Widespread use of fuel oxygenates, coupled with their high water solubility and slow degradation rate, have led to an increase in the potential for human exposure. We developed an accurate, precise, sensitive, and high-throughput analytical method to simultaneously quantify trace levels (low parts-per-trillion) of four fuel oxygenates in human blood: methyl tert-butyl ether (MTBE), ethyl tert-butyl ether (ETBE), di-isopropyl ether (DIPE), and tert-amyl methyl ether (TAME). The analytes were extracted from the head space above human blood samples, using solid-phase microextraction, desorbed into the heated injector, and chromatographically resolved by capillary gas chromatography. Analytes were detected by high-resolution mass spectrometry with multiple ion monitoring, and quantified against known standard levels by use of stable isotope-labeled internal standards for recovery correction. The low limits of detection (0.6 ng/L) allowed for measurement of MTBE, ETBE, DIPE, and TAME in parts-per-trillion levels with excellent precision (coefficient of variation ranging from 1.7 to 5.4%) and accuracy (96-100%). This method provides a means to assess fuel oxygenate exposure and study the potential relationship between exposure and adverse health outcomes.

This variation in practice indicates an opportunity exists to establish an evidence-based approach to QC that can be generalized across institutions.

Objectives Our academic health care institution was the victim of a cyberattack that led to a complete shutdown of major patient care, operational, and communication systems, including our electronic health record (EHR), laboratory information system, pharmacy, scheduling, billing and coding, imaging software, internet, hospital shared computer drives, payroll, and digital communications. The EHR remained down for 25 days, significantly affecting our clinical pathology (CP) laboratory operations. Methods During the downtime, our CP laboratory incorporated manual interventions for patient specimen testing, recruited additional staff for reporting results, and employed multiple communication modalities to support patient care. The crisis required a swift response, employing innovative approaches to mitigate patient harm; regular, multidisciplinary engagement; and consistent, broad-reaching communications. CP leadership worked with hospital administration, staff, and our referral clients to provide the timely laboratory results needed for acute patient care. Results During this downtime, the laboratory lacked accurate information about the number of patient samples diverted to other laboratories, the number of specimens processed, and the number of test results reported. Conclusions This paper focuses on the approaches the CP division took to develop and maintain downtime operations. Laboratories should consider these strategies in preparation for a prolonged downtime.

Objectives Our institution was subject to a multi-institutional, systemwide cyberattack that led to a complete shutdown of multiple major patient care, operational, and communication systems for more than 25 days. The electronic health record computer system was taken offline, as was the hospital email and authentication systems, internet access, and the laboratory information system. The impact on the hospital and patient care was substantial, and our laboratories were crippled. Methods Our laboratory endured challenges in communication because of the loss of connectivity and difficulties in laboratory management, and we recognized a need to restructure leadership to maintain operations during the crisis. As an academic institution, residents and trainees were also significantly affected by the disaster. Results We developed an incident command team (ICT), alternative methods of communication, and innovative management strategies to remain operational. Trainees were incorporated into the disaster-relief efforts, with negative impacts on resident education. Conclusions This paper focuses on the challenges in communication and lab management as well as the need for an alternative leadership structure during the crisis. We also highlight the unique experience of our trainees during this prolonged downtime, underscoring the importance of incorporating resident trainees into the daily ICT’s administrative activities as an invaluable lab management experience.

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