This document defines critical and alert values for microbiology test results. Critical values require immediate notification to clinicians, while alert values require timely intervention. Any positive results for certain dangerous pathogens like Cryptococcus in CSF or AFB in sputum smears are considered critical. Personnel must verify critical results, notify clinicians within 30 minutes, and document all communication. The laboratory has escalation procedures if the responsible clinician cannot be contacted. Proper patient identification and result verification steps must be followed to privately notify the healthcare team by phone. Various microbiology test results that would be reported as critical values are also listed.

1. ALERT VALUES
DR. ANIRUDH GUPTA
MBBS, MD, PGDHHM, PGDCR
CONSULTANT & HEAD, MICROBIOLOGY
SCIENTIFIC PATHOLOGY, AGRA

2. ISO 15189:2022
 CLAUSE – 7.4.1.3

3. DEFINITIONS
 CRITICAL VALUES
- Any test result that may require rapid
clinical attention to avert significant patient
morbidity or mortality.
- Critical values are defined by the medical
director of each technical section.
- Prompt verbal notification is provided to
clients for results that are defined critical
values and require the immediate attention of
a clinician.

4. CONTD.
 Alert values refer to any result that is not a
critical value but that requires timely
intervention (e.g., therapeutic drug
monitoring, public health, infection control
indication).

6. CRITICAL REPORT VALUES
 When examination results fall within established
critical decision limits:
a) the user or other authorized person is notified as
soon as relevant, based on clinical information
available;
b) actions taken are documented, including date, time,
responsible person, person notified, results conveyed,
verification of accuracy of communication, and any
difficulties encountered in notification;
c) the laboratory shall have an escalation procedure
for laboratory personnel when a responsible person
cannot be contacted.

7. CONTD.
 Persons responsible for informing
alert/critical values – Doctors & Technicians
on duty.
 All critical values to be informed within 30
mins.
 Record is to be maintained in ALERT VALUE
INFORMATION SHEET (SP/TECH/FR/02).

9. HOW TO VERBAL TEST RESULTS NOTIFICATION
 In compliance with HIPAA, test results are communicated verbally only to a
member of the healthcare team responsible for the patient and authorized to
take patient results. For authentication, client contacts are asked for:
a) Their full name (first and last)
b) Their department
c) Their position or title
 In addition to the critical test result(s), and any accompanying information, the
following information is provided:
a) Patient name, spelled out
b) medical record number and client ID number
c) Full test name
d) Date and time of collection
 The client contact receiving the verbal information is asked to:
a) Read back the test results
b) Read any other information provided
c) Correctly spell the patient’s full name

10. 5 STEPS
 CHECK
 CONFIRM
 CALL
 ASK FOR READ BACK
 MAINTAIN RECORD

11. ACTIVITIES RELATED TO CRITICAL ALERT
REPORTING
 Defining and identifying critical care results.
 Define and Identify pre-
analytical/analytical/post-analytical errors prior
to communication.
 Informing concerned lab consultant.
 Confirming Critical result.
 Communicating to concerned personnel
(verbal/report dispatch/electronic modes).
 Documentation (specific register and in case
files) and Communication of critical results (for
both in-house and outsourced).
 Performing Mock Drills.

15. LIST OF CRITICAL VALUES
MICROBIOLOGY
GRAM STAIN, CSF OR OTHER CNS SYSTEM SAMPLE POSITIVE
GRAM STAIN GAS ANGRENE
INDIA INK, CSF CRYPTOCOCCUS
ZN STAIN POSITIVE FOR AFB
STOOL CULTURE SALMONELLA/ SHIGELLA/ VIBRIO
EYE/ OCULAR CULTURE POSITIVE
ALBERT STAIN C. DIPHTHERIAE
HANGING DROP PREPARATION DARTING MOTILITY SEEN (PRESUMPTIVE V.
CHOLERAE)
CULTURE OF STERILE BODY FLUIDS/ BLOOD POSITIVE
SURGICAL WOUND GAS (S. PYOGENES)
BRUCELLA, LEGIONELLA, VRSA & VRE CULTURES POSITIVE
ANY MOULD (BAL,SPUTUM, TISSUE ETC.) POSITIVE
C. AURIS POSITIVE
NOCARDIA POSITIVE
B. anthracis, B. mallei, B. pseudomallei, F. tularensis, Y. pestis POSITIVE

16. CONTD.
INFECTIOUS SEROLOGY
VIRAL HEPATITIS (HAV, HBV, HCV,
HEV)
POSITIVE
ASO >600 IU/mL
CRP >320 mg/L
RA Factor >120 IU/mL

17. CONTD.
MOLECULAR TESTING
SARS CoV-2 POSITIVE
SWINE FLU (H1N1 2009) POSITIVE
MTB DETECTION RIFAMPICIN RESISTANT

18. THANK YOU