Mechanisms to Assess Gram Stain Proficiency of Technologists at Satellite Laboratories

To address Gram stain proficiency in a satellite/centralized microbiology laboratory paradigm, non-microbiology technologists were required to interpret standardized Gram-stained preparations of clinical material (quality assurance program 1). Clinical Gram stains prepared and read by satellite laboratorians were reviewed by microbiologists (quality assurance program 2). Satisfactory performance was achieved (94%) in quality assurance program 1. In contrast, quality assurance program 2 had a significantly lower overall performance (89%; P < 0.0001) due to poorer identification of host cells (93%) and bacteria (84%). A variety of intervention mechanisms, including continuous monitoring, resulted in overall performance improvement (P ≤ 0.006). While technologist challenge has educational merit, review of previously-read slides is a better indicator of technologist Gram stain proficiency. AC CE PT ED on N ovem er 5, 2017 by gest ht://jcm .sm .rg/ D ow nladed fom Gram staining of primary clinical specimens has tremendous clinical utility. Studies have shown 1 that Gram staining sputum can be predictive for several etiologies of lower respiratory tract 2 disease [1,10,11,15,16,17,19,23]. Gram stain data also influence the treatment of clinically3 significant bloodstream infection [8,13]. In addition, proper performance of the primary Gram 4 stain can guide the processing of expectorated sputum specimens [14] and aid in interpretation of 5 cultured skin and soft tissue specimens [3,26]. 6 7 Bartlett [2] cited virtual elimination of house staff laboratories (as an indirect result of the 8 Clinical Laboratory Improvement Amendments of 1988) and outsourcing of primary specimens 9 as two factors contributing to the decline in clinical microbiology studies for patients with lower 10 respiratory tract disease. Others have raised concerns over Gram stain clinical diagnostic value 11 in terms of protocol standardization [5,7,18]. As a result, many have discouraged utilization of 12 Gram-stained smears as predictors of certain clinical infections, particularly those involving the 13 lower respiratory tract [10,20,21]. 14 15 Technologist competency has become of even greater importance with the centralization of 16 microbiology testing and creation of satellite processing (rapid response) laboratories staffed by 17 non-traditional microbiologists [6]. Moreover, accrediting agencies mandate proficiency 18 documentation of all technologists who execute clinical Gram staining protocols. In this report, 19 we describe a mechanism for objectively assessing the Gram stain interpretation competency of 20 non-microbiology laboratorians and present a quality assurance program for monitoring and 21 increasing proficiency of Gram staining. 22 23 AC CE PT ED on N ovem er 5, 2017 by gest ht://jcm .sm .rg/ D ow nladed fom