting in Providence, RI. 

Having worked in an HLA lab for the past 3 years, it is easy to see how small the histocompatibility community is. Since this group makes up a smaller portion of the laboratory science field, often we find people that either don’t know what HLA is or how to get into the field. Because of this, it was exciting to not only attend my first JAM meeting, but to talk about a field of medicine I have grown to love. One of the things that made this experience memorable was the support I had from family and friends for my first conference presentation. Not only did my peers from Florida attend my session at 8 am, but my dad flew in from Atlanta to also be there.

Attending JAM was also a chance to meet many current, new, and previous members of FSCLS and hear about how members are active across Florida. My first JAM meeting was definitely a memorable one and I hope to have more like it in the future.

"Re-Emerging Infectious Diseases: Should We Be Worried?", by Maridaliz Rodriguez-Rosado

Last summer, the Florida Department of Health issued a Mosquito-Borne Illness Advisory after four confirmed local Malaria cases in Sarasota. Malaria is a parasitic disease transmitted by an infected mosquito (the vector) from the species Anopheles. The causal agent is a blood parasite of the genus Plasmodium. Humans are considered the intermediate host for four species: P. falciparum, P. vivax, P. ovale and P. malariae. Infections with Malaria occur in areas where environmental conditions allow the parasite to replicate in the vector. Malaria cases are usually restricted to tropical and subtropical areas. This geographical distribution could be affected by population movement and climate change. Can we consider this parasite an emerging pathogen? Let’s define first what is an emerging pathogen.  Emerging infectious diseases can be defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range, or that are caused by one of the NIAID Category A, B, or C priority pathogens which determine and response to emerging pathogen threats in the United States. Based on this definition, Malaria infections can be categorized as an emerging pathogen. Clinical manifestations include fever, chills, sweats, nausea/vomiting, and headache. Diagnosis can be missed if providers are not alerted to the possibility of this disease. Malaria can progress to severe forms that can be fatal. Patient history is a must when considering a suspicious malaria infection. Microscopic morphological analysis is the gold standard for Malaria diagnosis. Blood smears stained with Giemsa, Wright, or Wright-Giemsa stains can be visualized on both thick and thin smears. Presence of parasites can be visualized by thick smears, while thin smears are used for species-level identification. Both smears can be used for quantification.  Comparison of the Plasmodium species which causes Malaria in humans are based in the stages found in the blood (ring, trophozite, schinzont, and gametocyte). Confirmatory Molecular Diagnosis can be used for the detection of Plasmodium species using using PCR analysis. In addition, antibody detection using indirect florescent antibodies (IFA) has been used to determine if a patient has been infected with Plasmodium. Antigen detection based on enzymatic activities associated with the parasite are used as rapid diagnostic test or RDTs. However, there is only one RTD kit licensed for use in the United States.

Summer is one of my favorite seasons of the year. But despite the intoxicating smell of the ocean breeze and BBQ gatherings with friends, the Hurricane season is always a threat for all Floridians. Last year, Hurricane Ian hit the peninsula. The rain and hard winds were not the only thing that Ian brought us. Hurricane Ian increased the risk of Vibrio Vulnificus as a serious waterborne infection. Vibrio vulnificus is a bacterium that normally lives in warm seawater and is part of a group of Vibrios that are called “halophilic” because they require salt for survival. Transmission with this bacterium can occur by eating raw shellfish and oysters. In addition, since it is naturally found in warm marine waters, patients with an open wound can be exposed to Vibrio vulnificus through direct contact with seawater. There is no evidence of person-to-person transmission of Vibrio vulnificus. How we can identify it in the lab? It is a Gram-negative non-spore forming rod-shape halophilic organism, and it is considered a reportable disease.  Vibrio vulnificus infection is diagnosed by stool, wound, or blood cultures. It is also known as lactose-positive Vibrio that ends in the development of septicemia. Some of the virulence factors include a capsular polysaccharide, and different toxins mediating tissue invasiveness, motility expression, and regulation of biofilm formation for intestinal colonization. Patients with underlying conditions are at a high risk, with a 40-60 % mortality rate. Many people with V. vulnificus infections require intensive care or limb amputations, and 15-30% of infections are fatal (Centers for Science in the Public Interest, CSPI), 2020). Infection with Vibrio vulnificus is rare, but an increase in positive cases were seen with the arrival of Hurricane Ian. The Center for Disease Control and Prevention has developed a national surveillance system for V. vulnificus from the Gulf Coast states, where most cases occur. Conventional microbiology testing like gram staining, cultures and MALDI-ToF technologies can identify the microorganism. Molecular testing, including whole genome sequencing can help determine Vibrio spp. outbreaks, epidemiology, surveillance, route of transmission, and host susceptibility. Patient treatment should be initiated immediately because antibiotics can improve survival.

Cytomegalovirus (CMV) is a common virus for people of all ages; however, a healthy person’s immune system usually keeps the virus from causing illness. Once CMV is in a person’s body, it stays there for life and can reactivate. A person can also be re-infected with a different strain (variety) of the virus. Most people with CMV infection have no symptoms and aren’t aware that they have been infected. People with CMV may pass the virus in body fluids, such as saliva, urine, blood, tears, semen, and breast milk. CMV is spread from an infected person in the following ways: direct contact with saliva or urine (especially in babies and young children), through sexual contact, breast milk to nursing infants, and through transplanted organs and blood transfusions. Immunocompromised patients that become infected with CMV can have more serious symptoms affecting the eyes, lungs, liver, esophagus, stomach, and intestines. Babies born with CMV can have brain, liver, spleen, lung, and growth problems. The most common long-term health problem in babies born with congenital CMV infection is hearing loss, which may be detected soon after birth or may develop later in childhood. Blood tests can be used to detect the virus in adults, but the best sample for the diagnosis in newborns is saliva or urine. CMV is the most common infectious cause of birth defects in the United States. About 1 out of 200 babies are born with congenital CMV. One out of 5 babies with congenital CMV will have symptoms or long-term health problems, such as hearing loss. Antiviral medications (primarily valganciclovir) might improve hearing and developmental outcomes.

These emerging pathogens are considered a global public health problem due to the increase of transmission, lack of missed of diagnosis and rising mortality rates. Education, training, research, and awareness are the keys to decrease exposure with these emerging pathogens and to keep our communities safe.

References:

Garam Choi, et al. (2022). Complex regulatory networks of virulence factors in Vibrio vulnificus. Trends in Microbiology, Vol.30(2

https://www.cdc.gov/dpdx/malaria/

https://www.cdc.gov/cmv/overview.html