A Guide To Specimen Management In Clinical Microbiology

A Guide to Specimen Management in Clinical Microbiology is the classic reference that addresses and meets the needs of everyone in the "total testing process" circle. It provides complete, concise information on the unique needs of the microbiology laboratory regarding specimen management and is the only single source for the specimen management policies required for laboratory results that are accurate, significant, and clinically relevant. Medical, nursing, and medical technology students, practicing physicians, private practice offices, clinical laboratories, and public health laboratories can turn to this valuable resource to answer their questions on issues such as the correct procedures of specimen selection, collection, transport, and storage in the clinical microbiology laboratory, the rationale associated with the specimen requirements, and proper communication between the lab and its clients.

This valuable and much needed reference/text provides details on proper communication between the lab and its clients, the rationale associated with the specimen requirements, and the correct procedures for specimen collection and management in the clinical microbiology laboratory. The first section looks at the premises on which quality microbiology diagnostic processes depend. It outlines the criteria that must be followed by the lab in the interest of good lab practice. The next section details the reasons why the lab must be involved in each part of the testing process, including the preanalytical, analytical and postanalytical steps. The rationale for stringent standards for specimen quality is also outlined. Section III gives instruction on how to select, collect, store and transport specimens for microbiological analysis. The last section contains excellent summary charts for quick reference for bacteriology, virology, mycology and parasitology specimens that can be used as a quick reference guide to answer most questions regarding the lab needs for a particular specimen.

This valuable and much needed reference/text provides details on proper communication between the lab and its clients, the rationale associated with the specimen requirements, and the correct procedures for specimen collection and management in the clinical microbiology laboratory. The first section looks at the premises on which quality microbiology diagnostic processes depend. It outlines the criteria that must be followed by the lab in the interest of good lab practice. The next section details the reasons why the lab must be involved in each part of the testing process, including the preanalytical, analytical and postanalytical steps. The rationale for stringent standards for specimen quality is also outlined. Section III gives instruction on how to select, collect, store and transport specimens for microbiological analysis. The last section contains excellent summary charts for quick reference for bacteriology, virology, mycology and parasitology specimens that can be used as a quick reference guide to answer most questions regarding the lab needs for a particular specimen.

In response to the ever-changing needs and responsibilities of the clinical microbiology field, Clinical Microbiology Procedures Handbook, Fourth Edition has been extensively reviewed and updated to present the most prominent procedures in use today. The Clinical Microbiology Procedures Handbook provides step-by-step protocols and descriptions that allow clinical microbiologists and laboratory staff personnel to confidently and accurately perform all analyses, including appropriate quality control recommendations, from the receipt of the specimen through processing, testing, interpretation, presentation of the final report, and subsequent consultation.

Although there are a number of comprehensive books in clinical micro biology, there remains a need for a manual that can be used in the clinical laboratory to guide the daily performance of its work. Most of the existing publications provide detailed and precise information, for example, by which a microorganism can be characterized and identified beyond any doubt; however, the number of tests involved in this process exceeds the capabilities and resources of most clinical laboratories and are irrele vant for patient care. It is, therefore, necessary in any clinical laboratory to extract from reference manuals, textbooks, and journals those tests and procedures that are to be used to complete the daily workload as efficiently and accurately as possible. It is also essential in the clinical laboratory to determine, on the basis of the kind of specimen being exam ined, which microorganisms are clinically relevant and require isolation and identification and which should either be excluded selectively or simply regarded as indigenous flora and, therefore, not specifically identi fied. Cost and time limit a laboratory's resources, and priorities must be established for handling the workload. The procedures described in the second edition of this manual are those selected by our staff for use in the clinical laboratory on the basis of clinic~l relevance, accuracy, reproducibility, and efficiency. Alternative procedures, when considered equivalent on the basis of personal or pub lished experience, have been included where appropriate.

Each year, NHS clinical laboratories carry out more than 700 million laboratory tests, of which 50 million are microbiology investigations. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, and up to 46% of ordered microbiology tests are inappropriate. In light of these accounts, the present study was undertaken to evaluate the process of microbiology specimen management in order to assess microbiology test utilisation and the appropriateness of the test ordering processes. The study focussed on respiratory tract specimens using sputum microbiology as a model for the microbiology service inappropriate test utilisation. The overall main aim of this study was to determine the appropriateness of clinical microbiology test utilisation, its clinical relevance and cost-effectiveness, hence recommend better utilisation strategies. A total of 15,941 respiratory tract samples from Barts and The London NHS Trust were randomly selected from the years 2004/05 and analysed retrospectively. Seven hundred microbiology laboratory request forms from patients for whom respiratory tract cultures were requested over a three month period were examined in detail. These requests were derived from 511 sputum specimens, 100 throat swabs, 63 ear swabs and 76 samples from other respiratory tract sites. 641 (91 %) of microbiology test requisition forms were completed, provided all requested details by the service users and were therefore considered as appropriate microbiology test requisitions. 660 (94%) of those examined stated the patient's clinical diagnosis and only in 65 (13%) of these patients was the stated diagnosis as respiratory tract infection. Sixty percent of sputum specimens examined were considered as poor quality. Forty percent of respiratory specimens were reported as culture positive, based on the local hospital criteria of microbiology test reporting. In sputum culture, 39% was reported as culture positive; however, less than 18% were positive with recognised respiratory pathogens, whilst 27% of throat swabs were reported as culture positive, of which 67% had throat pathogens. From the beginning of this study and before, there were no microbiology test comments and interpretation of test results provided with the test result reporting. The test turnaround time of respiratory microbiology results reported within three days in .2004/2005 was only 20%. The total inappropriate respiratory specimens processed locally were 9,575. Extrapolating from our results, this suggests that 2,153,977 nationally were inappropriate in NHS hospitals in 2004/2005. The total cost of inappropriate respiratory microbiology test use was approximately £152,000 in local NHS hospitals. Extrapolating from our results, this suggests that £23,900, 000 nationally was the total cost of inappropriate tests in the NHS hospitals. Following implementation of this study, follow up studies in 2006 and onwards indicated that there has been an improvement in the quality of the microbiology service. The number of good quality sputum specimens was 69% compared to 40% in 2004/2005. While the total microbiology test turnaround time that was reported within three days in 2009/2010 was more than 94%. From mid 2006 onwards, test interpretation comments have been used in all microbiology test result reporting. The total workload of respiratory tract microbiology activity decreased from 18,915/year to 16,651/year over the years 2004/2005 to 2007/2008, which is down nearly 8%. Analysis of the findings showed that the usefulness of culture results was limited by the collection of inappropriate specimens, and lack of clinical information on the microbiology request form. The crucial importance of the role of clinical and nursing staff is stressed if the clinical relevance of sputum culture is to be maximised. The increasing introduction of electronic pathology test requests gives new opportunities to restrict the collection of inappropriate specimens and make substantial savings in resources, both in the ward and the laboratory. This type of study and audit can give invaluable information about the rationale behind testing, and the appropriateness of sampling and transport time. Appropriate measures for corrective actions can be identified.

A collaborative effort of 150+ clinical microbiologists, medical laboratory technologists, and laboratory supervisors. • Provides step-by-step protocols and descriptions to enable clinical microbiologists and laboratory staff personnel to perform all analyses, including appropriate quality control recommendations, from the receipt of the specimen through processing, testing, interpretation, presentation of the final report, and subsequent consultation. • Emphasizes areas such as molecular approaches, bioterrorism, safety, and epidemiology/infection control in medical facilities. • Includes procedures that are formatted to adhere to the GP02-5A (2006) document of the National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute (NCCLS/CLSI).