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REPORTING
IN
DIAGNOSTIC
MICROBIOLOGY
Dr.T.V.RaoMD
5/1/2018 Dr.T.V.Rao MD
FROM PAST TO FUTURE
WE ARE IN TRANSITION
5/1/2018 Dr.T.V.Rao MD
WHAT IS A REPORT
•Writing lab reports is part of
learning to be a scientist, and
provides you with experience in
writing in a scientific style similar
to that used in articles published
in Text books scientific journals.
5/1/2018 Dr.T.V.Rao MD
Future of Biology Changed with PCR
5/1/2018 Dr.T.V.Rao MD
Career in Transition from Clinics to Laboratory
5/1/2018 Dr.T.V.Rao MD
Infectious Diseases
are many limited by our knowledge, facilities
and ignorance?
•Bacterial
•Viral
•Fungal
•Parasitic
5/1/2018 Dr.T.V.Rao MD
3 great ideas to improve the
diagnostic microbiology
• Were the reports provided
are accurate?
• Were they clinically
relevant?
• Could we improve?
5/1/2018 Dr.T.V.Rao MD
Supporting Laboratory Results
• Viral
• Identification of virus
• Normal or Decreased WBC Count
• Increased Lymphocyte Count
• Parasitic
• Identification of parasite
• Increased Eosinophil Count
• Bacterial
• Identification of bacteria
• Increased WBC Count
• Increased Neutrophil Count
• Left-shift in Neutrophil Cell Line
• Increased CRP
• Increased Sed-Rate
• Fungal
• KOH Prep Test
• Identification of fungal elements
5/1/2018 Dr.T.V.Rao MD
Think before reporting
Microbiology results we perform has
many limitations
• To determine significance
of result requires
knowledge of the
patient’s clinical status
• The report should
encourage communication
between clinician and
medical microbiologist
5/1/2018 Dr.T.V.Rao MD
Microbiology is not a accurate Science
• To determine significance
of result requires
knowledge of the patient’s
clinical status The report
should encourage
communication
•GOOD
COMMUNICATION ?
Makes a difference
5/1/2018 Dr.T.V.Rao MD
Key points - 1
• Microbes are infectious agents not visible to the naked eye
• Widespread in nature and some cause human disease
• Diagnosis of infection by the microbiology laboratory has two important
functions
•Clinical
• Epidemiological surveys within and outside the Hospital
•The laboratory should determine the most frequent
microbes causing infections, including HAI
pathogens
5/1/2018 Dr.T.V.Rao MD
Why Plan?
• Laboratory requirements relate to investigation objectives
• confirm a diagnosis to document an infection?
• document a common source?
• provide information to help clinical management (antibiotic
resistance)?
•What laboratory tests help answer the
objective(s)?
•What specimens are required for the laboratory
test(s)?
•What’s the sampling strategy?
5/1/2018 Dr.T.V.Rao MD
Definition of Terms
• Normally sterile site: sites in the human body that are normally free
from organisms or foreign material, e.g. blood, joint, brain, etc.
• Unsterile site: sites in the human body that generally harbor
microorganisms, e.g. gut, oral cavity, nose, skin, etc
•Specimen: a sample of tissue (blood, urine, etc.) that may or may not
contain organisms
•Isolate: a population of organisms (bacteria) that has been separated
from a mixture
• Serotype: a group of closely related organisms with distinct
characteristics.
• Assay: A test to detect or quantify a substance in a sample.
Dr.T.V.Rao MD5/1/2018
Laboratory Reports
5/1/2018 Dr.T.V.Rao MD
Simplifying Laboratory
Test Interpretation
•WE SHOULD REPORT
THE LABORATORY TEST
RESULTS AND MAKE
MATTERS SIMPLE
•WE ADVICE AND
SUGGEST
•WE IGNORE TOO
5/1/2018 Dr.T.V.Rao MD
Laboratory Tests
Detection Methods
oMicroscopy
oCulture
oAntigen test*
 Identification Methods
o PCR*
o Viral load*
o PFGE
o Genotyping
 Serology
 Antimicrobial susceptibility
 Ancillary tests
Dr.T.V.Rao MD5/1/2018
DEFINITION of
• Critical results are results that
are considered potentially life
threatening unless acted
upon promptly. Fast
communication matters ?
• Urgent results are results that
are not critical but
sufficiently significant to alert
the health care provider
5/1/2018 Dr.T.V.Rao MD
Culture
The process of growing and propagating organisms in a media
that is conducive for their growth.
Pros:
• Confirm the organism
• Reproduce the organism and use
for additional testing
Cons:
• Delay in confirmation
• Require viable organism
• Difficult for fastidious organisms
S. pneumoniae on blood agar plate
Dr.T.V.Rao MD
colony
5/1/2018
HOW TO USE THE LABORATORY
• Reports to the clinician from
the clinical microbiology
service can provide comments
that interpret isolate
significance, provide
antimicrobial susceptibility
interpretation and provide
antimicrobial management
advice
5/1/2018 Dr.T.V.Rao MD
Microbiology Differs from other Laboratory
services
•'How is this result
to be explained to
the clinician?' is an
equally important
question, as yet
little discussed.
5/1/2018 Dr.T.V.Rao MD
Tips when reviewing a laboratory report
IS IT A INFECTION
• Is the organism (or disease)
reportable?
• When was the specimen
obtained in relation to
onset of illness?
• Was the source from a normally
sterile site?
• Were antibiotics used prior
to specimen collection?
Dr.T.V.Rao MD5/1/2018
LIST OF
CRITICAL
RESULTS
• ·Positive results from direct
examination (e.g., Gram stain) of
normally sterile body
• fluids/sites, including blood, CSF and
tissue.Positive culture results for
normally sterile body fluids/sites,
including blood, CSF and tissues.
• ·Malaria5/1/2018 Dr.T.V.Rao MD
'Is it significant
•'Is it significant?' is
the question posed,
implicitly or
rexplicitly, whenever
a culture from a
patient has yielded a
micro-organism.
5/1/2018 Dr.T.V.Rao MD
Antimicrobial Susceptibility
MIC (minimum inhibitory concentration)
• lowest concentration of antimicrobials
that will inhibit the growth of organisms.
MICs are important to confirm resistance of
organisms to an antimicrobial agent.
Methods:
• Disk diffusion test
• E test
• Broth dilution test
Dr.T.V.Rao MD
MIC
5/1/2018
Reporting susceptibility reports
•Consider:
Recommendations for
therapy at each stage
of reporting
Adding interpretive
comments
Keep it clinically
relevant
5/1/2018 Dr.T.V.Rao MD
Utilization of Culture Reports
•Review of culture
reports in 1050
hospitalized patients
Only 7% of culture
results resulted in a
change of therapy
• Ref Edwards et al Arch Intern Med 1973
5/1/2018 Dr.T.V.Rao MD
Why many Antimicrobial susceptible results are
not used by clinicians?
•Information overload multiple specimens
from different sources eg from ICU in a
critical patient,
Reports more allied to the laboratory than
to the clinician
Confusion between accuracy and clinical
relevance
Common laboratory terms cause confusion
• Ref Edwards et al Arch Intern Med 1973
5/1/2018 Dr.T.V.Rao MD
a laboratory result cannot be confusing factor
try solving the problem
5/1/2018 Dr.T.V.Rao MD
MEDICAL LABORATORY
PROFESSIONALS WEEK
APRIL 22-28, 2018
• Medical Laboratory Professionals Week
(MLPW) provides the profession with a
unique opportunity to increase public
understanding of and appreciation for
clinical laboratory personnel.
• MLPW, which takes place the last full
week in April each year, is coordinated
by a collaborative committee with
representatives from 17 national clinical
laboratory organizations, including
ASCLS. Now in it's 43rd year,
5/1/2018 Dr.T.V.Rao MD
Faster Results in ICU Care
•The establishment of
best practice
procedures for rapid
microbiological
evaluation is critical to
delivering timely and
accurate information
5/1/2018 Dr.T.V.Rao MD
Laboratory reports in ICU Care
• Intensive care units are an area
of particular importance, as the
control of resistance in these
units can affect other areas of
the hospital. The clinical
microbiology service
should therefore pay particular
attention to services provided to
these areas.
5/1/2018 Dr.T.V.Rao MD
How Surveillance Data helpful
•The clinical microbiology
service provides
surveillance data on
resistant organisms for
infection control
purposes. Try implement
the WHONET software
with inclusion of CLSI
GUIDELINES,
5/1/2018 Dr.T.V.Rao MD
The Wisdom of Microbiologists a great
contribution
•Microbiology reports
should also include a
range of comments to
help clinicians
distinguish infection
from contamination or
colonisation (i.e.
antimicrobial therapy is
therefore not required)
5/1/2018 Dr.T.V.Rao MD
Challenges with Automation
•Rushing to introduce
automation without
careful planning to
account for existing
clinical processes is the
Achilles’ heel of any
health IT implementation
5/1/2018 Dr.T.V.Rao MD
Interpretative reporting of microbiology
• Interpretative reporting of
microbiology results entails
the addition of a comment
to the report, giving the
likely significance of the
organism(s) isolated and,
where necessary, specific
advice on therapy.
5/1/2018 Dr.T.V.Rao MD
How much our Reports accepted ????
•The use of
interpretative
comments appended to
microbiology reports
has been shown to
allow clinicians to make
informed decisions
based on such reports.
5/1/2018 Dr.T.V.Rao MD
Parasitology & Mycology
• Direct Examination
• Macroscopic and Microscopic
5/1/2018 Dr.T.V.Rao MD
Education of Clinicians a challenging task
•There is clearly a need
for education of
clinicians regarding
indications for sending
specimens and
applying results to
patient management.
5/1/2018 Dr.T.V.Rao MD
Alert organism reports
• Identify possible agreed ‘alert’ microorganisms
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Vancomycin-intermediate S.aureus (VISA)
• Vancomycin-resistant enterococci (VRE)
• MDR Pseudomonas aeruginosa
• MDR Acinetobacter baumannii
• MDR Mycobacterium tuberculosis
• ESBL enterobacteria
•Clostridium difficile
5/1/2018 Dr.T.V.Rao MD
5/1/2018 Dr.T.V.Rao MD
Writing style in lab reports
• When writing a lab report it is important you use
a scientific writing style. This means you should
aim for writing that is clear, objective, accurate and
brief.
• It is best to use short simple sentences rather than
long complicated ones that have the potential to
confuse the reader. Although you will need to use
specialist terms in your report, you should also use
familiar non-technical terms where possible
5/1/2018 Dr.T.V.Rao MD
Communication solves many ill understood
ideas
• Encourage two way
communication with laboratory
• Employ terms that are readily
understood
• Communicate clinically relevant
results
• (probable infection or probable
contamination) State when
further clinical assessment
required
5/1/2018 Dr.T.V.Rao MD
Documenting and Auditing with WHO NET
•The clinical
microbiology service
provides surveillance
data on resistant
organisms for infection
control purposes. Try
implement the
WHONET software with
inclusion of CLSI
GUIDELINES,
5/1/2018 Dr.T.V.Rao MD
GRWOING DEMANDS ON CLINICAL
MICROBIOLOGISTS
• The clinical microbiology
laboratory is being
challenged to do more
work, identify more
microorganisms, report
complex and changing
drug-related
information, automate
procedures,
5/1/2018 Dr.T.V.Rao MD
Technology developing faster than we
understand the pitfalls
• With change, though, as always,
there are challenges: technology
is developing at an almost too-
rapid pace, vast amounts of
information which are difficult to
manage and communicate are
being generated, standards
either do not exist or are not
adequately useful for many
targets/platforms,
5/1/2018 Dr.T.V.Rao MD
Growing Challenge to Medial Microbiologists
• Many decisions in clinical
microbiology practice are not
being made using evidence
based information.
Ultimately, we need to be
able improve how we
communicate so that we are
more effective in our ability
to report results and ensure
appropriate interpretation
5/1/2018 Dr.T.V.Rao MD
Using laboratory evidence to confirm a
diagnosis during an outbreak
•Short list potential etiologic agents (hypothesis generating)
according to:
• Epidemiological characteristics
• Clinical characteristics
• Setting
•Test for agents short listed (hypothesis testing)
• Positive test
• Negative test
•Use predictive values positive and negatives
5/1/2018 Dr.T.V.Rao MD
Whats the Clinical Benefit of our reporting
•'How is this
result to be
explained to
the clinician?'
5/1/2018 Dr.T.V.Rao MD
A test was negative only for the pathogens that
were looked for
•If the culture on a specific medium was
not done, the test cannot be interpreted
as negative for the specific pathogen
•If you did not ask for Campylobacter
culture, the “negative” stool culture is not
really “negative” for Campylobacter
5/1/2018 Dr.T.V.Rao MD
Reporting Results
•Clinical microbiology
laboratory needs
include reporting
nonnumerical results,
such as the genus and
species name of an
identified organism.,
5/1/2018 Dr.T.V.Rao MD
qualitative, semiquantitative, and/or
quantitative data,
•Microbiology
results often
include qualitative,
semiquantitative,
and/or
quantitative data,
5/1/2018 Dr.T.V.Rao MD
laboratory REQUEST is consolation
• Every microbiology sample is
a consultation, Making sure
the report it is accurate is
good Making sure the report
is clinically relevant and
clear is better
Making sure the report
optimizes clinical outcome is
best
5/1/2018 Dr.T.V.Rao MD
Err is Human
• Sources of potential cases of
laboratory-related adverse
events include internal
laboratory incident reports, risk
management incident reports,
physician complaints and other
forms of physician collaboration,
and a variety of daily
information system reports
5/1/2018 Dr.T.V.Rao MD
Correction is Divine
•In the testing process
areas involving non-
laboratory personnel,
interdepartmental
communication and
cooperation are crucial
to avoid errors.
5/1/2018 Dr.T.V.Rao MD
TEAM EFFORT MAKES A GREAT DIFFERENCE
• Therefore the entire
health care system must
be involved in improving
the total testing process.
There must be adequate
and effective training of
personnel throughout
the institution
5/1/2018 Dr.T.V.Rao MD
Who will Sign Laboratory Reports
5/1/2018 Dr.T.V.Rao MD
Solving Laboratory conflicts
• Very simply, Scott believes that the first step
should be to get rid of the emotions behind the
issue..
Step two is a close examination of the issues
behind the conflict. This rational thought
process is then (in step three) supplemented by
your intuition about the choices in front of you.
Overcoming Conflicts in the Lab—and Beyond
5/1/2018 Dr.T.V.Rao MD
HUMAN NEEDS MORE IMPORTANT THAN OUR
EGOSTIC FIGHTING
•You can't solve the
problem without
understanding the
human needs and
interests of the
people involved in
the conflict.
5/1/2018 Dr.T.V.Rao MD
Summary
•Basic understanding of a laboratory test
is key to maximizing its use.
•Laboratory tests have ‘strengths’ and
‘weaknesses’.
•Timing is everything!
(between disease onset and specimen
collection)
5/1/2018 Dr.T.V.Rao MD
LIFE IS A GREAT FIGHT TO SURVVIE
MORE QUESTIONS THAN ANSWERS
5/1/2018 Dr.T.V.Rao MD
Younger Microbiologists Under stress and
accountability
5/1/2018 Dr.T.V.Rao MD
•Program Created by Dr.T.V.Rao MD for benefit
of Medical and Clinical Microbiologists in the
Developing world
• Email
• doctortvrao@gmail.com
5/1/2018 Dr.T.V.Rao MD

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How the clinical microbiologist should report the laboratory Results

  • 2. FROM PAST TO FUTURE WE ARE IN TRANSITION 5/1/2018 Dr.T.V.Rao MD
  • 3. WHAT IS A REPORT •Writing lab reports is part of learning to be a scientist, and provides you with experience in writing in a scientific style similar to that used in articles published in Text books scientific journals. 5/1/2018 Dr.T.V.Rao MD
  • 4. Future of Biology Changed with PCR 5/1/2018 Dr.T.V.Rao MD
  • 5. Career in Transition from Clinics to Laboratory 5/1/2018 Dr.T.V.Rao MD
  • 6. Infectious Diseases are many limited by our knowledge, facilities and ignorance? •Bacterial •Viral •Fungal •Parasitic 5/1/2018 Dr.T.V.Rao MD
  • 7. 3 great ideas to improve the diagnostic microbiology • Were the reports provided are accurate? • Were they clinically relevant? • Could we improve? 5/1/2018 Dr.T.V.Rao MD
  • 8. Supporting Laboratory Results • Viral • Identification of virus • Normal or Decreased WBC Count • Increased Lymphocyte Count • Parasitic • Identification of parasite • Increased Eosinophil Count • Bacterial • Identification of bacteria • Increased WBC Count • Increased Neutrophil Count • Left-shift in Neutrophil Cell Line • Increased CRP • Increased Sed-Rate • Fungal • KOH Prep Test • Identification of fungal elements 5/1/2018 Dr.T.V.Rao MD
  • 9. Think before reporting Microbiology results we perform has many limitations • To determine significance of result requires knowledge of the patient’s clinical status • The report should encourage communication between clinician and medical microbiologist 5/1/2018 Dr.T.V.Rao MD
  • 10. Microbiology is not a accurate Science • To determine significance of result requires knowledge of the patient’s clinical status The report should encourage communication •GOOD COMMUNICATION ? Makes a difference 5/1/2018 Dr.T.V.Rao MD
  • 11. Key points - 1 • Microbes are infectious agents not visible to the naked eye • Widespread in nature and some cause human disease • Diagnosis of infection by the microbiology laboratory has two important functions •Clinical • Epidemiological surveys within and outside the Hospital •The laboratory should determine the most frequent microbes causing infections, including HAI pathogens 5/1/2018 Dr.T.V.Rao MD
  • 12. Why Plan? • Laboratory requirements relate to investigation objectives • confirm a diagnosis to document an infection? • document a common source? • provide information to help clinical management (antibiotic resistance)? •What laboratory tests help answer the objective(s)? •What specimens are required for the laboratory test(s)? •What’s the sampling strategy? 5/1/2018 Dr.T.V.Rao MD
  • 13. Definition of Terms • Normally sterile site: sites in the human body that are normally free from organisms or foreign material, e.g. blood, joint, brain, etc. • Unsterile site: sites in the human body that generally harbor microorganisms, e.g. gut, oral cavity, nose, skin, etc •Specimen: a sample of tissue (blood, urine, etc.) that may or may not contain organisms •Isolate: a population of organisms (bacteria) that has been separated from a mixture • Serotype: a group of closely related organisms with distinct characteristics. • Assay: A test to detect or quantify a substance in a sample. Dr.T.V.Rao MD5/1/2018
  • 15. Simplifying Laboratory Test Interpretation •WE SHOULD REPORT THE LABORATORY TEST RESULTS AND MAKE MATTERS SIMPLE •WE ADVICE AND SUGGEST •WE IGNORE TOO 5/1/2018 Dr.T.V.Rao MD
  • 16. Laboratory Tests Detection Methods oMicroscopy oCulture oAntigen test*  Identification Methods o PCR* o Viral load* o PFGE o Genotyping  Serology  Antimicrobial susceptibility  Ancillary tests Dr.T.V.Rao MD5/1/2018
  • 17. DEFINITION of • Critical results are results that are considered potentially life threatening unless acted upon promptly. Fast communication matters ? • Urgent results are results that are not critical but sufficiently significant to alert the health care provider 5/1/2018 Dr.T.V.Rao MD
  • 18. Culture The process of growing and propagating organisms in a media that is conducive for their growth. Pros: • Confirm the organism • Reproduce the organism and use for additional testing Cons: • Delay in confirmation • Require viable organism • Difficult for fastidious organisms S. pneumoniae on blood agar plate Dr.T.V.Rao MD colony 5/1/2018
  • 19. HOW TO USE THE LABORATORY • Reports to the clinician from the clinical microbiology service can provide comments that interpret isolate significance, provide antimicrobial susceptibility interpretation and provide antimicrobial management advice 5/1/2018 Dr.T.V.Rao MD
  • 20. Microbiology Differs from other Laboratory services •'How is this result to be explained to the clinician?' is an equally important question, as yet little discussed. 5/1/2018 Dr.T.V.Rao MD
  • 21. Tips when reviewing a laboratory report IS IT A INFECTION • Is the organism (or disease) reportable? • When was the specimen obtained in relation to onset of illness? • Was the source from a normally sterile site? • Were antibiotics used prior to specimen collection? Dr.T.V.Rao MD5/1/2018
  • 22. LIST OF CRITICAL RESULTS • ·Positive results from direct examination (e.g., Gram stain) of normally sterile body • fluids/sites, including blood, CSF and tissue.Positive culture results for normally sterile body fluids/sites, including blood, CSF and tissues. • ·Malaria5/1/2018 Dr.T.V.Rao MD
  • 23. 'Is it significant •'Is it significant?' is the question posed, implicitly or rexplicitly, whenever a culture from a patient has yielded a micro-organism. 5/1/2018 Dr.T.V.Rao MD
  • 24. Antimicrobial Susceptibility MIC (minimum inhibitory concentration) • lowest concentration of antimicrobials that will inhibit the growth of organisms. MICs are important to confirm resistance of organisms to an antimicrobial agent. Methods: • Disk diffusion test • E test • Broth dilution test Dr.T.V.Rao MD MIC 5/1/2018
  • 25. Reporting susceptibility reports •Consider: Recommendations for therapy at each stage of reporting Adding interpretive comments Keep it clinically relevant 5/1/2018 Dr.T.V.Rao MD
  • 26. Utilization of Culture Reports •Review of culture reports in 1050 hospitalized patients Only 7% of culture results resulted in a change of therapy • Ref Edwards et al Arch Intern Med 1973 5/1/2018 Dr.T.V.Rao MD
  • 27. Why many Antimicrobial susceptible results are not used by clinicians? •Information overload multiple specimens from different sources eg from ICU in a critical patient, Reports more allied to the laboratory than to the clinician Confusion between accuracy and clinical relevance Common laboratory terms cause confusion • Ref Edwards et al Arch Intern Med 1973 5/1/2018 Dr.T.V.Rao MD
  • 28. a laboratory result cannot be confusing factor try solving the problem 5/1/2018 Dr.T.V.Rao MD
  • 29. MEDICAL LABORATORY PROFESSIONALS WEEK APRIL 22-28, 2018 • Medical Laboratory Professionals Week (MLPW) provides the profession with a unique opportunity to increase public understanding of and appreciation for clinical laboratory personnel. • MLPW, which takes place the last full week in April each year, is coordinated by a collaborative committee with representatives from 17 national clinical laboratory organizations, including ASCLS. Now in it's 43rd year, 5/1/2018 Dr.T.V.Rao MD
  • 30. Faster Results in ICU Care •The establishment of best practice procedures for rapid microbiological evaluation is critical to delivering timely and accurate information 5/1/2018 Dr.T.V.Rao MD
  • 31. Laboratory reports in ICU Care • Intensive care units are an area of particular importance, as the control of resistance in these units can affect other areas of the hospital. The clinical microbiology service should therefore pay particular attention to services provided to these areas. 5/1/2018 Dr.T.V.Rao MD
  • 32. How Surveillance Data helpful •The clinical microbiology service provides surveillance data on resistant organisms for infection control purposes. Try implement the WHONET software with inclusion of CLSI GUIDELINES, 5/1/2018 Dr.T.V.Rao MD
  • 33. The Wisdom of Microbiologists a great contribution •Microbiology reports should also include a range of comments to help clinicians distinguish infection from contamination or colonisation (i.e. antimicrobial therapy is therefore not required) 5/1/2018 Dr.T.V.Rao MD
  • 34. Challenges with Automation •Rushing to introduce automation without careful planning to account for existing clinical processes is the Achilles’ heel of any health IT implementation 5/1/2018 Dr.T.V.Rao MD
  • 35. Interpretative reporting of microbiology • Interpretative reporting of microbiology results entails the addition of a comment to the report, giving the likely significance of the organism(s) isolated and, where necessary, specific advice on therapy. 5/1/2018 Dr.T.V.Rao MD
  • 36. How much our Reports accepted ???? •The use of interpretative comments appended to microbiology reports has been shown to allow clinicians to make informed decisions based on such reports. 5/1/2018 Dr.T.V.Rao MD
  • 37. Parasitology & Mycology • Direct Examination • Macroscopic and Microscopic 5/1/2018 Dr.T.V.Rao MD
  • 38. Education of Clinicians a challenging task •There is clearly a need for education of clinicians regarding indications for sending specimens and applying results to patient management. 5/1/2018 Dr.T.V.Rao MD
  • 39. Alert organism reports • Identify possible agreed ‘alert’ microorganisms • Methicillin-resistant Staphylococcus aureus (MRSA) • Vancomycin-intermediate S.aureus (VISA) • Vancomycin-resistant enterococci (VRE) • MDR Pseudomonas aeruginosa • MDR Acinetobacter baumannii • MDR Mycobacterium tuberculosis • ESBL enterobacteria •Clostridium difficile 5/1/2018 Dr.T.V.Rao MD
  • 41. Writing style in lab reports • When writing a lab report it is important you use a scientific writing style. This means you should aim for writing that is clear, objective, accurate and brief. • It is best to use short simple sentences rather than long complicated ones that have the potential to confuse the reader. Although you will need to use specialist terms in your report, you should also use familiar non-technical terms where possible 5/1/2018 Dr.T.V.Rao MD
  • 42. Communication solves many ill understood ideas • Encourage two way communication with laboratory • Employ terms that are readily understood • Communicate clinically relevant results • (probable infection or probable contamination) State when further clinical assessment required 5/1/2018 Dr.T.V.Rao MD
  • 43. Documenting and Auditing with WHO NET •The clinical microbiology service provides surveillance data on resistant organisms for infection control purposes. Try implement the WHONET software with inclusion of CLSI GUIDELINES, 5/1/2018 Dr.T.V.Rao MD
  • 44. GRWOING DEMANDS ON CLINICAL MICROBIOLOGISTS • The clinical microbiology laboratory is being challenged to do more work, identify more microorganisms, report complex and changing drug-related information, automate procedures, 5/1/2018 Dr.T.V.Rao MD
  • 45. Technology developing faster than we understand the pitfalls • With change, though, as always, there are challenges: technology is developing at an almost too- rapid pace, vast amounts of information which are difficult to manage and communicate are being generated, standards either do not exist or are not adequately useful for many targets/platforms, 5/1/2018 Dr.T.V.Rao MD
  • 46. Growing Challenge to Medial Microbiologists • Many decisions in clinical microbiology practice are not being made using evidence based information. Ultimately, we need to be able improve how we communicate so that we are more effective in our ability to report results and ensure appropriate interpretation 5/1/2018 Dr.T.V.Rao MD
  • 47. Using laboratory evidence to confirm a diagnosis during an outbreak •Short list potential etiologic agents (hypothesis generating) according to: • Epidemiological characteristics • Clinical characteristics • Setting •Test for agents short listed (hypothesis testing) • Positive test • Negative test •Use predictive values positive and negatives 5/1/2018 Dr.T.V.Rao MD
  • 48. Whats the Clinical Benefit of our reporting •'How is this result to be explained to the clinician?' 5/1/2018 Dr.T.V.Rao MD
  • 49. A test was negative only for the pathogens that were looked for •If the culture on a specific medium was not done, the test cannot be interpreted as negative for the specific pathogen •If you did not ask for Campylobacter culture, the “negative” stool culture is not really “negative” for Campylobacter 5/1/2018 Dr.T.V.Rao MD
  • 50. Reporting Results •Clinical microbiology laboratory needs include reporting nonnumerical results, such as the genus and species name of an identified organism., 5/1/2018 Dr.T.V.Rao MD
  • 51. qualitative, semiquantitative, and/or quantitative data, •Microbiology results often include qualitative, semiquantitative, and/or quantitative data, 5/1/2018 Dr.T.V.Rao MD
  • 52. laboratory REQUEST is consolation • Every microbiology sample is a consultation, Making sure the report it is accurate is good Making sure the report is clinically relevant and clear is better Making sure the report optimizes clinical outcome is best 5/1/2018 Dr.T.V.Rao MD
  • 53. Err is Human • Sources of potential cases of laboratory-related adverse events include internal laboratory incident reports, risk management incident reports, physician complaints and other forms of physician collaboration, and a variety of daily information system reports 5/1/2018 Dr.T.V.Rao MD
  • 54. Correction is Divine •In the testing process areas involving non- laboratory personnel, interdepartmental communication and cooperation are crucial to avoid errors. 5/1/2018 Dr.T.V.Rao MD
  • 55. TEAM EFFORT MAKES A GREAT DIFFERENCE • Therefore the entire health care system must be involved in improving the total testing process. There must be adequate and effective training of personnel throughout the institution 5/1/2018 Dr.T.V.Rao MD
  • 56. Who will Sign Laboratory Reports 5/1/2018 Dr.T.V.Rao MD
  • 57. Solving Laboratory conflicts • Very simply, Scott believes that the first step should be to get rid of the emotions behind the issue.. Step two is a close examination of the issues behind the conflict. This rational thought process is then (in step three) supplemented by your intuition about the choices in front of you. Overcoming Conflicts in the Lab—and Beyond 5/1/2018 Dr.T.V.Rao MD
  • 58. HUMAN NEEDS MORE IMPORTANT THAN OUR EGOSTIC FIGHTING •You can't solve the problem without understanding the human needs and interests of the people involved in the conflict. 5/1/2018 Dr.T.V.Rao MD
  • 59. Summary •Basic understanding of a laboratory test is key to maximizing its use. •Laboratory tests have ‘strengths’ and ‘weaknesses’. •Timing is everything! (between disease onset and specimen collection) 5/1/2018 Dr.T.V.Rao MD
  • 60. LIFE IS A GREAT FIGHT TO SURVVIE MORE QUESTIONS THAN ANSWERS 5/1/2018 Dr.T.V.Rao MD
  • 61. Younger Microbiologists Under stress and accountability 5/1/2018 Dr.T.V.Rao MD
  • 62. •Program Created by Dr.T.V.Rao MD for benefit of Medical and Clinical Microbiologists in the Developing world • Email • doctortvrao@gmail.com 5/1/2018 Dr.T.V.Rao MD