best practices in diagnostic microbiology
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05/03/2023 Dr.T.V.Rao MD 1
BEST PRACTICES IN DIAGNOSTIC MICROBIOLOGY
Dr.T.V.Rao MD
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Why to Rethink on Diagnostic Microbiology
• Diagnostic Microbiology in India is at a critical juncture and needs support from many in the health care, Recent and emerging trends such as changing demographics, exponential growth in medical discovery, raise of Superbugs, and new expectations about the way physicians and patients partner and interact are demanding innovative change in medical education and health care delivery. Clinicians need today greater support from Diagnostic Microbiology elaborates than the past, Superbugs continues to be challenge to all and to the society at large. Academic medicine is rising to the challenge. Medical schools and colleges, teaching hospitals and health systems are adapting education and training programs to meet these needs. The Diagnostic Microbiology has to improve in better direction with best practices Dr.T.V.Rao MD
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Why we need good practices
•All microbiology investigations require the user to adopt good microbiology
practice. Whenever working with organisms there are practical
procedures to ensure safe transfer and avoid contamination, which are
common to most activities.
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Plan your laboratory with resources
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Organise the laboratory to the needs
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Organisation of Work• Practise good housekeeping
policy at all times. Do not keep tubes or reagents any longer than necessary. All reagents, reaction tubes etc. should be clearly labelled. Records of batch numbers of all reagent batches used in individual assays should be kept.
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Biosafety - Working with Microbes a
Concern • It is essential that good
microbiology laboratory practice is observed at all times when working with any microbes. Before any practical activity is undertaken a risk assessment should be performed to ensure there is minimal hazard to all concerned.
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Safety guidelines •The small size of microbes and the consequent need to deal with cultures that contain many millions of microbial cells require special procedures for their safe use
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Record keeping and Documentation
•Proper recordkeeping is critical for the Micro Lab. A test should be performed as per SOP, and the laboratory notebook should provide a record of all critical details needed to confirm the integrity of the data
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The laboratory write-up should include the following:
• Date Material tested Microbiologist's name Procedure number Document test results Deviations (if any) Documented parameters (equipment used, microbial stock culture nos. used, media lot nos. used) Management/Second review signature
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There are areas for consideration when embarking on practical microbiology investigations which make planning
ahead essential.
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Steps for safety and optimal results in
Microbiology •1. Preparation and sterilization of equipment and culture media.
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Stocking and utility of cultures •2.Preparation of microbial cultures as stock culture for future investigations and inoculum for current investigation.
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Inoculation and incubation needs aseptic
methods •3.Inoculation of the media with the prepared culture.•4.Incubation of cultures and sampling during growth.
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Sterilization and disposal of infective materials
•5.Sterilization and safe disposal of all cultures and decontamination of all contaminated equipment
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Training the staff on documentation
•6 Diligent recording and evaluation of data, and training of the laboratory stuff
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Protection• Food or drink should
not be stored or consumed in a laboratory that is used for microbiology. No one should lick labels, apply cosmetics, chew gum, suck pens or pencils or smoke in the laboratory.
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Hand washing creates personal safety from microbial Infections •Hands should be washed with
disinfectant soap after handling microbial cultures and whenever leaving the laboratory. If hand contamination is suspected, then the hands should be washed immediately with disinfectant soap.
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Wear a glove - protects against many odds
•To ensure that any wounds, cuts or abrasions do not get infected or infection is passed on, protect them by the use of waterproof dressings or wear disposable surgical gloves
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General personal safety• The individual must
include in the planning and performance of the investigation a risk assessment to assess any hazard that the investigation may pose and ways of minimising it
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Aseptic technique• Sterile equipment and
media should be used to transfer and culture micro-organisms. Aseptic technique should be observed whenever micro-organisms are transferred from one container to another.
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Aseptic techniques• Contaminated equipment
should preferably be heat sterilised by either incineration or autoclaving. A suitable chemical disinfectant can be used but this may not ensure complete sterilization.
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Major areas of audit in the microbiological laboratory
• 1Reagents and Media 2. Reference Standards 3. Equipment and Instruments 4. Method Validation 5. Laboratory Controls 6. Recordkeeping and Documentation 7. Employee Training 8. Sample Control
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Sample Control Audit Questions
• 1 Ask how Micro samples are logged in and stored.• 2. Does the sample log book (or
other record) provide spaces for who delivered the sample and who then took it for testing (chain of custody)?• 3. What type of samples might be
temporarily stored while awaiting testing
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Matters on laboratory variables • The question of laboratory variability
was central to this concern. Microbiologists work every day with variability in the detection, recovery and growth of microbiological species. This variability can be thought of in two categories, “avoidable” variability (variability due to poor practice) and inherently unavoidable variability (variability due to limitations of the methods and the vagaries of dealing with biological samples - see Jarvis, 1989).
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The Goal of best practices to reduce errors
.The goal of “best practices” would then, be to minimize “avoidable” microbiological errors.
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Training man power for NABL and NABH accreditations • Since ‘competency’ is becoming a
buzzword in our industry, and microbiologists do have options to prove their competency, this discussion is important to develop ways of meeting the regulatory inspection requests as well as the quality improvement approaches of the laboratories
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Auditing help us to know all the lacunae in our practice
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It is certain that Everybody has a Role to perform the
best practices • No Good Hospital can
faction without good practices in Laboratory Medicine, • As it matters Microbiology continue
to be game changer to life and death As it can reduce mortality if done with caution and dedication • Dr.T.V.Rao MD
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•All the matters mentioned above are beneficial to practice and understanding Microbiology in
its role in quality assessment and be incorporated at Better practices