Blood culture

AUTOMATION IN
MICROBIOLOGY
(for blood cultures)
Ms Tissymol Thomas
Nursing Superintendent
Quality Team-Ford Hospital & Research Centre -Patna

Blood culturing most
important and live saving
Investigation
Needs optimal Methods for
Diagnosis of Blood Borne
Pathogens

Why Blood Culture
 Physician can find source of
infection
 Physician can initiate life-saving
support measures
 Physician can start targeted
antibiotic therapy

What is a Blood Culture?
 A blood culture is a
laboratory test in
which blood is
injected into bottles
with culture media to
determine whether
microorganisms have
invaded the patient’s
bloodstream.

Need for Blood Culture?
No microbiological test is more essential to the
clinician than the blood culture. The finding of
pathogenic microorganisms in a patient’s
bloodstream is of great importance in terms of
diagnosis, prognosis, and therapy.”
- L. Barth Reller, Clin. Infect. Diseases, 1996

Proof in Blood borne Infection
 A clinically suspected infection is ultimately
confirmed by isolation or detection of the
infectious agent. Subsequent identification
of the microorganism and antibiotic
susceptibility tests further guide effective
antimicrobial therapy. Bloodstream
infection is the most severe form of
infection and is frequently life-threatening,
and blood culture to detect circulating
microorganisms has been the diagnostic
standard.

Blood culture is a Important a
Diagnostic tool in Infectious
diseases
 Blood culture is a microbiological
culture of blood. It is employed to
detect infections that are spreading
through the bloodstream
(such as bacteraemia, septicaemia amongst
others). This is possible because
the bloodstream is usually a sterile
environment.

What are We doing Now is not
optimal – Needs Rapid Methods
 Most microbiological culture procedures
require the use of solid media, like blood
agar and MacConkey agar plates that need
to be visually monitored by trained
personnel at intervals of 24 hours. These
conventional cultures using normal media
take at least a minimum of 72 hours to
isolate the pathogen and carry out
susceptibility test to know the efficacy of
antibiotics on simple aerobic bacteria

Optimal Methods of Blood
Collection makes difference
 The physicians consent with filled in request with details
for culturing the Blood
Gloves will be worn in accordance with standard
precautions..
Appropriate verification of the patient's identity, by
means of an armband or area specific procedure, will
occur before the specimen collection.
Cultures should be drawn before administration of
antibiotics, if possible.
If at all possible, blood cultures should not be drawn
from lines, but should be drawn only via venepuncture
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PHLEBOTOMY TRAINING
PROGRAMS
WHO?
WHAT?
WHERE?

NEW CATEGORY OF
LAB PERSONNEL
 Phlebotomist
Defined as a person who collects blood for
clinical laboratory test or examination
purposes

Principles for Collection
 Gloves will be worn in accordance with standard
precautions.
•A physician’s order must be obtained for specimen
collection.
•Appropriate verification of the patient's identity, by
means of an armband or area specific procedure, will
occur before the specimen collection.
•Cultures should be drawn before administration of
antibiotics, if possible.
•If at all possible, blood cultures should note drawn from
lines, but should be drawn viavenipuncture.
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Materials
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Chlorhexidine swabs (1-2 packages) Alcohol swabs
Blood culture bottles (2 bottles per set) 2 syringes
(adult: 20 cc, paediatric: 5 cc)
2 needles (adult: 22 gauge or preferably larger butterfly
or standard needle; pediatric: 25 or 23 gauge butterfly or
standard needle)
Gloves (sterile &nonsterile) Tourniquet
Sterile gauze pad Adhesive strip or tape Self-sticking
patient labels
Plastic zip lock specimen bags
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Steps 1 – 3, Check, Explain,
Wash
 1.Identify the patient by
checking the arm band or
area-specific procedure.
2.Explain the procedure to
the patient.
3.Wash hands with soap
and water with friction for
15 seconds or use alcohol
based hand rub
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Step 4 –Prep Cap
 Prep the rubber cap
of the blood culture
bottles with an
alcohol pad in a
circular motion. Allow
the alcohol to dry.

Step 5 -Prep the Puncture Site
 Prep the puncture site with Chlorhexidine:
– •Using aseptic technique, remove the applicator from
its package.
– •Holding the applicator downward, gently squeeze the
wings to release the solution.
– •Scrub with a back & forth motion using friction for 30
seconds on dry skin or 2 minutes on wet skin.
 •Do not wipe the site after cleansing the skin
with Chlorhexidine.

Step 6 -Gloves
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Apply gloves:
If palpation of site prior
to puncture is
anticipated, wear sterile
gloves.
If palpation of site prior
to puncture is not
anticipated, wear
nonsterile gloves.

Step 8 -Mix
 Gently rotate the
bottles to mix the
blood & the broth (do
not shake vigorously).

Step 9 and 10 (Label)
 Place the patient label on each bottle & label
each culture bottle with the site of specimen
collection. When applying patient identification
labels, do not cover the bar code label on the
blood culture bottles. Attach the laboratory
requisition.
 Send the blood cultures to the Clinical
Microbiology receiving area as soon as possible.

Step 11
 11.Document the following in the medical
record Date & time specimen obtained
 –Site of specimen collection
 If 2 sets of blood cultures have been
ordered, obtain the second set in the same
manner as the first, making a new
venepuncture at a different site

Techniques of Paediatric Collections
Tourniquet Application
Need to maximize chances of
successful collection
Remember that the vein is still
developing and might need to rely on
firm tightness
Ideally, tourniquet should not be kept
on for more than one minute
If possible, apply heat
If using a hand, consider a bucket of
warm water

Techniques of Paediatric Collections
Insertion Principles
Cantilevering of elbow
The option factor:
-Choose your options of direction before insertion
-Minimize the odds of unnecessary “digging”
Avoid plunging the needle right up to the
hilt
Often, a drawback does the trick
If vacutainer is slowing down, replace with
a syringe

Self Protection
A few ways to make sure your
role in the collection process is
carried out with efficiency,
orderliness and safety

The Contaminated Blood
Culture
 If the skin is not adequately cleansed before
drawing blood for culture, bacteria on the skin will
be injected into the bottle, producing a false
positive blood culture.
 It is sometimes difficult for the physician to
determine whether the bacteria growing in the
blood culture is a real pathogen causing
bloodstream infection or whether bacteria on the
skin have contaminated the culture. This can lead
to excess use of antibiotics and prolongation of
hospital stay.

Sample Labeling Efficiencies
 Bar coding at the point-
of-phlebotomy
 2D vs. 1D bar codes
– Reduce the number
of computer
interfaces
– Self directing
specimens

Technological Improvements for All
Steps in the Diagnostic Process
Just in Time Supplies
Biorepository
Process Control
Pre-analytical
Analytical and
Automation
Automated
Phlebotomy
Trays
RFID
Mobile Robot
2D-Codes
Instruments
Designed for
Automation
EMR

Blood & Body Fluid Cultures

Blood cultured by the BacT/Alert 3D leads to early
detection of pathogens (>89 per cent within 24 hours
and 97 per cent within 48 hours) especially in cases of
septicaemia, enteric fevers, bacterial endocarditis and
other pyrexias of bacterial origin.
Activated charcoal neutralises antimicrobials and toxins
enhancing early recovery of pathogens. Positives are
detected faster than Bactec even at low concentrations
in blood and body fluids like CSF, CT guided aspirates
etc.
Delayed transport does not compromise results.
The instrument is capable of recovering significantly
more organisms that resin.
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BacT/AlerT 3D culture system
 BacT/AlerT 3D culture system. This is the
first automated non-radiometric and non-
invasive culture system that continuously
monitors system for culture of bacteria
(both aerobic and anaerobic), fungi and
mycobacteria. All these bacteria can be
cultured using different media as
prescribed..

Principles in BacT/AlerT 3D
culture system
 This is a closed system and works on the
colorimetric principle of detection of CO2
produced by the organisms. The CO2
causes a lowering of the pH of the
medium, which in turn produces a colour
change in a sensor attached to the CO2-
sensitive base of each bottle.

You are guided by
Computerized
Systems
 The instrument reacts before this colour
change is apparent by means of an
audible or visible alert flagged by the
computer. The bottles are constantly
agitated and are read at 10-minute
intervals. The readings are transmitted to
a computer compiler, which computes
results. This

bioMérieux BacT/ALERT® 3D
 The bioMérieux BacT/ALERT® 3D provides
an optimal environment for the recovery of a
wide range of pathological organisms,
including bacteria, yeasts and mycobacteria;
utilizing proprietary plastic culture bottles
ensuring added safety to the user.

Principles of functioning of BacT alert
Monitors
 Microorganisms multiply
in the media, generating
CO2. As CO2 increases,
the sensor in the bottle
turns a lighter colour.
Measuring reflected light,
the BacT/ALERT 3D
monitors and detects
color changes in the
sensor.
Algorithms analyze the data to
determine positivity, and the
laboratory is notified
immediately with visual and
audible alarms.
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Automation becomes more
complex

Automation becomes need of the
Hour
 Full microbiology laboratory automation
needs have never been so apparent, with
financial constraints and increasing testing
volumes at the same time that labour is
becoming both harder to find and more
expensive. Implementation of full
microbiology lab automation is one
solution, as fewer technologists are
required to process automated tests..

Automation improves quality of
services
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Overall, laboratories
transitioning from
conventional to
automated processes
find that technologists
and microbiologists
are more open to
innovation and
improved quality.

Industry flourishes too..

An entire industry of
microbial diagnostic kits
flourished to the present
day. Next in the 70s the
development was in
immunological test kits
and instruments to
monitor the presence of
food borne pathogens
and biomass and to
predict microbial growth
automatically.

Advantages of automation
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Automated solutions have recently
emerged in the marketplace that address
key areas of the microbiology lab.
Automating these processes-simple,
standard, or complex-can revolutionize
the microbiology lab with more efficient,
standardized practices that will improve
quality, safety, and cost-efficiency.

Automation increases efficacy and
eliminates individual variations
 For example, automating small, yet vitally
important tasks, can make a huge impact
on the efficiency and accuracy of
laboratories. Lab technicians streak an
estimated ??? agar plates a day, a
process that is laborious, tedious, and
inconsistent. Each lab technician has his
own streaking technique

Automation is
Advantageous
 Include the elimination of subjective
variability,
 Savings in media and reagents, and the
earlier production of useful information in
many instances, all of winch can make a
substantial contribution to productivity and
the control of runaway cost escalation.

Automation combined with
Laboratory Information management
 The combined use of laboratory
automation and laboratory
information management software
(LIMS) has been shown to increase
productivity, reduce human error and
improve tracking and traceability in a
microbiology lab

Workflow Management
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Accessioning Specimen
tracking
Data logging and reporting
Quality control documentation
 Sample quality
assessment
Optimal routing and
scheduling
Intelligent reporting
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Data
DATA
PROCESS MANAGEMENT
Automation Information

Bar coding, robotics and computers
 Bar coding, robotics and computers that replace
manual transcription significantly reduce data
loss and errors. Automation also makes it less
likely that plate information and patient
identification will be duplicated or transposed.
Three trends will drive laboratory automation’s
future: smaller, more-flexible analysers and
automation based on next-generation
technology, including micro fluidics, easy-to-use,
powerful software for centralised lab
management, and internet-based real-time
service for better up-time.

Bar coding replacing the Manual
reading – Reduces errors
 The key to this real-time automation was
real time barcode labelling of all sample
carriers (such as bags, tubes, dishes,
bottles) provided by Kiestra's Barcode
system. This was used in conjunction with
Auto scribe's Matrix LIMS. Real time
barcode reading is known to reduce
transcription error rates to only 1 in 36
trillion characters - compared to 1 in 300
characters with manual reading.

Kiestra's BarcodA
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Kiestra's BarcodA
automatically places
an optical barcode on
all tubes, bottles and
petri-dishes that
contains important
information such as
composition, sell-by
date etc.

Bar-coding helps in tracing the
errors
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The barcode makes
every sample carrier
unique and recorded
meaning full
traceability for the
laboratory. Samples
are also provided with
a barcode which is
generated by Matrix
LIMS.

Quality replacing Quantitity
 Quality issues are becoming increasingly
important in diagnostic laboratories. The fact of
quality is no longer sufficient and we must now
develop mechanisms to assure consumers, the
public and, most importantly, ourselves of the
continuing quality of our service. Moving
towards a quality-assured system is not easy,
requiring a meticulous attention to detail in all
areas of a laboratory's working and organization.

Automation gained the Universal
acceptance
 A further plus for lab automation is that it
promotes consistency and quality. Without
automation, lab tasks that are necessarily
repetitive can lead to inconsistent or
inappropriate ways of work and, from
there, to improper treatment, longer
patient stays, medication errors and
unwanted drug side-effects.

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for “e” learning Programme
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Blood culture

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