Impressions on the quality control of sputum specimens in clinical laboratories

In the circle of clinical microbes has been mixed for many years, although the things on the tall are not enough, but still pay more attention to some details in the clinical work; although the eyes are relatively low, but usually even thought, even Some thoughts, today from a certain point of view on the quality control of sputum specimens, share with you, welcome to shoot bricks.

In some laboratories, due to the indifference to the quality control of sputum specimens, the clinical value of cultured bacteria that are considered to be “value” is not adequately evaluated. Regardless of the three or seventy-one, these bacteria are directly “slatted” or “ On-machine identification and susceptibility testing, reports of such treatment have no clinical value, or risk of false positives. Perhaps the report reviewer found that the results were of no value or could not determine whether the detected pathogen was a pathogen, but the reagents had been consumed and the patient’s expenses had been collected. The result is still not reported? Is it a report or two or three? Tangled ah! Some people do not do it, and they don’t stop doing it. "If you have it, whatever you report, let the clinician guess it yourself!"

At present, sputum specimens account for the largest proportion of clinical microbiology laboratories and are the best specimens for testing pathogens of lung infection. The collection of sputum specimens is usually caused by patients (except children and those who are unable to breathe spontaneously). They cough up from the deep, but they must pass through the upper respiratory tract and oral cavity when coughing up. There are many colonized and contaminated bacteria in the upper respiratory tract and oral cavity. "Mixing". These "microorganisms" are attached to the surface of the sputum specimen and contaminate the sputum specimen. If you do not further treat the coughed sputum specimens and remove the "microorganisms", do you think the bacteria that are cultivated are bacteria or pathogens? Can you tell the difference? Obviously it can't be guessed; and the excessive growth of "microorganisms" can also mask the growth of real pathogens, especially the bacterium, causing false negatives. Some would say, "Selective media can inhibit the growth of bacteria," but objectively, inhibition is limited.

Excuse me, what is the significance of Acinetobacter baumannii cultivated in sputum specimens? Clinicians have questioned this. There is also more water in the statistical analysis of the hospital sense and statistical analysis of drug resistance, so you need to squeeze it. If the sputum specimen is washed, the "bacteria" is removed, and then the washed sputum specimen is digested, so that it is possible to culture a very pure pathogen colony, and it is possible to directly perform identification and susceptibility testing without passage purification, so that it is not clarified. Have you raised the above question and raised TAT?

First of all, it is necessary to establish and strengthen the awareness of quality control of sputum specimens, and actively take measures to control the quality of specimens, starting from me (laboratory). Some people say that it is not very troublesome? Not also. Technically speaking, the awareness of quality control of specimens strengthens the way that technology will naturally be derived. For example, sputum specimens can be easily washed and washed with a washing device; ASM specimen collection and processing chapters also have many methods and knowledge for quality control of specimens, which need to be studied and applied; stained or unstained specimens can be used to observe the quality of specimens by microscopy. Make an assessment; do some quick, easy, flexible tests for identification and so on. There is also the need to have the responsibility and courage to reject unqualified specimens sent by the clinic, which requires the establishment of systems and processes to regulate behavior and management.

Since the manager mainly considers the labor cost and microbial profit to be low, and the microbiology laboratory personnel are less configured, the quality control of the specimen is difficult to implement. Establishing good systems and processes can help solve human resource allocation problems and help balance costs and benefits. The processing of specimens does not require high-education personnel to do it, and it can be handled by low-demand personnel. The division of duties is clear and closely coordinated. This can reduce labor costs in the laboratory, reduce the work pressure of important staff and waste of talents, and bring a virtuous cycle to the development of the laboratory. These are system problems of management.

In short, the quality of sputum specimens has been controlled, and false positives and false negative reports have been reduced, which not only brings many benefits to the laboratory, such as cost reduction, labor saving, improved TAT, but also increased clinical trust in the laboratory. And dependencies. For this reason, why don't we be happy!

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