Construction starts on Dubbo pathology laboratory

November 14, 2023 by Liz Farquhar Leave a Comment

The Dubbo community is a step closer to a new, expanded NSW Health Pathology laboratory, with construction work now underway on the $6 million facility.

The project will deliver a larger, more modern pathology department to meet the growing health needs of the Dubbo community.

The new laboratory will ensure NSW Health Pathology staff can access fit-for-purpose facilities, including modern, automated testing platforms.

As part of NSW Health Pathology’s commitment to environmental sustainability, the Dubbo laboratory has also been selected for a pilot project to install sensor taps to conserve water and support energy efficiency.

Laboratory Manager Monique Mintern said the sustainability pilot project will be a welcome addition.

“The sustainability of sensor taps is significant,” Ms Mintern said.

“They create a hygienic and safe environment, reducing the chances of cross-contamination in the laboratory while also conserving water.

“Our local community here in Dubbo has lived through many years of drought and we appreciate how precious our local water supply is.”

NSW Health Pathology has awarded the $6 million contract to North Construction and Building following a competitive tender process.

North Managing Director Matthew Cook said North will work alongside NSW Public Works to refurbish the former ambulatory care section of the hospital which will house the new pathology laboratory.

“North has a long history of not only delivering essential medical facilities for NSW Health but also working collaboratively with NSW Public Works to bring these, and other, projects to fruition throughout regional NSW,” Mr Cook said.

“Our local team of experts is looking forward to completing these much-needed upgrades for the staff, patients and broader community.”

Construction work is due to be completed in late 2024. The existing pathology laboratory will continue to operate while the new laboratory is built.

Training the next generation of pathology collectors

November 13, 2023 by Liz Farquhar Leave a Comment

Meet Claire Padgett. A pathology collections trainer who works on the NSW Central Coast, ensuring our collectors are providing the best possible care.

Claire has worked for NSW Health Pathology as a collections trainer since 2002 and says she loves facilitating learning and the interaction it brings.

A Central Coast local, Claire works mostly at Gosford Hospital, but her job can take her all around the region from Umina to Wyong.

“I had previously worked as a paramedic for NSW Ambulance for 15 years,” she explains.

“I decided to work in pathology after realising I had a strong desire to remain within a health care role.”

Claire has a Diploma in Paramedical Science, a Cert IV in Training and Assessment and a Cert III in Pathology Collections.

She says training collectors sometimes requires her to think outside the box.

“You need to be creative when designing learning tools to keep it fun and your audience engaged,” she said.

“We all have different learning styles and learn at different rates, so patience is definitely required to be a collections trainer and facilitate effective learning.”

Claire gets a lot of joy from her work, particularly when it comes to inspiring young people to consider a career in pathology.

“I attend a careers expo each year and I love seeing the excited faces of all the school leavers,” she says.

“I take the manikin arm up to the expo, and one of our scientists takes along a microscope and slides.

“Together we spruik a career within NSW Health Pathology, it’s a very rewarding experience.”

She says she practices mindfulness to tackle the challenges of juggling multiple roles at work.

Claire’s hobbies away from work include bushwalking, reading, and baking.

Thanks Claire, for helping our collectors here at NSW Health Pathology to be the best they can be.

How COVID challenged us and what lies ahead

November 8, 2023 by Liz Farquhar Leave a Comment

On International Pathology Day, NSW Health Pathology’s A/Director of Public Health Pathology Dr Catherine Pitman and her colleagues consider the impact of climate change on the spread of disease and the implications for public pathology services.

As we know, 70 per cent of all clinical decisions are based on pathology results and most cancer diagnoses start with pathology.

NSW Health Pathology is the largest public pathology provider in the country and has more than 60 laboratories and over 150 collection centres located throughout New South Wales.

Australia and its citizens have access to one of the best pathology services in the world, partly due to the legislated high accreditation standards of NATA, the National Association of Testing Authorities (a not-for profit accrediting body) and the requirements of the RCPA, Royal College of Pathologists of Australasia. It is envied by many nations.

The COVID-19 pandemic challenged us all on many fronts, but it also has given us the opportunity to do better with outbreaks, big and small and adapt to the highly changing environments that we are facing in Australia and globally.

The latest risk modelling from London-based disease forecaster Airfinity suggests there is a 27.5% chance that a pandemic as deadly as COVID-19 could occur by 2033.

An independent Australian review of the COVID-19 pandemic outlined four areas where we as a country could have done better, five overarching lessons and six recommendations to improving our response to the next health crisis in Australia.

Those recommendations are:
– Strengthen crisis preparation
– Establish an expert body and trusted voice eg: an Australian Centre for Disease Control and Prevention
– Improve government decision-making
– Enhance public service collaboration, capability and communication
– Modernise how governments use data
– Build a culture of real-time evaluation and learning in the public sector

The first cases of COVID-19 in Australia were detected on 25 January 2020, concurrently in Victoria (one case) and NSW (three cases) on four returned travellers from Wuhan. The first known cases of community transmission in Australia were detected on 2 March 2020 in NSW.

The first SARS-CoV‑2 genomic sequence was released internationally on 10 January 2020 (ref 1 & 2) enabling the pathway for the development of in-house COVID-19 PCR assays across the world.

How NSW Health Pathology responded

On 22 January 2020, NSW Health Pathology’s Institute of Clinical Pathology and Medical Research at Westmead commenced COVID-19 PCR testing using an in-house PCR test, and the first NSW case was diagnosed on 25 January 2020. The first few PCR-positive cases of SARS-CoV‑2 were retested and confirmed at the VIDRL (Victorian Infectious Diseases Reference Laboratory).

Our Public Health Pathology Service co-ordinated the development of NSWHP testing capabilities under the leadership of then Chief Executive Tracey McCosker and Incident Management Controller Dr Stephen Braye in early 2020. The development of the COVID-19 PCR assays required a fully secure virus isolation facility, virus whole genome sequencing and SARS-CoV-2-specific serology as cases expanded in NSW.

Without these NSW Health Pathology facilities, the development of some of the first pathology assays in Australia would not have been possible. In the first 10 weeks of the pandemic, all testing was provided by the public pathology sector.

NSW Health Pathology was able to provide reliable, scalable, and prompt diagnostic services for COVID-19 diagnostics and has been instrumental in offering unique and public health-related laboratory advice to NSW Health. A unique collaboration with the world-renowned biosecurity facility at the Elizabeth Macarthur Agricultural Institute (EMAI) assisted with the expansion of COVID-19 during surges in 2020 and 2021.

What’s next?

When will the next major public health challenge be? Creating foundational capacity in pathology laboratories is critical to being able to rapidly and effectively contain the next health crisis.

The unpredictability of a changing climate will be a significant challenge. Climate change will not only lead to increased risk of mosquito-borne diseases but also extreme weather, including storm events, flooding, and bushfire. These could all impact health and result in new and changing diseases, which will require agile surveillance and response programs.

We now have new viruses that were not present in Australia before the COVID pandemic, such as Japanese Encephalitis Virus (JEV). With now more than 45 known cases of the disease and seven fatalities in Australia, the outbreak and presence of JEV has had a significant impact on health, as well as significant economic impacts on the Australian pork industry.

Similarly, the global outbreak of Mpox in 2022–2023, required new pathology assays and the capacity to monitor to help protect community health and safety.

Confronting our rapidly changing environments and diseases will require collaboration and commitment by all Australian citizens and organisations. Australia will be in a better position to meet the difficult and complex health challenges ahead if we continue to invest in the first-class pathology services of Australia and embed the learnings from the COVID-19 pandemic.

Authors: Dr Catherine Pitman, A/Director NSWHP Public Health Pathology, Vishal Ahuja, NSWHP Project Officer Public Health Pathology and Prof Dominic Dwyer, NSWHP medical virologist and infectious diseases physician.

References
1) Wu, F. et al. (2020) ‘A new coronavirus associated with human respiratory disease in China’, Nature, 579(7798), pp. 265–269. doi:10.1038/s41586-020‑2008‑3.
2) Lu, R. et al. (2020) ‘Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding’, The Lancet, 395(10224), pp. 565–574. doi:10.1016/s0140-6736(20)30251–8.

Randwick Microbiology laboratory celebrates 25-year milestone

November 8, 2023 by Liz Farquhar Leave a Comment

Our Randwick laboratory was designated a World Health Organisation Collaborating Centre in 1998 and since then has been tracking the spread of serious disease across Australia.

The World Health Organisation (WHO) has over 800 institutions in over 80 countries designated as Collaborating Centres – supporting its work in areas such as nursing, communicable diseases, chronic diseases and nutrition.

These centres are an international network of laboratory institutions that help the WHO fulfill its mandated activities, harnessing expertise, skills and resources.

Twenty-five years ago, NSW Health Pathology’s Randwick microbiology laboratory was designated by the WHO Director-General as a Collaborating Centre for sexually transmitted infections and antimicrobial resistance. This WHO Collaborating Centre is also now the national coordinating centre for the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS).

The GLASS supports global antimicrobial resistance surveillance and research efforts and helps inform decision-making to drive national, regional, and global actions. Since the 1980s the laboratory has also coordinated the national surveillance program for invasive meningococcal disease.

Medical Director at the Randwick Laboratory, Professor Monica Lahra (pictured above far right) congratulated her colleagues on the 25-year milestone, saying it was an honour to be working with the WHO as a Collaborating Centre.

“Antimicrobial resistance occurs when bacteria become resistant to antibiotics and is a major emerging health threat around the world. It can affect anyone and can result in longer hospital stays, higher medical costs, and cause long-term side effects or even death,” Prof Lahra said.

“Our world-leading experts are providing vital surveillance of antimicrobial resistance and working to keep all our communities safe. We coordinate these programs and collaborate with partner organisations globally to support the WHO,” Prof Lahra said.

“Our laboratory coordinates the Australian Gonococcal Surveillance Programme (AGSP) and the Australian Meningococcal Surveillance Programme (AMSP). These programs are part of the work of the National Neisseria Network which includes the Neisseria Reference Laboratories across the states and territories of Australia.

“Noting that gonococcal and meningococcal diseases are very different and the focus of the two programs differs. The AGSP focuses primarily on antimicrobial resistance surveillance, whereas for invasive meningococcal disease the AMSP focuses on genetic typing to determine the serogroup.

“This is important as there are different meningococcal serogroups circulating (mainly B, W, Y and C in Australia) and a number of meningococcal vaccine types.”

Prof Lahra said notifications for both gonococcal and meningococcal diseases were down during the COVID pandemic.

“In particular meningococcal disease rates in Australia were the lowest ever recorded,” Prof Lahra said.

“This was attributed to a range of factors including public health restrictions and very low rates of influenza, as meningococcal disease is known to increase with seasonal influenza. Other factors include a change in vaccine on the immunisation schedule in 2018 to cover additional meningococcal serogroups (from C to ACWY).”

Following the easing of restrictions from COVID there has been an increase in meningococcal disease reported in Australia and elsewhere.

Tracking of antimicrobial resistance is showing more notifications and more resistance, in many cases associated with travel or contact overseas, where antimicrobial resistance rates are higher.

Find out more about our Randwick WHO Collaborating Centre.

Genomic testing: shining a light on breast cancer risk

November 7, 2023 by Renee Mantle Leave a Comment

NSW Health Pathology’s Cancer Genomics Service offers genetic testing to provide accurate cancer diagnosis’ and help treating clinicians select the most effective treatment for their patients.

Genomics can also predict a person’s risk of developing a particular set of cancers, including inherited gene abnormalities or genetic predispositions.

For over 25 years, the dedicated scientists and technicians at NSW Health Pathology’s Division of Molecular Medicine, led by Laureate Professor Rodney J. Scott, have been working to accurately diagnose genetic predispositions to breast cancer.

“Our Newcastle Division of Molecular Medicine is at the forefront of genetic medicine and research and is one of the largest dedicated centres for screening and diagnosis of breast cancer in Australia. We have provided genetic testing for over 30,000 patients in NSW,” said Professor Scott.

“By equipping patients and their treating doctors with accurate testing results and knowledge about their genetic predisposition to breast cancer, we help to ensure that potentially lifesaving monitoring, early detection strategies and treatment therapies can be put in place.”

Knowledge about the genetic basis of breast cancer risk is constantly evolving and breast cancer treatments are continually improving, especially for those with a genetic predisposition to disease.

“Our internationally-recognised, highly-skilled genetic pathologists, scientists and technicians are constantly updating their approach and developing faster, more comprehensive tests to remain at the forefront of cancer predisposition testing and diagnosis,” said Martin Canova, NSWHP Director Strategy & Transformation.

“We continue to use genomics in new ways to improve patient care and the health of our communities.”

Trial of new treatment for rare neurological disorder

November 6, 2023 by Liz Farquhar Leave a Comment

NSW Health Pathology senior researcher Professor David Brown has received a $2.9 million grant to evaluate immunotherapy treatments for CIDP, a neurological disorder that attacks the body’s nerves.

Celebrated Australian swimming legend Michael Klim is one of the country’s most high-profile sufferers of chronic inflammatory demyelinating polyneuropathy, or CIDP, describing the debilitating effects of muscle wastage in his legs, sensory loss in his feet and the struggle to walk or even stand for long periods.

Klim has recently become a spokesman for a Red Cross Lifeblood campaign promoting plasma donation – a product used to help treat his condition and keep him walking.

But the plasma treatment that provides relief to CIDP sufferers is expensive – costing around $150,000 per patient – and that’s something Professor David Brown, Director of NSW Health Pathology’s Institute of Clinical Pathology and Medical Research (ICPMR) in Westmead, is aiming to address.

The Medical Research Future Fund (MRFF) has granted Professor Brown $2.9 million to evaluate immunotherapy treatments for CIDP.

“People with chronic inflammatory demyelinating polyneuropathy have the insulation of their nerves stripped off by their disease and this causes changes in sensation and weakness of muscles,” Professor Brown explained.

“These patients are treated with intravenous immunoglobulin, which is very expensive and requires life-long treatment, often every three weeks.”

Prof Brown said targeting and eliminating immune cells has significantly improved outcomes for patients with several neurological and inflammatory demyelinating diseases.

“This study will determine if removing B‑lymphocytes, a type of white blood cell which makes antibodies, might be a suitable early treatment for CIDP and lead to responses that will allow less immunoglobin to be used to manage the condition. Aside from anecdotal evidence, there has not been a trial to work out whether this approach works in CIDP,” Prof Brown said.

He said there would be benefits for both patients and the health system if the therapeutic antibody treatment proves to be effective.

“It would mean that instead of having intravenous immunoglobulin treatment by either weekly injections or infusions every few weeks, treatment may be able to be given twice a year,” he said.

“Patients would get back up to 15 days a year of time that they currently dedicate to treatment. This approach would also see significant cost savings for the health system.”

He says the trial is a great example of how collaboration between doctors and researchers can work.

“Different arms of the health system can work hand in glove with researchers to generate and translate findings in the bedside to bench and back to bedside research model that NSW Health Pathology plays a central role in.”

Professor Brown says the research project is now in the final stages of approvals and he expects to be ready to start recruiting people to take part in the treatment trial in early 2024.