MICROBIOLOGY
Introducing a Total Sepsis Solution In 2009, the NHS GG&C microbiology department began to look at how it could use innovation and automation to improve patient care. By 2017, a major part of this work included the aim to increase the speed, efficiency and productivity of their blood culture workflow; and to implement a Total Sepsis Solution that would provide clinicians with the vital information they need to treat sepsis patients promptly and effectively.
One of the first things examined was the time it took for blood cultures to be transported from the ward to the laboratory and incubated. UK guidelines state that blood culture bottles should be incubated within four hours of the blood sample being taken.3
Once specimens arrive in the laboratory they are incubated immediately in the blood culture system. With the large number of blood cultures arriving in the laboratories every day, the value of automated technologies, such as the bioMérieux Full Microbiology Laboratory Automation (FMLA) solution deployed within NHS GG&C, was evident.
Automated detection of positive blood cultures
The introduction of the NHS GG&C microbiology department’s Total Sepsis Solution began with the installation of the bioMérieux BacT/ALERT 3D blood culture system. This modular automated blood culture system detects microbial growth in blood culture bottles quickly and efficiently by way of a colorimetric change. Continuous monitoring provides immediate notification of positive cultures, which are then further investigated for identification purposes and antimicrobial susceptibility testing. The planned installation of BacT/ALERT VIRTUO will further enhance the blood culture workflow by introducing smart scanning of bottle barcodes, reducing operator hands-on time, and providing even earlier detection (up to three hours earlier) of bacterial growth.4–6
Figure 2. The NHS Education for Scotland News and Sepsis Screening Tool App.
Automated identification and sensitivity testing
The next step in the sepsis workflow to be automated in the NHS GG&C microbiology laboratories was microbial identification (ID) and antibiotic susceptibility testing (AST) using VITEK 2. A standardised inoculum is loaded into the system and linked virtually to an appropriate ID/AST card. Once loaded, the incubation and reading of each card is managed by the system without the need for further operator intervention, performing automated AST to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.7
This eliminates
the need for repetitive manual tasks, improves standardisation and ensures rapid (next day) reporting of results. An extensive database and expert rules ensure accurate interpretation and confidence in results.
In 2012, microbial identification was transformed at NHS GG&C with the introduction of VITEK MS, an automated mass spectrometry (MS) microbial identification system that uses matrix-assisted laser desorption/ionisation-time of flight (MALDI-TOF) technology. Fully integrated with VITEK 2 for an optimised workflow, VITEK MS provides rapid and accurate microbial identifications from a comprehensive and regularly updated phenotypic global database. Results are obtained within just 30 minutes, allowing an identification to be telephoned to the ward on the same day.
The combination of VITEK 2 and VITEK MS encourages better antibiotic stewardship, ensuring that patients receive the correct, most effective antibiotic at the earliest opportunity.
Table 1. Example time to WASPLab identification and AST results compared to previous method. Previous method
WASPLab identification
DAY 0 14:00 Blood cultures taken DAY 0 14:00 Blood cultures taken DAY 1 09:00 Blood cultures +ve DAY 1 09:00 Blood culture +ve
09:15 Blood onto WASP 15:15 Read on WASPLab 15:30
Load on VITEK MS 16:00 MS ID phoned to ward
DAY 2 09:30 Organism ID on MS DAY 3 09:30 AST RESULT
ID 17 hours earlier 96 I
WWW.CLINICALSERVICESJOURNAL.COM WASPLab AST result
DAY 0 14:00 Blood cultures taken DAY 1 09:00 Blood culture +ve
09:15 Blood onto WASP 15:15 Read on WASPLab 15:30 Load on MS
16:00 MS ID phoned to ward Inoculate VITEK AST card
DAY 2 09:00 AST RESULT AST result 24 hours earlier NOVEMBER 2019
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