Quality Assurance of Gram-stained Direct Smears

Bartlett, Raymond C.; Tetreault, Janice; Evers, Jane; Officer, Janet L.; Derench, Judith

doi:10.1093/ajcp/72.6.984

Cited by 16 publications

(13 citation statements)

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“…In 1979, Bartlett et al described a program for staining and evaluation of replicate smears for purposes of monitoring the interpretive skills of medical technologists (39). In 1980, Bartlett and Rutz described a detailed cost analysis of the effect of applying control to the assessment of the quality and extent of work performed on specimens of lower respiratory tract secretions, wound exudate, cervicovaginal exudate, and urine (37).…”

Section: Advent Of Government Regulationmentioning

confidence: 99%

Evolving approaches to management of quality in clinical microbiology

et al. 1994

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Quality management in clinical microbiology began in the 1960s. Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation. Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices. The initial emphasis was placed on intralaboratory process. Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information. Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care. Continuous quality improvement should be introduced. This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another. Prevention of error is accomplished more through effective training and continuing education than through surveillance. Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations.

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Section: Advent Of Government Regulationmentioning

confidence: 99%

Evolving approaches to management of quality in clinical microbiology

et al. 1994

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“…This contamination can be quantified by evaluating Gram-stained sputum samples for polymorphonuclear leukocytes and squamous epithelial cells. The resulting objective measure, called the quality (Q) score, has been validated and recommended for use in evaluating the quality of the specimen (1).…”

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confidence: 99%

Utility of Gram Staining for Evaluation of the Quality of Cystic Fibrosis Sputum Samples

Nair

Stapp

et al. 2002

J Clin Microbiol

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The microscopic examination of Gram-stained sputum specimens is very helpful in the evaluation of patients with community-acquired pneumonia and has also been recommended for use in cystic fibrosis (CF) patients. This study was undertaken to evaluate that recommendation. One hundred one sputum samples from CF patients were cultured for gram-negative bacilli and examined by Gram staining for both sputum adequacy (using the quality [Q] score) and bacterial morphology. Subjective evaluation of adequacy was also performed and categorized. Based on Q score evaluation, 41% of the samples would have been rejected despite a subjective appearance of purulence. Only three of these rejected samples were culture negative for gram-negative CF pathogens. Correlation between culture results and quantitative Gram stain examination was also poor. These data suggest that subjective evaluation combined with comprehensive bacteriology is superior to Gram staining in identifying pathogens in CF sputum.Gram staining is considered key in the workup of sputum from patients with pneumonia and other lower respiratory tract infections (10). Unfortunately, sputum samples are often contaminated with saliva and resident oropharyngeal microbial flora. This contamination can be quantified by evaluating Gram-stained sputum samples for polymorphonuclear leukocytes and squamous epithelial cells. The resulting objective measure, called the quality (Q) score, has been validated and recommended for use in evaluating the quality of the specimen (1).Cystic fibrosis (CF) lung infections are chronic and polymicrobial, occasionally marked by exacerbations accompanied by increased, purulent sputum production and systemic symptoms. Antibiotic treatment based on sputum culture results is a mainstay of CF management. The specific use of the Gram stain for evaluating the adequacy of sputum samples from patients with CF has also been recommended (4). In addition, past literature reports excellent sensitivity, specificity, and predictive values of examination of the morphology of bacteria seen in Gram-stained specimens compared with microbiological culture techniques for the prediction of specific organisms in CF sputum samples (11).At the Therapeutic Development Network (TDN) Core Microbiology Laboratory, we have had experience processing thousands of CF respiratory samples. It is the impression of the technologists at the bench that the Q score of the Gramstained specimen is less useful than subjective evaluation of the specimens for adequacy. In addition, because specimens are solubilized and diluted prior to plating on selective media (2), it is rare that organisms are detected by Gram staining and not cultured from the sample. To validate these impressions, we performed a prospective study to compare the objective scoring (Q score) and Gram stain evaluation with subjective characterization of purulence and quantitative culture results. MATERIALS AND METHODSStudy design. The present study was a substudy in the investigation of tobramycin-containing media fo...

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“…In order to determine smear adequacy and increase the specificity of the methods of microbiological investigation, the samples were examined under optical microscopy by the method described by Bartlett et al for grading the quality of sputum. (19) The sputum samples selected for microscopy were examined by Gram staining and smeared onto media for the culture of aerobic bacteria. This was achieve by a semiquantitative technique, samples from each patient being cultured on a blood agar plate, a chocolate agar plate, and a MacConkey agar plate.…”

Section: Resultsmentioning

confidence: 99%

“…Despite being low, the blood culture positivity rate found in the present study is similar to those reported in other studies (5-14%). (10,27) Despite being performed after the use of the qualitative test described by Bartlett et al (19) and having their positivity assessed only in the properly collected samples, neither sputum of CAP cases began to be standardized in the hospital under study. Regarding elucidation of the diagnosis, loss to clinical follow-up after hospital discharge made it impossible to arrive at a definitive etiological diagnosis in some cases (those in which a second biological sample for serology was not collected).…”

Section: Discussionmentioning

confidence: 99%

“…As shown in Table 5, the rate of positivity on sputum smear microscopy and sputum culture was 13.3% and 15.5%, respectively, considering only the 45 samples (73%) determined to be adequate by the method described by Bartlett et al (19) The antibiotic therapy of choice was the clavulanate-amoxicillin combination, which was prescribed in 25 patients (73.5%), although it was necessary to change the regimen to other classes of antibiotics in 13 patients (48.1%) who had an unfavorable clinical course and in 5 (14.7%) who were discharged within less than 10 days. Quinolones, clindamycin, and third-generation cephalosporins were also administered, as were other combinations.…”

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confidence: 99%

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Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP

Donalísio

Arca²,

Madureira

2011

J. bras. pneumol.

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Objective: To analyze the clinical, etiological, and epidemiological aspects of community-acquired pneumonia (CAP) in hospitalized individuals. Methods: We prospectively studied 66 patients (> 14 years of age) with CAP admitted to the Hospital Estadual Sumaré, located in the Sumaré microregion of Brazil, between October of 2005 and September of 2007. We collected data related to clinical history, physical examination, pneumonia severity index (PSI) scores, and laboratory tests (blood culture; sputum smear microscopy and culture; serology for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; and detection of Legionella sp. and Streptococcus pneumoniae antigens in urine). Results: The mean age of patients was 53 years. Most had a low level of education, and 55.7% presented with at least one comorbidity at the time of hospitalization. The proportion of elderly people vaccinated against influenza was significantly lower among the inpatients than in the general population of the Sumaré microregion (52.6% vs. > 70%). Fever was less common among the elderly patients (p < 0.05). The clinical evolution was associated with the PSI scores but not with age. The etiology was confirmed in 31 cases (50.8%) and was attributed to S. pneumoniae, principally detected by the urinary antigen test, in 21 (34.4%), followed by C. pneumoniae, in 5 (8.2%). The mortality rate was 4.9%, and 80.3% of the patients were classified as cured at discharge. Conclusions: The knowledge of the etiologic profile of CAP at the regional level favors the appropriate choice of empirical treatment, which is particularly relevant in elderly patients and in those with comorbidities. The lack of influenza vaccination in elderly patients is a risk factor for hospitalization due to CAP.Keywords: Chlamydophila pneumoniae; Community-acquired infections; Pneumonia; Streptococcus pneumoniae; Influenza vaccines. ResumoObjetivo: Analisar aspectos clínicos, etiológicos e epidemiológicos das pneumonias adquiridas na comunidade (PAC) em indivíduos internados. Métodos: Foram estudados prospectivamente 66 pacientes com PAC maiores de 14 anos no Hospital Estadual Sumaré, localizado na cidade de Sumaré (SP), entre outubro de 2005 e setembro de 2007. Coletamos dados sobre história clínica, exame clínico, escore pneumonia severity index (PSI) e exames laboratoriais (hemocultura, bacterioscopia/cultura de escarro, sorologias para Chlamydophila pneumoniae, Mycoplasma pneumoniae e Legionella pneumophila, além de antígenos urinários de Legionella sp. e Streptococcus pneumoniae). Resultados: A idade média dos pacientes foi de 53 anos, a maioria tinha baixa escolaridade, e 55,7% apresentavam pelo menos uma comorbidade no momento da internação. O percentual de idosos vacinados contra influenza entre os internados foi significativamente menor que os da comunidade dos municípios da microrregião de Sumaré (52,6% vs. > 70%). A febre foi menos frequente entre os idosos (p < 0,05). A evolução clínica se associou com o escore PSI, mas não com a idade. A ...

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Quality Assurance of Gram-stained Direct Smears

Cited by 16 publications

References 0 publications

Evolving approaches to management of quality in clinical microbiology

Evolving approaches to management of quality in clinical microbiology

Utility of Gram Staining for Evaluation of the Quality of Cystic Fibrosis Sputum Samples

Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP

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