MICROBIOLOGY
blood culture bottle sets are not filled accurately. The latest recommendation calls for the collection of two sets (two aerobic, two anaerobic bottles) of blood cultures with 8-10mL of blood in each bottle and a target volume of 40mL for adult patients. Paediatric patients continue to pose their own challenges with variances in guidance.19
Since the publication of the executive
summary, and its update this year, a new standard for blood culture investigation has been published as part of the overarching SMI S12, Sepsis and systemic or disseminated infections. This document echoes the recommendations from NHS England and does not deviate from this or its parent SMI in terms of guidelines for time to instrument, blood volume, number of sets etc. The difference is the emphasis of auditing some of these elements specifically. The SMI lists six auditable outcome measures, with total turnaround time (TAT) and blood fill volume getting their own specific mention. With the executive summary report and the new SMI, a focus on time to instrument and blood fill volumes will now put a spotlight on pre-analytical activities, the success or failure of which may need to be monitored by the laboratory. The inclusion of these KPIs in the 2022/23
NHS Standard Contract20 suggests the
change is already underway and we may well see the particular KPIs for time to load and blood fill volume a focus of laboratory accreditation standards in the near future.
Challenges for the laboratory Most laboratories (and indeed trusts) have well-established quality systems in place and are familiar with the requirements from guidelines in terms of key performance indicators (KPIs) relating to TATs and so the challenge will not lie in the concept of auditing in itself, the challenges lie in auditing aspects of the pathway that for the majority, do not lie within their scope to control.
n Time to load Time to load or time to instrument is, in fact a two-step process that makes up only the initial steps of the overall TAT for
a blood culture specimen. From patient to laboratory makes up step one and laboratory receipt to time of loading on to the instrument step two. The first hurdle to overcome recording this in a real and measurable way is the accuracy of the data involved. Blood culture instruments may be able to log the time of loading, but the time of sample collection and the time of receipt in the laboratory may be dependent on manual recording of time on a form which is prone to human error. Even the use of automated test request systems will not alleviate the challenge completely as they may automatically equate the order request time to the time a sample is taken so, some margin of error will need to be accepted and risk assessed. While ownership of the first of these two steps lies outside of laboratory scope, the second step is certainly one where laboratories can adapt and implement change and any efforts that
Delaying the incubation of the bottle can reduce the number of live organisms within the sample, increasing the time it takes for the sample to flag positive and can allow the overgrowth of contaminant organisms masking the true cause of infection
Introducing the
NEW OsmoPRO® MAX Automated Osmometer
• Automated pipetting directly from primary tubes reduces errors • Continuous loading improves result turnaround time • Testing without plastic cups minimizes user intervention and frees up tech time • Onboard video instruction enhances ease of use • Automatic peer group data upload ensures effortless compliance
WWW.PATHOLOGYINPRACTICE.COM JUNE 2023 _International Print
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