MICROBIOLOGY


Fully automated specimen processing and reading


The most recent advances in automation to be added to the NHS GG&C Total Sepsis Solution are WASP and WASPLab. Empowered by bioMérieux, these fully automated, connected solutions have minimised specimen handling and enhanced standardisation within the microbiology laboratories (Figure 3). WASP (the Walk Away Specimen


Processor) is a robotic platform that automatically plates out positive blood culture samples. Using bacterial loops of 1 µL, 10 µL or 30 µL and reproducing human gestures, it can adapt to various sample sizes and performs the streaking pattern preferred by the laboratory. Once inoculated, WASPLab automatically transfers the plates to another part of the system for incubation and imaging. The full WASPLab solution went live at the Glasgow Royal Infirmary in November 2018 and at the Queen Elizabeth University Hospital in March 2019.


Change management process


The automation made possible by WASP and WASPLab at the NHS GG&C laboratories ensures a safer and more efficient workflow by minimising the need for repetitive manual tasks. However, the introduction of this technology involved a significant change in practice and mindset for staff. The smooth and successful transition to WASPLab automation at NHS GG&C was enhanced by bioMérieux’s unique change management consultancy.


Faster microbial identification and AST results


The new, automated Total Sepsis Solution at NHS GG&C has the potential to improve the management of sepsis significantly by ensuring patients are receiving the correct treatment as soon as possible. For example, if a patient presents in A&E with suspected sepsis and blood cultures are taken at 14:00, these would be sent immediately to the microbiology laboratory and loaded onto BacT/ALERT 3D (or, in the future, BacT/ALERT VIRTUO) for incubation. If the bottle flags positive then a sample of blood culture is then loaded onto WASP for plating out. These plates are read on WASPLab after six hours’ incubation and an MS identification can be telephoned to the ward that same day, some 17 hours earlier than the previous method (Table 1). At the same time, a VITEK AST card can be inoculated, with AST results available in the morning of the second day. This is 24 hours earlier than the previous method, which is game-changing for the management of sepsis patients. Earlier results allow both prompt adjustment of empiric treatment using broad-spectrum antibiotics (Sepsis Six protocol) and faster initiation of appropriate targeted treatment, as well as preventing unnecessary use of antibiotics where they


NOVEMBER 2019


Figure 3. The WASP and WASPLab solution at the Queen Elizabeth University Hospital.


are not required or indicated. In the initial validation of WASP and


WASPLab for processing blood cultures, it was shown that, in two cases of sepsis due to a Gram-negative bacterium, the laboratory was able to provide the identification of the causal organism 17 hours earlier than would have been possible previously. More importantly, the antibiotic sensitivity result was provided 24 hours earlier, allowing patients to be changed from a broad- spectrum antibiotic (used as per the Sepsis Six protocol) to a narrower targeted antibiotic against the organism. This earlier intervention aided patient recovery.


Improved laboratory processes


Enhancing workflows and processes through automation and innovation has helped the Greater Glasgow and Clyde microbiology laboratories cope with expanding blood culture numbers, particularly following the recent consolidation of laboratories from three to two locations. The modular design of the equipment also ensures that the capabilities of the department are secure for the future. Staff feedback following installation of


WASPLab has been extremely positive. They find the equipment to be reliable and easy to use, reducing stress and repetitiveness in their work. They particularly like how the imaging software allows faster screening of large numbers of culture plates, allowing rapid elimination of negatives and earlier work-up of positive plates.


A United Kingdom Accreditation Service (UKAS) audit was required to add WASPLab to the scope of the NHS GG&C microbiology department’s UKAS accreditation. This took place at the Glasgow Royal Infirmary laboratory two weeks after the system went live. There were no significant findings and the department was commended for project management, good collaboration and teamwork, as well as for the success of its cascade training programme. In the future, the department hopes to extend its Total Sepsis Solution by increasing its operating hours, which will offer further


While such campaigns can help to ensure that patients seek help at the earliest opportunity, technology that is able to impact the speed of clinical intervention and potential outcomes also has an important role to play in the fight against sepsis. CSJ


potential for faster results and even greater improvements to the management of the sepsis patient pathway at NHS GG&C. The Scottish government continues to raise awareness about sepsis in a new campaign that focuses on spotting the early signs of the disease.8


References


1 Harrison N. Sepsis campaign – what did it achieve? Scottish Government 2018 (https://blogs.gov.scot/ marketing/2018/09/12/sepsis-campaign-what-did- it-achieve).


2 Increase in awareness of sepsis. Scottish Government 2018 (www.gov.scot/news/ increase-in-awareness-of-sepsis)


3 National Institute for Health and Care Excellence. Tests for rapidly identifying bloodstream bacteria and fungi (LightCycler SeptiFast Test MGRADE, SepsiTest and IRIDICA BAC BSI assay). Diagnostics guidance [DG20]. London: NICE, 2016 (www.nice.org.uk/guidance/dg20/chapter/ 2-Clinical-need-and-practice).


4 Liotti, FM, Menchinelli G, De Angelis G et al. Laboratory evaluation of the BacT/ALERT VIRTUO automated blood culture system (Poster). ESCMID 2016 (www.escmid.org/ escmid_publications/ escmid_elibrary/material/?mid=47211).


5 bioMerieux. BacT/ALERT VIRTUO: A New Automated Colorimetric Microbial Detection System for Detection of Bacteremia (www.biomerieux- diagnostics.com/sites/clinic/files/bactalert_virtuo_ 4_pages_9312574_002_gb_b_web.pdf).


6 Deol P, Ullery M, Totty H et al. Rapid time to detection difference between the BacT/ALERT VIRTUO and the BacT/ALERT 3D (Poster #EV0459). ESCMID 2016 (www.escmid.org/escmid_ publications/escmid_elibrary/material/?mid=48737).


7 European Committee on Antimicrobial Susceptibility Testing. Antimicrobial susceptibility testing. Basel: ESCMID, 2019 (www.eucast.org/ast_of_bacteria).


8 Raising awareness of sepsis. Scottish Government 2019 (www.gov.scot/news/ raising-awareness-of- sepsis).


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