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  • 1. SPECIMEN MANAGEMENT IN DIAGNOSTIC MICROBIOLOGY Dr.T.V.Rao MD It is a new concept in changing world of Microbiology accreditations. Few years back the clinicians were demanding the specimens to be collected by laboratory staff, however I never agreed for the idea, as technicians are trained in laboratory technology, more than anything it disrupts the laboratory work efficiency. Microbiology specimen selection and collection are the responsibility of the medical staff, not usually the laboratory, although the qualified specialist may be called upon for consultation or assistance when the clinical do not know what is the importance and locating the site of infection. 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. If we wish to change the functional efficacy by decision making on the several specimens we receive in the laboratory, following criteria will certainly benefit 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. 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). 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. This can facilitate collaboration between the laboratories, with the microbiology expertise, and the specimen collection personnel, who may know very little about microbiology or what the laboratory needs in order to establish or confirm a diagnosis
  • 2. 1 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. Most errors are done in Sputum specimens just observe 25-30% specimens do not contain sputum. In this process we process the specimens and many junior staff start reporting commensals and oral flora as pathogens, equally ignorant clinician accepts the results with confidence, Physicians should not demand that the laboratory report “everything that grows,” thus providing irrelevant information that could result in inaccurate diagnosis and inappropriate therapy. 2 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. 3 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),make it difficult to get bacteria or fungi away from the swab fibres and onto media, and the inoculum from the swab is often not uniform across several different agar plates. Do remember if the organisms are growing on selective Medium but not growing on Blood agar or enriched there can be many basic errors should be acted on the matters immediately. 4 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. 5 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. 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. Ref and Abstracts -A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious
  • 3. Diseases Society of America (IDSA) and the American Society for Microbiology (ASM) a Ellen Jo Baron,etal. Dr.T.V.Rao MD Professor of Microbiology Freelance writer