Article from ASCLS-IN Microbiology SA

What we Thought Would Never Happen…Did

The microbiology laboratory many of you see today will not exist in 10 years, or even 5 years, in some laboratories “traditional” microbiology is disappearing as we speak. The world of microbiology is changing rapidly and I believe the standard of care will begin to change just as rapidly. There will not be spot testing such as oxidase, indole, catalase being performed. Latex agglutination identification tests will also disappear. Microbiology laboratory scientists will no longer manually manipulate plates and be able to use the inadvertent whiff (‘cause we all know good microbiologists don’t sniff plates) to help obtain an identification. Cultures take days to perform. Instead, microbiology clinical laboratory scientists will be reading plates via pictures on a computer, an automated track will move the plate from position to position, never to be touched by a technologist, identifications will be reported within an hour of colony detection, with a completed culture in less than 48 hours. The microbiologist will have to be as much chemist and engineer as microbiologist. The disappearance of the routine microbiology testing as we know it today is being brought about by gigantic leaps in technology, namely microbiology laboratory automation, MALDI-TOF and multi-plex PCR. I would like to discuss laboratory automation in more detail.

Microbiology Laboratory Automation

The point behind automation is to do more with less. Microbiology laboratories all across the country are experiencing spectacularly increasing volumes through the healthcare consolidation that is happening, making automation an attractive prospect. However, small laboratories there are wins for you as well, since the other reasons for automation still apply, namely standardization of processes and improved quality. Let me walk you through the steps of the automated microbiology laboratory:

First is the specimen processor which inoculates all media the same way every time, yielding standardized streaking and the highest concentration of isolated colonies. With isolated colonies less time is spent subculturing to achieve isolated colonies to perform identification/ susceptibility testing, which in turn reduces TAT.

Next are the incubators. They are designed to incubate each plate individually, which allows for maximum airflow completely around the plate. This creates the ultimate growth conditions.

Last in the line is the imaging software. Pictures of each plate are taken at specified time intervals including time 0. Taking a picture at time zero is helpful for the technologist to ensure that the plate was streaked and to check if anything was on the plate prior to bacterial growth. HD imaging will allow an almost 3D image so that all colony characteristics including depth can be visualized. The software includes a dashboard that tells exactly when each culture will be ready for review. So, no more reading plates that are outside the optimal viewing zone- those that are too old (have to subculture) or too young (not enough growth to work with – have to subculture or reincubate another 24 hours).   To make best use of this feature, plate reading will begin to occur on all shifts, not just day shift.

Finally, snaked around all of the above processes, is the track. The track moves plates from the processor to the incubator, from the incubator to the camera, from the incubator to the plate reader. In the future there will be part of the instrument that will be responsible for making the McFarland standards for susceptibility testing and picking a colony to load on a MALDI-TOF plate and the track will move the plate to all of these locations. This means that there will be fewer chances of technologists being exposed to aerosols.

Other wins for automation include the ability of the supervisor to view the same pictures as the technologists when reviewing the culture workup. This allows for more consistency, aids in competency assessment and training, and allows the supervisor to truly detect when a technologist needs re-training or is having problems detecting certain organisms. The software also has productivity tracking. The question of how long it takes for a technologist to read a plate may be monitored and standardized in the future. This will help in justifying adding new positions if a laboratory is understaffed.

There are some challenges to overcome with Microbiology laboratory automation, namely price and space. Administrators are not used to spending the type of money involved with these systems in microbiology. Our instruments have historically been workhorses. They do not get replaced very often and are relatively inexpensive compared to chemistry or hematology analyzers. Space is another limiting factor. The processors, track, and incubators take up a great deal of real estate in a laboratory and many don’t have the space to spare.

Regardless of these challenges, automation is being adopted very quickly in microbiology laboratories all across the country and may be coming to yours soon. Those of you working in smaller laboratories, it will come. Soon, automation will be the standard of care and to compete, you will have to automate. Chemistry and Hematology has already gone through this revolution, so we can learn our lessons from them.

 

Posted July 28, 2015 by ASCLS-IN

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