The impact of automation on organizational changes in a community hospital clinical microbiology laboratory

The diagnosis of infectious diseases and the role of the microbiology laboratory are currently undergoing a process of change. The need for overall efficiency in providing results is now given the same importance as accuracy. This means that laboratories must be able to produce quality results in less time with the capacity to interpret the results clinically. To improve the clinical impact of microbiology results, the new challenge facing the microbiologist has become one of process management instead of pure analysis. A proper project management process designed to improve workflow, reduce analytical time, and provide the same high quality results without losing valuable time treating the patient, has become essential. Our objective was to study the impact of introducing automation and computerization into the microbiology laboratory, and the reorganization of the laboratory workflow, i.e. scheduling personnel to work shifts covering both the entire day and the entire week. In our laboratory, the introduction of automation and computerization, as well as the reorganization of personnel, thus the workflow itself, has resulted in an improvement in response time and greater efficiency in diagnostic procedures.     

Cost-containment strategies for the diagnostic microbiology laboratory

The goal of any cost-containment program should be to minimize operational expenses without reducing the quality of patient care. At present, microbiology is essentially a manual function; therefore, increases in specimen load and additional work per specimen lead to increased operating costs. Effective strategies are those that improve the efficiency of the laboratory by supplying only relevant information as quickly as possible and limit tests to those that impact directly on patient management. Educational effort to alter the ordering behavior of physicians should be instituted, but regulatory measures must be in place that permit the laboratory director to restrict excessive or inappropriate testing.     

The role of the clinical microbiology laboratory in transplantation

The clinical microbiology laboratory plays a central role in any transplantation program. Pretransplantation microbiologic testing often determines prophylactic treatment, donor selection, and blood product use. With suspected infection, rapid microbiologic tests permit prompt therapy but are challenged by an ever-changing diversity of potential pathogens and limited specimen size. Antigen detection and the polymerase chain reaction with nucleic acid hybridization are newer methods that promise earlier detection of such serious infections as disseminated aspergillosis and primary cytomegalovirus and may reveal new microbial causes of various posttransplantation syndromes.     

HIV检测对MSM人群艾滋病感染风险的影响

目的分析艾滋病检测对MSM人群知识、行为与感染HIV风险的影响,为调整MSM人群艾滋病防治策略提供依据。方法以过去一年接受过艾滋病检测的MSM人群为干预组,未接受过艾滋病检测的为对照组,比较两组的人口学特征、知识、行为以及梅毒与HIV感染率。结果干预组和对照组分别有423人和528人,平均年龄分别为（26.8±8.0）岁和（26.3±6.2）岁。干预组艾滋病防治知识知晓率高于对照组（χ2=28.9,P〈0.001）,最近6个月与男性发生无保护性性行为的比例低于对照组（χ2=14.7,P〈0.001）,HIV感染率明显低于对照组（χ2=15.0,P〈0.001）。结论艾滋病检测可以有效提高MSM人群安全套使用率,降低感染艾滋病的风险,应在MSM人群中倡导主动咨询检测,扩大咨询检测覆盖面。     

An audit of microbiology laboratory utilization: the diagnosis of infection in orthopedic surgery

Objective: To analyse the quality of ordering, collection and transport of specimens for microbiological analysis by a department of orthopedic surgery.
Methods: The analysis consisted of a prospective formal evaluation performed by two consultant microbiologists.
Results: One hundred and seventeen consecutive requests were audited. These requests belonged to 55 clinical episodes, 39 of which were of (presumed) infection and 16 of surveillance. The main sites sampled were: joint 28 (51%), and extra-articular bone or tissue 6 (11%). Of 98 surgical specimens, 20 (20%) yielded a relevant microorganism. The requests were classified as definitely appropriate in 67% and 85% of episodes, by the two consultants respectively. No request was considered unjustified. Collection, handling and transport were categorized as definitely appropriate in 56% and 73% of requests. Analysis of compliance with an existing protocol for prosthetic joint revision revealed similar errors.
Conclusion: Audits of this type can give invaluable information about the area of uncertainty between the clinician and the laboratory and can identify appropriate measures for corrective action.     

Evaluation of serum gentamicin assay procedures for a clinical microbiology laboratory

Four methods for the measurement of serum gentamicin concentration were evaluated with respect to cost-effectiveness, accuracy, and precision. Gentamicin concentration was determined in 112 clinical samples by the Staphlococcus epidermidis agar diffusion bioassay procedure in routine service in our laboratory at the time this study was initiated. Appropriate portions of these clinical samples were frozen and later thawed for remeasurement of gentamicin by bioassay or for measurement of gentamicin in one of three other systems. These included the Enzymatic Radiochemical Assay, the Diagnostic Products Corporation Radioimmunoassay and the New England Nuclear Corporation Radioimmunoassay. In addition, gentamicin dissolved in horse serum at 2, 4, 6, 8, 10, and 12 micrograms/ml was aliquoted, frozen, and later thawed for assay in each of the above systems. The data were analyzed for evidence of constant and proportional bias as well as for accuracy and precision.     

The use in routine of mass spectrometry in a hospital microbiology laboratory

Objectives

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been introduced in diagnostic microbiology laboratories for the identification of microorganisms. The mass fingerprint obtained by analyzing the ribosomal proteins and proteins associated with membranes is compared to spectra and superspectra of database. Microbiological Laboratory of Mulhouse acquired this system 1 year ago.

Method

The MALDI-TOF MS analyses of all strains were performed on Axima^® (Shimadzu), data analysis with Saramis^® software (Anagnostec) and integration with SirWeb^® software (I2A society).

Results

Rapidly, laboratory technicians and biologists are able to turn the system after a few days of training. The data prospectively gathered in the present study demonstrated that MALDI-TOF mass spectrometry identification is an efficient method included fastidious bacteria. Exactly 98.8 % of 10,000 isolates were identified in genus and species levels. Use of identification techniques was seldom necessary for a few clinical relevant isolates. The database is in constant evolution. The superspectra contain characteristic signals of genus, species allowing reliable microorganism identifications with high confidence.

Conclusion

In conclusion, our results show that MALDI-TOF MS is a fast and reliable technique for identification of most bacterial strains routinely isolated in a clinical microbiology. Identification and susceptibility testing with a single cell colony are more often possible. The simple tests, such as Gram staining and oxidase and catalase tests are usually performed in our laboratory.     

Data handling and reporting for microbiology specimens with a small laboratory computer system.

A small laboratory computer system designed for general application in chemistry, haematology, and urinalysis has been adapted for the bacteriology section of the laboratory using the same available programming routines. Specimens are requisitioned according to predetermined common site codes, with both preliminary and final reporting allowed for where desired. Sensitivity data also appended and entered where required, even for different organisms in the same culture.     

Psychosocial impact of the lipodystrophy syndrome in HIV infection

Lipodystrophy is a poorly understood condition associated with antiretroviral therapy in HIV infection. The symptoms may include some combination of central fat accumulation, peripheral fat depletion, and metabolic disturbance. A qualitative survey of 33 HIV-infected heterosexual women and gay men with lipodystrophy assessed psychosocial impact and effect on quality of life. Dominant themes included erosion of self-image and self-esteem, problems in social and sexual relations, threats to locus of control, forced HIV disclosure, and demoralization and depression. Another theme was clinicians' minimization of the importance of lipodystrophy. Further research is required to fully understand the psychosocial impact of lipodystrophy and to develop strategies that help individuals cope.