specimen management in diagnostic microbiology
TRANSCRIPT
SPECIMEN MANAGEMENT IN DIAGNOSTIC MICROBIOLOGY
Essential Basics Dr.T.V.Rao MD
BASIC THINKING ON LABORATORY MEDICINE
Isn’t it interesting how
little attention is paid to
the one process in
clinical microbiology
that has the most
influence on accurate
laboratory results and
contributes so much to
patient outcome and
safety?
A NEW CONCEPT IN DIAGNOSTIC MICROBIOLOGY
but only
Recently have microbiologists begun to promote specimen management as a process
critical to diagnostic success. Microbiology laboratory results that are accurate, significant, and clinically relevant depend
almost entirely on the specimen management process
PROPER MANAGEMENT HELPS THERAPEUTIC DECISIONS
Proper specimen
management is the key
to accurate laboratory
diagnosis and
reducing laboratory
errors; it directly
affects patient care
and patient outcome; it
influences therapeutic
decision
• ACCEPTING EVERY TRANSPORTDEVICE
IS IT SCIENTIFIC ?
A swab is not the collection device of choice for
many specimens, and for some specimens
special swabs will be necessary. The laboratory
must receive a specimen that is representative of
the disease process. Specimens submitted for
the diagnosis of otitis media should not be sent
on swabs since the flora on the swab will likely
be that of the external ear canal. The specimen of
choice is an aspirate from a tympanocentesis
SPECIMEN MANAGEMENT A NEW CONCEPT
The impact of proper specimen management on
patient care is enormous. It is the key to accurate
laboratory diagnosis and confirmation, it directly
affects patient care and patient outcomes, it
influences therapeutic decisions, it impacts hospital
infection control, and it impacts patient length of stay,
hospital costs, and laboratory costs, and influences
laboratory efficiency. Today it is essential the
clinicians should change the attitude towards the
Laboratory and to be more empowered with
interaction with laboratory specialists.
CLINICIAN INTERACTION IMPROVES THE LABORATORY PERFORMANCE
Today it is essential
the clinicians should
change the attitude
towards the
Laboratory and to be
more empowered with
interaction with
laboratory specialists.
TRY TO COLLECT THE SPECIMENS BEFORE ANTIBIOTIC THERAPY
Most Important criteria
of sample collection
continues to be a
specimen should be
collected prior to
administration of
antibiotics. Once
antibiotics have been
started, the flora
changes, leading to
potentially misleading
culture results
COLLECTING SPECIMENS FROM CRITICAL SITES
Microbiology
laboratories need
precise concepts to
collect the specimens
and use of special
skills and selective
media a must for
effective methods in
Diagnosis
APPROPRIATE LABELLING A MUST
Specimens must be labelled
accurately and completely so
that interpretation of results
will be reliable
Labels such as “eye” and
“wound specimens” are not
helpful to the interpretation
of results without more
specific site and clinical
information (e.g., surgical
site infection after
laparotomy).
FOLLOW THE LABORATORY MANUALS
The microbiology
laboratory policy manual
should be available at all
times for all medical staff
to review or consult and it
would be particularly
helpful to encourage the
nursing staff to review the
specimen collection and
management portion of the
manual
POOR QUALITY OF SPECIMENS TO BE REJECTED
Specimens of poor
quality must be rejected.
Microbiologists should
act correctly and with
responsibly when they
call physicians to clarify
and resolve problems
with specimen
submissions.
DO NOT PROCESS COMMENSALS
These specimens processed and many junior staff start reporting commensals and oral flora as pathogens, equally ignorant clinician, Physicians should not demand that the laboratory report “everything that grows,” thus providing irrelevant information that could result in inaccurate diagnosis and inappropriate therapy.
DO NOT CULTURE NORMAL MICROBIOTA
Many body sites have
normal microbiota that can
easily contaminate the
specimen. Therefore,
specimens from sites such
as lower respiratory tract
(sputum), nasal sinuses,
superficial wounds,
fistulae, and others require
care in collection.
SWABS ARE NOT OPTIMAL SPECIMENS FOR PROCESSING
Never forget the swab is never optimal, the laboratory requires a true clinical specimen, not a swab of a specimen. Actual tissue, aspirates, and fluids are always specimens of choice, especially from surgery. A swab is not the specimen of choice for many specimens because swabs pick up extraneous microbes, hold extremely small volumes of the specimen (0.05 mL),
HAVE TECHNICAL POLICY
The laboratory should
be allowed to set
technical policy; this is
not the purview of the
medical staff. Good
communication and
mutual respect will
lead to collaborative
policies.
APPROPRIATE MICROBIOLOGY SKILLS REDUCE SUPERBUGS
Microbiology laboratory
results that are reported
should be accurate,
significant, and clinically
relevant, do not report S.
pneumonia from throat
swabs, Susceptibility
testing should be
performed on clinically
significant isolates, not on
all microorganisms
recovered in culture.
APPROPRIATE MICROBIOLOGY SKILLS REDUCE SUPERBUGS
I wish you refer the Peer
reviewed Diagnostic
Microbiology text books or
else you are
communicating the
commensal and
contaminants as
pathogens and with
misuse of antibiotic as it a
concern in the Era of raise
of SUPER BUGS.
• ACCEPTING EVERY SPECIMEN.
This occurs mainly because laboratories
either are afraid or have no support
to say “no” to a physician or to reject
the specimen that was inappropriately
selected, collected, or transported. This
indicates that there is little support for
promoting quality in microbiology and
that someone other than the microbiologist is in charge of the technology
MICROBIOLOGY IS A UNIQUE SPECIALITY CARES LIFE
Good laboratory
practice always
puts patients
first.
Microbiology is
a unique
NEVER FORGET IT IS CLINICAL MICROBIOLOGY WE NEED SUPPORT OF PHYSICIANS
The microbiology laboratory needs th
support of its physicians, not just that of
laboratory management, to optimize the
information coming from it Laboratories
must be charged with the critical task of
evaluating specimen quality and this report
must be transmitted to the submitting
physician in order for an accurate
interpretation of specimen results to be
accomplished.
The Programme is Created and
Designed by Dr.T.V.Rao MD for Health
Professionals in Developing World