993. How to Improve Gram Stain Competency by Core Laboratory Technologists
Session: Poster Abstract Session: Diagnostic Microbiology: Quality Improvement and Rapid Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • poster IDSA Gram stain.pdf (3.1 MB)
  • Background: Many microbiology laboratories have disappeared from hospitals as consolidation has taken place. This trend has cut cost but has left core laboratories (CL) in hospitals without the expertise to perform the most basic stat microbiology test: Gram stains on primary specimens. Gram stain competency impacts greatly treatment decisions.

    Methods: In order to maintain proficiency at a CL of a community 450-bed hospital with an active emergency room we have designed bimonthly challenges that require reporting Gram staining and morphology of different organisms. The challenges consist of 5 specimens prepared by the reference microbiology laboratory from cultures and primary specimens. Gram staining is performed at the CL. Twenty to 23 CL technologists (tech) participate reading the 5 specimens in each challenge. Results from the challenges are discussed by a supervisor with each tech.  In addition, printed images from the challenges as well as other cases that have occurred in the hospital are presented at huddle to add microbiology knowledge. Here we report the improvement in performance by CL techs after 5 challenges.

    Results: On the first two challenges 77-73% of techs read Gram staining correctly while morphology was read correctly by 56-53%. In addition, no tech had all answers correct. By the fourth and fifth challenges, Gram staining was read correctly by 97-94% while morphology was read correctly by 76-73% and 6 of 21 techs answered all specimens correctly.

    Conclusion: We observed approximately 20% improvement when reading Gram stains by providing frequent challenges to CL techs and discussing the different features of the cases. CL techs are better at determining Gram staining properties of bacteria, while morphology still has room for improvement. Another benefit has been an increased motivation to perform the test for patients as the clinical importance of Gram stain results is emphasized during the discussions.

    Jeannette Guarner, MD1, Cassandra Street, MT, ASCP2, Margaret Matlock, MT, ASCP3, Lisa Cole, MT, ASCP3 and Francoise Brierre, MT, ASCP3, (1)Pathology and Laboratory Medicine, Emory University, Atlanta, GA, (2)Microbiology Laboratory, Emory Healthcare, Atlanta, GA, (3)Core Laboratory at Emory Midtown, Emory Healthcare, Atlanta, GA


    J. Guarner, None

    C. Street, None

    M. Matlock, None

    L. Cole, None

    F. Brierre, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.