Ready? Set? Test! Patient Testing is Important. Get the Right Results. 

Hey everyone, we can go ahead and get started. My name is Julie Sun. I am a consultant with Guide House supporting the CDC's OneLab initiative. A couple of notes about the webinar before we dive in, if you're having any technical issues throughout, feel free to e-mail the one lab inbox just for support at OneLab@cdc.gov. If you have questions throughout the session, insert them into the Q&A function by clicking on the Q&A icon there below in your menu. We'll do a Q&A session at the very end of this presentation where we'll review questions and do our best to answer. And then lastly, please, note that we've also posted the link to live captions in the chat. Please be sure to keep both the captions window open if you use it. In addition to this Zoom meeting. 

For today's agenda, we'll start by discussing new and relevant OneLab resources. Then we'll go into some introductions. Again, we'll have about 10 minutes Q&A session at the end where we'll review the questions and do our best to answer as much as we can. And then to today's session will end with a discussion on the upcoming OneLab events. For today's webinar we'll be leaving the chat open for your engagement. When utilizing the chat box, please keep in mind the appropriate rules of engagement here. Feel free to use the chat to connect with others by reacting to what you're hearing, sharing experiences, and asking questions to your fellow participants. If you have a question for the presenter. Please use the Q&A function and not the chat so that we're making sure that we can get to them. Additionally, please engage with respect and professionalism. Any inappropriate language, improper conduct or any form of discrimination may result in removal from the webinar. Please be sure to make sure that your comments are relevant to the topic, and if a moderator gives direction regarding chat behavior, please comply accordingly. Lastly, please notify moderators if you're experiencing any technical difficulties or observe disruptive behavior. I'll now turn it over to our OneLab test lead, Meredith Reagan, to share some of our new and relevant resources. 

Morning. Thank you, Julie. Thank you all, and thank you, Julie. So as Julie mentioned, I will be introducing a few resources that may be of interest to you all. So the first one is our personal protective equipment toolkit, which is a guide to resources on PPE. We also have a new job aid on Standard Precautions that you can take when cleaning up blood or bodily fluids, and another job aid which includes the instructions for performing external control testing, including a quality control log for qualitative and quantitative tests. 

So next slide please. And it's my honor to introduce our first speaker today. Theresia Snelling is one of our experts with 20 plus years of clinical laboratory experience in multiple areas, she's worked in multiple positions from bench tech, senior tech education coordinator and management. She's also trained a vast number of professionals, including communicable disease specialists, laboratory assistance phlebotomists, laboratorians and nurses in laboratory technique, best practices and regulatory guidelines. As a former state agency CLIA director, she directed a program of laboratory surveyors who monitored federal certification and state licensure of laboratory facilities. She participated in the development and revision of rules and regulations governing the state's laboratory facilities. And her main focus was the enforcement of regulatory rules and guidelines as well as training end users on the need for compliance. She developed good laboratory practices for wave testing, Ready? Set? Test! online training course, as well as the development of a booklet for individual quality control plans or IQCP. She is currently involved in planning CLIAC and in the logistics distribution and promotion of QSSB Training materials and online courses.

Next slide. I also would like to welcome Amanda Johnson. Amanda Johnson is a clinical laboratory scientist here at CDC in the Division of Laboratory Systems. She has a diverse background in the clinical laboratory, which spans more than a decade across both federal and private healthcare facilities. Before she came to CDC, she served as a point of care coordinator at the US Department of Veterans Affairs where she oversaw a comprehensive program that encompassed both waived and non-waived test systems. So with that I will pass it over to you. Amanda. Thank you. 

Thank you. Can you all see me? Everything looks good. Yes. OK, perfect. Good afternoon, everyone. We appreciate the opportunity to present to you all today. For today's presentation we will focus on the Ready? Set? Test! resources for waived testing. I'm Amanda Johnson and I'm joined today by my colleague Theresia Snelling, who you will hear from a little later in our presentation. We are both from the Quality and Safety Systems Branch and the Division of Laboratory Systems at the CDC. 

Patient testing is important and with the assistance of the Ready? Set? Test! resources which provide the basic training necessary to safely and accurately perform waived testing, all test sites, regardless of location, can get the right results. So today we will be discussing waived testing and the Ready? Set? Test! educational materials for waived testing. In the interest of time, today we will highlight the Ready? and the Set? sections in the Ready? Set? Test! educational materials. The Test! section and all other testing forms and logs that are included with these materials will be highlighted during October’s OneLab Test event.

More information about that session will be provided at the conclusion of today's presentation. And for today's learning objectives, by the end of the presentation, the learners will be able to explain what a waived test is and what the CLIA regulatory requirements are. They'll be able to identify the Ready? Set? Test! educational materials as resources for waived testing, describe best practices to follow when preparing for testing, describe test order, patient preparation and sample collection considerations for testing, and identify best practices to safely perform waived testing. 

So with that, let's get started. So what are waived tests? Wave tests are tests categorized as simple, having a low risk for erroneous results. Waived tests include test systems cleared by the FDA for home use, and those tests approved for waiver under the clear criteria. Waived test can be performed without routine regulatory oversight and they are often performed at the pointof-care. For the most current list of waived tests or to look up a test, you may be considering adding to your testing menu, refer to the FDA list linked here on this slide and in the chat. This list is continuously revised as new tests are waived by the FDA. 

The Clinical Laboratory Improvement Amendments, also known as CLIA, play a significant role in waived testing by establishing standards and regulations to ensure accurate and reliable results, regardless of where the test is performed. CLIA has very few requirements for waived testing and testing performed under a Certificate of Waiver. To perform waived testing a test site needs to enroll in the CLIA program, pay a fee, obtain their Certificate of Waiver, which will be effective for two years, and then follow the manufacturer's instructions for performing the test without any modifications. 

Testing sites with the Certificate of Waiver are not routinely inspected. However, if there is a complaint or if it is determined a site is performing testing that is not waived, CMS can inspect that site. For more specific information and forms to use when applying for CLIA certificate of waiver, refer to the CLIA brochure linked at the bottom of this slide and in the chat. So waived testing results are most commonly used to diagnose disease, diagnose prognosis, and monitor a patient's treatment or health status. Waived testing is performed typically in healthcare settings such as doctor's offices. 

However, waived testing is increasingly being performed at nontraditional sites such as nursing homes, clinics, and jails. As noted prior, waived tests are simple and they have a low risk of incorrect result, but we all must remember that this does not mean that waived tests are completely error poof. Errors can occur anywhere in the testing process, and particularly when the manufacturer's instructions are not followed and when testers are not familiar with all aspects of the test system. Testing sites performing waived testing can greatly reduce their likelihood of incorrect waived test results by cultivating an environment where all testers follow good testing practices. 

To assist testing sites in this area, the Ready? Set? Test! educational materials are available to help. So with that being said, I will now highlight the Ready? Set? Test! educational materials. These specific resources and all of the resources for waived testing offered by the CDC can be found at the link on this slide and also in the chat. Ok, so the Ready? Set? Test! educational materials are free resources that provide testers the basic training necessary to safely and accurately perform waived testing. Ready? Set? Test! booklet describes recommended practices for physicians, nurses, medical assistants, pharmacists, and other individuals who may or may not have a healthcare background, but who performed patient testing under a CLIA Certificate Waiver.  

The booklet includes forms and logs that can be used at testing sites. As an accompanying resource, the self-assessment Checklist for Good Testing practices is also available. This checklist emphasizes recommended practices while highlighting what should be checked, verified, or completed throughout all phases of the testing process. Both of these resources can be downloaded from the previous link that was dropped in the chat, and you can also request hard copies if you would like. We also offer a free Ready? Set? Test! online course. 

This course is a scenario-based training where the steps of the waived testing process are explained. A certificate of completion is provided to participants of the course scoring at least 80% on the post test. This course can be used as a supplement when assessing the competency of testers. Free PACE e-credit is also available for the course if needed. You can access this course by scanning the QR code or by referring to the link in the chat. So now we will give an overview of the Ready? and the Set? sections of the materials to provide a preview for testing sites that may be interested in these resources. Prepare for Testing. Before you're ready to start a testing process, you should take all necessary steps to prepare and ensure your results are accurate.  

The most important resource available to properly prepare for every step of the waived testing process is the manufacturer's instructions. Studies show that most problems found at sites that perform waived testing result from failing to follow and understand the information in the manufacturer's instructions. Here we have some practices to follow when you are preparing for testing. You want to routinely clean and dry work services before and after testing. Ensure all testing is performed in a well-lit and clean and dry area. 

It's a good practice to check and record temperatures of the testing reagent and test kit storage areas, also check supplies regularly to ensure that you have enough reagents, test kits, and other supplies needed for testing, including recording any expiration dates and discarding any expired reagents or test kits routinely. Ensure all test kit components and their reagents are from the same kit lot. 

Do not mix or combine reagents between lot numbers, inspect reagents and vials for damage, discoloration or contamination and discard if found. If any reagents require preparation, you should always prepare the reagents according to the manufacturer's instructions. 

Allow time for any refrigerated reagents, test kits, or patient samples to come to room temperature prior to performing patient testing. If indicated in the manufacturer's instructions for any type of equipment that you use, you want to perform the equipment calibration checks as needed. And then lastly, it's a good practice to always disinfect the surfaces with the appropriate disinfectant before performing any test procedure whenever contamination is visible and before leaving the testing area after all testing has been completed.  

When preparing for testing, it's a good practice to review a pretesting task checklist before starting the testing process. This specific checklist is included in the Ready? Set? Test! booklet as Appendix A and as a job aid with the online course. Using this checklist will assist testers with ensuring the testing work area is ready, All storage and testing temperatures have been recorded, equipment is maintained, and all reagents and test kits are acceptable for use. 

The CLIA certificate of waiver requires that all testing sites follow the most current version of the manufacturer's instructions. Manufacturers may update or change their guidance periodically, and instructions from different manufacturers may differ for the same type of tests. For example, glucose. To ensure that the most current and appropriate test instructions are being used, a copy of the manufacturer's instructions should always be on hand for easy reference. With each new lot or shipment of reagents or test kits, the manufacturer’s instructions should be checked to ensure there's been no changes from the previous lot or shipment. 

And in the event of any updates, the test site should replace the previous instructions with the new version and file the old just to have a record of it. It's important to communicate all changes in the manufacturer’s instructions to all testers and to the person who directs or supervises testing. We all must remember it is not acceptable to make changes to the manufacturer's instructions. If a test site makes a change to a test, it is no longer considered waived. Some manufacturers also provide quick reference instructions to use during the testing process. 

These instructions are intended to supplement the manufacturer’s instructions, but not replace them. If the manufacturer's instructions are updated, always check the quick reference instructions. They may also have been updated or may need to be updated. Quality control is important when preparing for the testing process, and it is required when indicated in the manufacturer’s instructions. Quality control testing ensures the tests being performed will yield the results as expected and it alerts users when problems in the testing process occur. 

The manufacturer's instructions will explain when, why and how to perform QC testing. Waived tests include two types of quality control, internal and external controls. Internal controls, also referred to as built-in or procedural controls, determine whether the test is working as it should, the test sample amount used was adequate for the test to perform properly,  the sample is moving through the test strip or the device correctly, and if the electronic functions of the instrument are working correctly. 

External controls determine whether the entire testing process is being performed correctly from sample application to the interpretation of the results. External controls will also indicate if the control values are within the expected ranges, printed on the control materials or in the control manufacturer’s instructions. External controls most commonly are liquids or other materials that are similar to patient samples, and they may be included with your test kit system, or they may need to be purchased separately. 

So who should perform QC testing and how often should it be done? The same personnel who routinely perform patient testing should perform QC testing. Quality control should be treated and tested as you would a patient sample. Again referring to the manufacturer’s instructions for the test system is essential to know when and how often quality control should be performed. Your testing site should perform QC at least as often as specified in the manufacturer's instructions and most commonly with each new reagent or test kit, and each new shipment of reagent or test kits, any change in lot numbers or with each new tester.  

But as a good practice, it's important to also consider additional factors when determining how often your test site needs to perform quality control, such as stability of the test, environmental changes which can cause QC or testing material to spoil, and the competency and scale of your testers. If unexpected out of range or invalid quality control results are obtained, the problem should be identified and corrected before reporting patient results. 

When troubleshooting QC results, always check to see if the manufacturer's instructions are being followed correctly. Look for possible sources of error such as your reagents being outdated, or if your control materials are outdated. Check whether the reagents test kits or control materials have been stored properly. You want to ensure that the controls and the reagents have not been cross contaminated by accidentally switching caps or by mixing the reagents. This is most commonly seen at test sites when the caps of the positive, negative, high and low controls may be swapped. 

Follow the troubleshooting steps in the manufacturer’s instructions or in your site-specific procedure if your test site has one. And you can always contact the manufacturer, the technical representative, or the person who directs or supervises the testing for additional assistance. Once the problem has been identified and corrected, repeat QC testing. If the QC results are acceptable, repeat the patient samples,  and then report the final results.  

So I know I've shared a lot of information so far, so I think it's a good time for us to pause here for a quick knowledge check. For this scenario you are working at a testing site that performs waived testing under a CLIA certificate of waiver. 

The manufacturer’s instructions for one of the waived test systems used at your test site. Requires quality control daily. Before you begin testing for the day, you perform external quality controls using quality control material on the counter near the test system. The quality control results are unexpected or invalid. What next steps would you take? So you can: A: mix the quality control materials and immediately test again. B: check the manufacturer’s instructions to ensure the testing process was performed correctly. C: inspect the test kit quality control materials for possible sources of error. Or D B and C. So I see a lot of people are already answering. So we'll give everybody just a few more seconds. 

Alright so. The correct answer. Is D and 92% of you got the correct answer. 

OK. Now that we have covered how to prepare for testing, we will move into our other considerations and steps you should take before testing the sample. We're going to start with set. 

Next slide please. The Test Order. The first thing you want to consider is the testing order. Closely examine the test order. If there is any question about whether the order is correct, check with the individual who ordered the test. Accurate patient identification is critical when collecting the patient sample because patient names can be similar and they can also be the exact same name. So you to make sure you have two patient specific identifiers, such as the patient's name and their date of birth. This is a good laboratory testing practice and it will assist you with ensuring the test is ordered for and collected from the correct patient.  

Next slide please. Consult with the Patient. Enhancing patient awareness regarding any information that may impact their health or the accuracy of the test is essential. In so you want to prepare the patient for sample collection by first consulting with them regarding any pretesting instructions or information. Some tests require preparation by the patients, such as fasting. 

So the first thing you want to do is ask them if they've eaten anything that day, and more than likely they they'll say no. I haven't eaten anything. Then you want to ask them if they've had anything to drink because they don't consider that cup of coffee as fasting, so you want to ask those questions. For some tests, medications may be interfering substances, so you may want to ask them what medicines they've taken that day. Verify the patient has followed the recommended instructions before collecting the sample and consider any test limitations noted in the manufacturer’s instructions.  

For the test ordered, it is helpful to ensure the patient understands the purpose of the test being ordered and what the test results will mean to their health. But ultimately, for some test results patient counseling may be beneficial. I know when I was a bench tech, we would send patients for mental health counseling if they were getting an HIV and AIDS test. Next slide. Collecting the Sample. Quality patient samples are critical for accurate and reliable test results. The sample collector should understand the type of sample needed for the test and prepare collection process. Manufacturer’s instructions provide all necessary sample collection handling and storage information. 

Do not test a sample that is or has been improperly collected or improperly handled. When a test is approved for both waived and non-waived testing, use the manufacturer's instructions may include for testing that could be performed using more than one sample type. However, waived test may only be performed using unprocessed samples, unmanipulated samples. Examples of unprocessed samples acceptable for waived testing include whole blood. A finger stick. If it is a venal punctured sample, it's probably an anticoagulated blood sample, urine, a throat swab, a nasal swab, a nasal pharyngeal swab or aspiration, a stool sample, a saliva or oral fluid or gastric biopsy. 

These are examples of unprocessed samples. When labeling your sample, I'm sorry. Next slide, when labeling your patient sample, always label the sample immediately after collection with at least two unique patient identifiers. The name, date of birth. To prevent sample mix up. It is a good practice to also include the date and the time that the sample was collected, and you could include the initials of the person who actually is collecting the sample. Test requires the sample be applied directly to the test device or to the test cassette. Label the test device or put the name on the cassette before you collect the sample. 

Next slide please. OK. Using Collection Devices. Collection devices are essential to sample collection and sample collectors must use them in accordance with the current manufacturer’s instructions. This means we use the swabs that come inside the sample collection kit or refer to as the test kit using the appropriately sized finger stick and venipuncture collection devices for your patient and only use it once. Some collection devices ensure the delivery of the correct sample volume, while some contain additives that are needed for the tests to work correctly.  

Next slide please. Safe Considerations for Testing. It is also good testing practice to follow safe workplace practices while performing waived testing. This includes: Handling all blood and blood fluids as if they are infectious. Using the required PPE and safety devices. Do cosmetics in the testing area. Be cautious during the testing process to reduce potential exposure to mucous membranes, so don't scratch your nose or anything. Wear goggles or face shields to protect against aerosols and droplet exposure. Avoid using needles and lancets if safe and effective alternatives are available. Avoid recapping needles, transferring body fluids between containers or opening blood tubes. Properly dispose of used sharps in puncture-proof sharps containers. In the event of an exposure, please report to a supervisor or the person who is overseeing or directs testing to ensure the appropriate follow up care is received. Biohazard Waste. 

All testing sites must comply with local, state, and federal requirements for the safe disposal of biohazard waste generated from sample collection and testing. Hazardous waste cannot be disposed of with regular trash. Instead, proper biohazard waste disposal bags and containers should be used. As a good testing practice each should have site specific procedures that comply with their local, state and federal requirements for safe disposal of biohazard waste. If you don't have a procedure and you're not sure what to do at this point, you could contact a local hospital or clinic and they may be useful resources for information about regulated waste disposal. 

During the testing process, the biohazard bags and containers used for disposal and contaminated materials should be in close proximity to the testing. Should be upright throughout the use. They should routinely be replaced and never over fill them. Should be constructed to contain all contents and prevent leakage of fluids during handling, storage, transportation, and or shipping. They should be labeled or color-coded to indicate biohazard waste. And when you're completely done with them, they should be closed before removal to prevent spillage or protrusion of contents during handling.  

Next slide please. Think we're on the knowledge check. 

This is our final knowledge. The scenario and questions for today ask: You are collecting a throat swab from a patient at your testing site. What best testing practices would you follow to ensure the sample is collected properly and from the correct patient? A. only use a swab from the test kit or sample collection kit for the test ordered. B. Check at least two unique patient specific identifiers to verify the patient and the test order. C. Follow the test kit's manufacturer's instruction for sample collection. Or D. All of the above. And the end of the poll is coming up. 

And 98% of you got it right. All of the of the above D all of the above. Thank you for participating. Next slide. This is Summary of Ready? Set? Test! or Ready? and Set?. The educational materials are resources to provide testers the basic training necessary to safely and accurately perform waived testing. Prepare for testing by taking all necessary steps to ensure your resource or your results are accurate. 

Always follow the manufacturer's instructions. Reference the manufacturer’s instructions for when, why, and how to perform QC testing. Before collecting a patient sample confirm the test order and verify the patient's identification. Use the appropriate collection device for your test system and patient. And follow safe working practices to reduce risk of exposure. Okay, next slide. Now we will have, I guess, brief discussion or question and answer period. 

Thank you, Theresia and Amanda. We will take a few minutes to answer as many questions as possible. If we do not get to your question today, we'll do our best to answer it if you have not submitted that question anonymously. If you have a question after today's webinar, feel free to e-mail us at onelab@cdc.gov. Let's take some time. Let's see. Try to. Move that off my screen. Let's see. What do we have in the box? Don't see anything in the box. Let's start with what recommendations do you have to ensure testers are trained properly to form wave tests. 

Sure. I'll take that question. So first, you want to ensure that all testers have read and understand the manufacturer’s instructions in any site-specific procedure. If your testing site has those. For hands-on training, I recommend the tester should be trained by a more experienced tester who should be able to explain and demonstrate the testing process. After they've completed the hands-on training, the new testers should be able to also demonstrate the testing process correctly, while more experienced person watches, and this should all happen prior to them reporting any patient results. And then of course you want to document and have them file a record of their training. 

Mm-hmm. 

Thank you. Next question, do you recommend an annual competency? For waived test. Of the of those who perform waived tests, do you think that an annual competency is necessary? 

You want to take that one, Theresia? 

Yes, that I believe that is required to have annual competency. So you just basically watch them do the test, sign off that you've seen them do X number of tests that your facility has. So if you only are doing two or three waived testing and you watch them do all three, you can sign that off and say, you know, they met standards. And it needs to be documented and kept on file. 

Here is, this is an interesting one. Waived tests can be performed in patient's home. Is it still required to have a physical lab office to perform waived test? 

So waived tests can be performed anywhere. So no, it is not. It is required though that you have a CLIA Certificate of Waiver. So that is one thing that you should be mindful of, but yeah, waived tests can be performed anywhere. And we're increasingly seeing them performed in locations that you wouldn't expect, so. Yeah, home is fine. 

This is a great one. Is there a limit to the number of analyte tests? Uh. I'm not sure that they didn't finish spelling out CW certificates and then it the follow up to that is there's a test that has multiple results count as one analyte or as each as a separate. 

So I don't think that there is a limit. Theresia, correct me if I'm wrong. I don't think there's a limit for waived testing as far as each analyte. If the test reports out multiple different, like say, glucose, potassium, what have you? Yes, each of those are considered a separate analyte, so I know there are some newer wave tests that came on the market that do like COVID or strep flu. Each of those are considered a separate analyte. 

On the FDA's website as waived, that is an analyte that is waived. 

Yeah. 

Yes. 

And it should be recorded as separate; each one of them should be recorded separately. 

Mm-hmm. 

Does it? Is it required that only people who do patient testing do the QC? Some clinics like to have a person do a QC, but they never do a patient test. 

So I'll take that one because. 

If CMS finds out about that, that will not be a good thing. That's all I'm going to say. 

Exactly. I was just going to add that in, but I've actually seen that in some of the clinics that I used to oversee, they had one person that wanted to do the QC and then everybody else did testing for the rest of the day. That is not a good practice. I would recommend and CMS basically would probably tell you if they had to come in. QC needs to be performed by the person performing patient testing. So if you do a patient test, you should be able to do and you should do QC and you should have a record that you've done QC. 

OK. And that says so. No need for a physical office. And I think the bigger question is, is if they're actually doing patient samples, they should not be doing that at their home. If that's the question, this is a follow up to the one about, since you can do waived tests at home, do you need a physical lab space to do it? But they should not be doing better. 

When I first. I'm sorry, when I first heard that I was thinking of a visiting nurse who would come out and maybe, you know, do a glucose on you or do a rapid strep or do a one of the rapid COVID test in your home if it's a visiting nurse. If it's a waived test, then yes, you need to do QC and it needs to be documented. 

If you're doing it in a parking lot like the COVID test then you yes, you need a CLIA certificate. 

If you're a visiting nurse, you need the CLIA certificate. 

Yeah, this has some layers to it. Someone asked as far as where can they find the resources that you are you mentioned today? 

So I know during the first couple of slides the link should have been dropped in the chat. I can re-paste it in though as well. So all of our resources are on our CDC waived testing website. And the Ready? Set? Test! materials are there as well as other resources for waived testing. So this is not the only resource that we have available to help you and your wave testing labs. 

I have a question.  How should those who actually perform point-of-care testing the waived test at home dispose of that test and the specimen? Is it OK for them to put it into the regular trash can or should they actually be travelling with you know at home, have a biohazard bag? 

That one's deep, because if you're performing your own say, you are the patient and you are a diabetic and you're doing your own testing on yourself, you're going to throw that in the trash. But if you're a visiting nurse and you're going from patient to patient, I would expect for you to have a sharps container with you. I would think. But ask your superiors. 

And we'll take this one last question. Should a waived test user conduct a risk assessment before performing the test? 

I don't know who wants to take that one.  

Read that one again. I didn't understand it. Say it again please. 

Those who actually perform waived tests, should they conduct a risk assessment before they begin? 

So it's not required but, but as a good practice it's probably a good idea to just assess your area and look for any risk that could happen if you perform waived testing, but it's not required for waived testing. 

It's not required. It's a good idea. 

Well, that's all the time we have questions for. I'll turn it back over to Meredith. 

Thank you, Alicia, for facilitating and at this time, I would like to thank our presenters, Theresia and Amanda. We very much appreciate you being here today. As we wrap up, I want to let you all know that we will be having a follow-up to today's event. So we invite you to join our second session on October 2nd. That and that will be at the same time noon to 1 Eastern, and Theresia and Amanda will be presenting on that session as well. We will provide the registration link in the chat and let's go ahead to the next slide please. 

And want to invite you all to complete the evaluation for this event and use the link in the chat. We are feedback based. We welcome your thoughts and input on your training needs and feedback on OneLab Test so that we can build out this community and our resources to better serve you and to better support your work. We do use your input to select topics for future events and to better understand your needs. 

Next slide please. Thank you. So if you are interested in obtaining PACE credit and certificate from this event, please complete the Ready? Set? Test! e-learning course that is sort of a companion to the session that we just had. There will be a QR code on the screen that will redirect you to that course. It is available online and then as a reminder, we do post the slides and any links and supplemental materials to cdc.gov/onelab. The turnaround time for that is usually a couple of weeks from the event. So just continue to check back and we do hope you'll join us for the second part of this session. And thank you so much for participating and hope you all have a wonderful rest of the day.