Improving Gram stain proficiency in hospital and satellite laboratories that do not have microbiology
-
Jeannette Guarner
,
Cassandra Street
Abstract
Background:
Consolidation of laboratories has left many hospitals and satellite laboratories with minimal microbiologic testing. In many hospitals and satellite laboratories, Gram stains on primary specimens are still performed despite difficultly in maintaining proficiency.
Methods:
To maintain Gram stain proficiency at a community 450-bed hospital with an active emergency room we designed bimonthly challenges that require reporting Gram staining and morphology of different organisms. The challenges consist of five specimens prepared by the reference microbiology laboratory from cultures and primary specimens. Twenty to 23 medical laboratory scientists participate reading the challenges. Results from the challenges are discussed with each medical laboratory scientists. In addition, printed images from the challenges are presented at huddle to add microbiology knowledge.
Results:
On the first three challenges, Gram staining was read correctly in 71%–77% of the time while morphology 53%–66%. In the last six challenges correct answers for Gram stain were 77%–99% while morphology 73%–96%.
Conclusions:
We observed statistically significant improvement when reading Gram stains by providing frequent challenges to medical laboratory scientists. The clinical importance of Gram stain results is emphasized during huddle presentations increasing knowledge and motivation to perform the test for patients.
Author contributions:All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership:None declared.
Honorarium: None declared.
Competing interests:The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Sautter R, Thomson R. Consolidated clinical microbiology laboratories. J Clin Microbiol 2015;53:1467–72.10.1128/JCM.02569-14Suche in Google Scholar PubMed PubMed Central
2. Clinical-Laboratory-Improvement-Ammendments. Proficiency testing. 2008. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/cliabrochure8.pdf. Accessed: Feb 2016.Suche in Google Scholar
3. Munson E, Block T, Basile J, Hryciuk J, Schell R. Mechanisms to assess Gram stain interpretation proficiency of technologists at satellite laboratories. J Clin Microbiol 2007;45:3754–8.10.1128/JCM.01632-07Suche in Google Scholar PubMed PubMed Central
4. Goodyear N, Kim S, Reeves M, Astion M. A 2-year study of Gram stain competency assessment in 40 clinical laboratories. Am J Clin Pathol 2006;125:28–33.10.1309/40WD3015CH1RYH58Suche in Google Scholar
5. Church D, Melnyk E, Unger B. Quantitative Gram stain interpretation criteria used by microbiology laboratories in Alberta, Canada. J Clin Microbiol 2000;38:4266–8.10.1128/JCM.38.11.4266-4268.2000Suche in Google Scholar PubMed PubMed Central
6. Tunkel A, Hartman B, Kaplan S, Kaufman B, Roos K, Scheld W, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267–84.10.1086/425368Suche in Google Scholar PubMed
7. Elbireer A, Jackson J, Sendagire H, Opio A, Bagenda D, Amukele T. The good, the bad, and the unknown: quality of clinical laboratories in Kampala, Uganda. PLoS One 2013;8:e64661.10.1371/journal.pone.0064661Suche in Google Scholar PubMed PubMed Central
8. Tissot F, Prod’hom G, Manuel O, Greub G. Impact of round-the-clock CSF Gram stain on empirical therapy for suspected central nervous system infections. Eur J Clin Microbiol Infect Dis 2015;34:1849–57.10.1007/s10096-015-2423-9Suche in Google Scholar PubMed
9. Shifflett G, Nwachukwu B, Bjerke-Kroll B, Kueper J, Koltsov J, Sama A, et al. The value of intraoperative Gram stain in revision spine surgery. Spine J 2015;15:2198–205.10.1016/j.spinee.2015.06.001Suche in Google Scholar PubMed
10. Yuan S, Astion M, Schapiro J, Limaye A. Clinical impact associated with corrected results in clinical microbiology testing. J Clin Microbiol 2005;43:2188–93.10.1128/JCM.43.5.2188-2193.2005Suche in Google Scholar PubMed PubMed Central
11. Parry C, White R, Ridgeway E, Corkill J, Smith G. The reproducibility of sputum gram film interpretation. J Infect 2000;41:55–60.10.1053/jinf.2000.0680Suche in Google Scholar PubMed
12. Bloch M, Cembrowski G, Lembesis G. Longitudinal study of error prevalence in Pennsylvania physicians’ office laboratories. J Am Med Assoc 1988;260:230–5.10.1001/jama.1988.03410020096036Suche in Google Scholar
©2017 Walter de Gruyter GmbH, Berlin/Boston
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Artikel in diesem Heft
- Frontmatter
- Editorials
- Targeting errors in microbiology: the case of the Gram stain
- Time for a holistic approach and standardization education in laboratory medicine
- Reviews
- Serum uric acid levels and risk of prehypertension: a meta-analysis
- Lactic acidosis: an update
- Mini Review
- Progress and impact of enzyme measurement standardization
- Opinion Paper
- Critical comments to a recent EFLM recommendation for the review of reference intervals
- IFCC Paper
- Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group “Laboratory Errors and Patient Safety” project
- Genetics and Molecular Diagnostics
- Evaluation and comparison of three assays for molecular detection of spinal muscular atrophy
- General Clinical Chemistry and Laboratory Medicine
- Risk analysis of the preanalytical process based on quality indicators data
- Analytical and clinical validation of the new Abbot Architect 25(OH)D assay: fit for purpose?
- Looking beyond linear regression and Bland-Altman plots: a comparison of the clinical performance of 25-hydroxyvitamin D tests
- Next-generation osmotic gradient ektacytometry for the diagnosis of hereditary spherocytosis: interlaboratory method validation and experience
- Diagnosis of sphingolipidoses: a new simultaneous measurement of lysosphingolipids by LC-MS/MS
- Monitoring nicotine intake from e-cigarettes: measurement of parent drug and metabolites in oral fluid and plasma
- Development of a rapid and quantitative lateral flow assay for the simultaneous measurement of serum κ and λ immunoglobulin free light chains (FLC): inception of a new near-patient FLC screening tool
- A real-world evidence-based approach to laboratory reorganization using e-Valuate benchmarking data
- Cancer Diagnostics
- Utility of proGRP as a tumor marker in the medullary thyroid carcinoma
- Cardiovascular Diseases
- Can non-cholesterol sterols and lipoprotein subclasses distribution predict different patterns of cholesterol metabolism and statin therapy response?
- Infectious Diseases
- Improving Gram stain proficiency in hospital and satellite laboratories that do not have microbiology
- Diabetes
- Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients
- Corrigendum
- EFLM Recommendation
- Corrigendum to: Recommendation for the review of biological reference intervals in medical laboratories
- Letters to the Editor
- Evaluation of the trueness of serum alkaline phosphatase measurement in a group of Italian laboratories
- Innovative software for recording preanalytical errors in accord with the IFCC quality indicators
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- Identification of 5-fluorocytosine as a new interfering compound in serum capillary zone electrophoresis
- How to define reference intervals to rule in healthy individuals for clinical trials?
- Evaluation of the performance of INDEXOR® in the archive unit of a clinical laboratory: a step to Lean laboratory
- Evaluation of an automated chemiluminescent immunoassay for salivary cortisol measurement. Utility in the diagnosis of Cushing’s syndrome
- Analysis of hemolysis, icterus and lipemia in arterial blood gas specimens
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