Why medical laboratories need accuracy and precision

Dr. Javeed Kakroo
Microbiologist Certified infection control Auditor
Kidney Hospital Srinagar

Today Clinicians need the optimal laboratory services than yesteryears. The evolution of

microorganism behaviour to include such phenomena as species jumping, increasing virulence, and emerging antibiotic resistance, SUPERBUGS has reinforced our dependence on medical laboratory expertise. Education and training in the field of medical technology–and, particularly, microbiology–has been tragically neglected. As many hospital managements think it is just loss making if truly working with principle of

microbiology, Today the Multispecialty and super specialties need better services and competent

Clinical Microbiologists/ pathologists/Technologists than in the past as the price of infection is

much costlier than many other investments   Major specimens we receive in the laboratories are

Bacteriological specimens as we have major limitation in Virology and Mycology.

LABORATORY VARIATIONS

Because of the wide variation in protocols used to process specimens among medical colleges,

private hospitals, and reference laboratories throughout India, the Clinicians choose their own

path to prescribe the Antibiotics, However there is no organization to decide the matters and

establish the standard operative procedures, rarely it happens, with mushrooming of many private

laboratories employing ill qualified technicians and work under no supervision, If you sincerely

observe the matters most of the laboratories in major private sector try to inform the clinicians

growth of some organism and start reporting the Antibiograms and sincerely feel it is true cause

of Antibiotic misuse among the private practitioners who dependent of private laboratory services with many conflicts of interests, as a country of more than 1.3 billion population Governments cannot provide major health care services, We have long way to go

establish the creditability of our reports and clinical correlations,

However as qualified Microbiologists we have a role to correct the matters, Anyhow it needs

greater coordination among the faculty in the department apart from the cooperating clinicians,

and technical manpower, Many just treat Technologists as least important, However Microbiology/pathology is a system coordinated by many steps many technical personals,  never forget 90% of the productive work lies with technologists

and we pay them little and try to get maximum out many limitations we face in the system, We

should consider Ourresponsibility begins with   Specimen acceptability as it is based on various factors that apply to a particular source/site of sampling. The quality and/or volume of the specimen as well as its condition upon arrival at the microbiology laboratory

are all important considerations. Immediate smear examination (e.g., Gram stain or acid-fast stain) can determine the need for further specimen-sampling.  If you ask me sincerely and believe there is no rapid test like Gram staining of Bacteriological specimens, by the

qualified people. It is unfortunate many seniors and Professors think and imagine Gram stain is

a simple job I could able save many with little patience by Microscopic observations, both in India

and even abroad, The presence of polymorph nuclear neutrophils, or PMNs, and the type and

number of epithelial cells and microorganisms seen are among the criteria used to determine

sample acceptability. It means that the specimens truly reflect infection and immune system is

responding to the infections, Pathogenic organisms may be lost due to overgrowth with colonizing

or indigent bacteria found in wounds or abscesses. On the other hand, presumed sterile fluids,

such as cerebrospinal fluid, joint, and other body fluids are considered “infected,” regardless of

species or quantity of microorganism present until proven otherwise. Anaerobic cultures may be

ordered by the clinicians for appropriate specimens only; this decision is determined by the

individual hospital or medical centre’s infectious-disease service. Unfortunately, we totally miss

the anaerobes, even well-established Medical colleges do not take interest to improve the matter.

The familiar and dangerous “bugs”–S aureus and Enterococcus spp., which are known causes of

nosocomial infection–have evolved to include the hyper-resistant strains, MRSA

, vancomycin-intermediate S aureus (VISA), vancomycin-resistant S aureus (VRSA), and VRE.

MRSA has further evolved to become the community health hazard, community-acquired

methicillin resistant S aureus (CA-MRSA). Other microorganisms in the newly emerging group

include the food contaminating E coli serotype 0157:H7, known for its devastation to children

from fast-food hamburgers and, more recently, fresh produce. Combined with the emerging

antibiotic resistance in both Gram-negative and Gram-positive pathogens, the challenge to

medical technologists in microbiology has become an increasing burden.

Unfortunately, non-compliance among laboratories with the recommended guidelines for error

prevention is common. The reasons are varied but include lack of resources, lack of agreement

to a timeline for updates. The ever-increasing number of guidelines recommended, Bacteriology

continues to be cornerstone of Diagnostic services, if we can do an optimal isolation and proper

Antibiotic sensitivity testing we can save many lives, among all the infections the most gratifying

results and the outcome of treatments will be possible if the sensible wise people control the

mattes, in spite of many limitations, The two words are often used synonymously, although

accuracy and precision carry decidedly different meanings in the clinical laboratory. As defined by

Merriam Webster, accuracy denotes “freedom from mistake or error, conforming exactly to truth

or a standard.” Precision is “the degree of refinement with which an operation is performed or a

measurement stated.” The novice technologist may not fully grasp the finite distinction between

these two words.

However, the diagnostic microbiology is at the verge of major crisis, we have few facilities to work

with Mycology, Mycobacteriology, Parasitology and Virology, and loaded with conflicts, personal

interests, and many seniors imagine to be great with power, being examiners and lesser talents to guide the post graduate students, and however Today few wish to be Medical Microbiologist as it is becoming a theoretical speciality lacking hand skills and interest in bench work .

 

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