Company insight Automation in Micro labs
Beckman Coulter, manufacturer of the MicroScan range of microbiology testing instruments, hears from Michael Dawson MSc FIBMS, chief biomedical scientist, Microbiology at East Kent Hospitals University NHS Foundation Trust about the role of automation in the microbiology labs and how this has changed over the years.
Your lab is one of the biggest in the region and it is also an accredited training centre for new Microbiology specialists. How do you manage the sheer number of samples? Michael Dawson: Pre-Covid, our lab was testing around 600,000 specimens for Virology, Serology and Bacteriology per year. Staffing numbers were stable and our move forward with the introduction of technology had slowed, primarily due to cost. Batch testing technology was primarily targeted at Virology and Serology; low-volume, non-urgent specimens or high-volume specimens were often batch tested to maximise testing capability, often leading to lengthy specimen turnaround times. The introduction of random access technology, particularly for virology and GUM screening (using Abbott’s Alinity M and DiaSorin Liaison XL), has meant that batch testing is now less essential and has ultimately improved the receipt to report turn-around-times; from days to hours in many cases. With workflow mapping and optimisation, staffing in virology and serology sections has been reduced with excess staff being diverted to the more manual Bacteriology sections, and the volume of work that can be done in a working day has increased.
MRSA screens, which has allowed staff to be released to spend more time on the more complicated clinical specimens – Maldi-TOF for organism identification (Bruker), and micro broth dilution for AST (Beckman Coulter’s MicroScan Walk- away 96). All the technology has allowed for more rapid, high-quality and reliable results. This is of upmost importance when investigating life-threatening conditions, such as sepsis. Time is of the essence and traditional techniques are too slow to make a significant patient impact. The introduction of technology has meant that we not only get results quicker but, in some cases, we can actually test more. For instance, pre-micro broth dilution we were testing seven antimicrobials at maybe two concentrations. Now we are testing up to 30 different antimicrobials and several concentrations. The result is more choice of antimicrobials for treatment, more targeted patient therapy, and improved patient outcome.
Would you say that the role of Microbiology lab has changed due to the Covid pandemic? Covid has highlighted how easily new infections can spread, the importance of hygiene in preventing disease spread, and the importance of getting rapid and
“Automation will be essential for reliable epidemiology of antimicrobial resistance.”
When you say automation of the lab, what do you mean? Virology is PCR-based, a technology that is now readily available and affordable for Virology, but Bacteriology is still primarily manual. There has been the introduction of automated plate culturing (Beckman Coulter’s DxM Autoplak) for high- throughput samples, such as urine and
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accurate results. Unfortunately, on an international scale, Covid has distracted from good, antimicrobial stewardship and antimicrobial resistance. There are new publications showing that antimicrobial resistance has increased during Covid, probably as a result of resources being redirected from the routine work to concentrate on the pandemic. Microbiology
has always had a role in antimicrobial stewardship in one form or another, and with the increase in and spread of antimicrobial resistance, this role is now more important than ever. Automation will also be essential for reliable epidemiology of antimicrobial resistance. As mentioned, automation allows for the testing of a larger range of antimicrobials at any one time, which means that it will be easier to note if there are changes in resistance earlier than with traditional disc diffusion technologies. By identifying resistance quicker, antimicrobial stewards will be able to address and amend local antimicrobial policies quicker by introducing new drugs or treatment regimens, preventing further resistance developing or spreading, and having positively impacted patient care.
Talking about the future, how would you describe the ideal Micro lab set up/workflow?
The pandemic has highlighted the role of near patient testing/point-of-care testing. PCR systems were readily placed in emergency departments. From an infection control perspective, it allowed for prevention of spread of disease by identifying infected patients at time of admission rather than a couple of days later if solely reliant on laboratory testing. This technology can be used to screen for other transmissible diseases too, and therefore has potential to prevent HAI from MRSA/ Clostridium difficile. Microbiology laboratories will always have a place in medicine for investigating non-time essential specimens and specialisation, but near-patient testing and newer, smaller, easier to use, technologies are showing to have an increased role in near patient or rapid testing. This could be the era of rapid laboratories on wards or even in communities. ●
www.beckmancoulter.com Practical Patient Care /
www.practical-patient-care.com
2022-10933
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