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Microbiological contamination of air in the operating room is generally considered to be a risk factor for surgical site infections in clean surgery. Evaluation of the quality of air in operating theatres can be performed routinely by microbiological sampling and particle counting, but the relationship between these two methods has rarely been evaluated. The aim of this study was to determine whether particle counting could be predictive of microbiological contamination of air in operating rooms. Over a three-month period, air microbiological sampling and particle counting were performed simultaneously in four empty operating rooms belonging to two surgical theatres equipped with conventional ventilation via high-efficiency particulate air filters. Correlation between the two methods was measured with Spearman's correlation coefficient. The ability of particle counting to discriminate between microbiological counting values higher and lower than 5 colony-forming units (CFU)/m3 was evaluated using receiver-operating characteristic (ROC) analysis. Microbiological counting ranged from 0 to 38CFU/m3, while the particle counts ranged from 0 to 46 262/m3. Methods of microbiological and particle counting did not correlate (Spearman correlation coefficient=0.06, P=0.6). Using the ROC curve, no particle count value could be predictive of a microbiological count higher than 5CFU/m3. The results of the current study suggest that there is no reason to replace microbiological sampling with particle counting for routine evaluation of microbiological contamination in conventionally ventilated operating theatres.
The microbiological meat examination (MFU), consisting of a bacteriological analysis and a testing for antibiotic residues, is one of several additional analyses used for an edibility rating of carcasses made during meat inspection. Reasons for performing a microbiological meat examination and procedures in the laboratory are defined in the Swiss ordinance for meat examination (FUV). The aim of this study was to analyze the data of 313 microbiological meat examinations from calves and 2882 microbiological meat examinations from cows carried out at the Institute for Food Safety and Hygiene during a period of 8 years. Reasons for microbiological meat examinations as reported by the meat inspectors were mainly classified to the category of "inflammation and necroses" (FUV, Annex 4, Pt 1.2; calves: 73%, cows: 48%). As declarations of the age of the pathological-anatomical changes (that influences directly the probability of detection of pathogens) were generally missing, it is not surprising that the compliance between a particular pathological-anatomical change and a specific detection of pathogens is poor (calves: 19%, cows: 18% of all MFU). About 18% (calves) and 45% (cows) of the reasons for microbiological meat examinations did not correspond to one of the reasons mentioned in the ordinance for meat examination. However, according to the data set, some reasons require a microbiological meat examination due to an often-found specific detection of pathogens. Otherwise, a remarkable number of reasons mentioned were missing the link to bacteriological etiology. Moreover, 14% (calf) and 7% (cow) of microbiological meat examinations with the declaration "no pretreatment" as well as 15% (calf) and 11% (cow) of microbiological meat examinations without declaration showed a positive result in the testing for antibiotic residues.
Interest in quality assurance(QA) in clinical laboratories in Japan has increased over the past 30 years. We have however been lagging behind countries such as the USA, Canada and the UK in QA of clinical microbiology. The main problem of QA in Japan is human resources. There are only about 400 laboratory physicians certified by the Japanese Society of Laboratory Medicine(JSLM). Almost no academics in microbiology are interested in QA and they mostly lack clinical competence. There is a small number of faculty positions, and promotions are mostly based on research productivity while medical graduates are increasingly drawn to bench work for basic, short-term research. The Japanese Society for Clinical Microbiology (JSCM) was established in 1990 in order to promote the development of clinical microbiology and its relevant fields in Japan. And 2001 was a milestone in sustained efforts of the JSLM to initiate qualifying examinations of medical technologists(MT) in clinical microbiology. 105 MT in clinical microbiology were newly certified by the Joint Committee of JSCM, JSLM, Japanese Association of Medical Technologists (JAMT) and College of Clinical Pathology of Japan(CCPJ). The certified MTs have appropriate educational background and are well motivated. With good on-the-job training, they are expected to perform effectively various tasks, including laboratory management. Recent radical changes in the health care delivery system have also had serious implications on laboratory services and QA of microbiological tests. The primary goal of the clinical microbiology laboratory is to provide accurate diagnostic testing and high-quality service at a low cost for its customers. It is believed that the Joint Committee and the newly certified MTs will contribute to narrowing the gap between Japan and other countries in clinical microbiology.
The improvement of microbiological information processing in clinical laboratories depends on retention of information concerning who, what, when, how, and why each process was performed, the implementation of quality control procedures, and finally, its evaluation. The four objectives to be addressed are as follows: (1) to improve the collection of information concerned with microbiological processes, (2) to evaluate results of implemented strategies, (3) to offer a model data base to be used in research projects, and (4) to propose an evaluation model for comparative studies. To do this, microbiological cultures were collected from hospitalized patients from June 1997 to June 2003. Data for the analytical matrix were obtained from lab requests, medical history and the microbiological data. Statistical analyses were performed in Epi-Info 6. The laboratory records for 46,072 microbiological cultures were analyzed. Completion levels in data collection were compared between years 1997 and 2003. Samples from 1997 and 2003 showed 11% and 99% of the request forms specifically requesting microbiological culture, 11% and 99% were completed in 1997 and 2003, respectively. For the same years, 9% and 85% specifically stated the time of the request. Ten percent and 68%, respectively, provided complete information. Zero and 83% respectively stated who had collected the sample. Zero and 77%, respectively, specified the time of sample collection. Forms containing all relevent microbiological data were most complete with 78% and 96%, respectively. A database with 44 variables related to microbiological processes was created. In conclusion, improvement of microbiological data processing depends not only on the method of collection and completion of recorded information, but also on constant quality control and evaluation.
INTRODUCTION: Severe asthma (SA) exacerbations impose a substantial healthcare burden. Microbiological characterization using molecular techniques may improve pathogen identification and contribute to a more individualized therapeutic approach. OBJECTIVE: To characterize the microbiological profile of exacerbations in patients with severe asthma and to analyze the prescription patterns for antibiotics (ATB) and systemic corticosteroids (SC). METHODS: This retrospective observational study was conducted in a Severe Asthma Unit. A total of 103 exacerbations were investigated using conventional microbiological methods and multiplex polymerase chain reaction (FilmArray™) performed on respiratory samples. Bacterial findings were classified according to operational criteria compatible with infection or colonization based on genomic load and culture results. Associations between clinical, microbiological, and therapeutic variables were explored using univariate analyses. RESULTS: Microbiological detection was achieved in 78.6% of exacerbations. Viruses were identified in 59.2% of episodes, with rhinovirus representing the predominant pathogen (62.3% of viral detections). Bacteria were identified in 53.4% of exacerbations (H. influenzae 36,6%), frequently in association with viral coinfection. Bronchiectasis was associated with a higher probability of bacterial detection (OR 2.50; p = 0.031). ATB and SC were prescribed in 61.2% and 44.6% of exacerbations, respectively, with frequent use of combination therapy. No significant differences in overall microbiological detection rates were observed according to biologic therapy status. Considerable microbiological variability was observed across recurrent exacerbations in the same patient. CONCLUSIONS: Microbiological findings were common during severe asthma exacerbations, with respiratory viruses, particularly rhinovirus, being the most frequently identified pathogens. Bronchiectasis was associated with higher rates of bacterial detection and ATB use. The marked variability observed between episodes supports the potential value of individualized microbiological assessment during exacerbations and warrants prospective studies aimed at optimizing therapeutic decision-making.
We evaluated a total of 160 treatment protocols from the unit of internal medicine (n = 100) and the intensive care unit (n = 60) of the Bonn University Hospital to detect the influence of microbiological diagnostics on the individual antimicrobial treatment. Ninety-six of hundred patients in regular care were set on empirical antibiotic treatment within 24 to 48 hours after onset of symptoms. In 91% of the cases cure or substantial improvement was achieved via the initial therapy. Microbiological survey revealed multi-resistant pathogens which could be handled using a specific treatment in six of the remaining patients. In contrast, sixty patients in intensive care proved to benefit significantly from microbiological diagnostics. In one quarter of the cases microbiological findings supported the decision on a reasonable escalated therapy, and in another quarter the initial therapeutic schedule could be confirmed. At any rate, about one third of the infections remained bacteriologically inexplicable in spite of excessive microbiological research. Thus, the results of this retrospective evaluation confirm the common practice of an initial antibiotic treatment without bacteriological investigation in less severe and in severe infections. Microbiological screening may help to decide on effective routine antibiosis in patients with less severe infections. We recommend comprehensive individual microbiological diagnostics in patients with severe nosocomial pneumonia or sepsis and in patients at high risk for Candida superinfections. Due to steadily increasing economic pressure, it is necessary to reflect on the expenditure for microbiological diagnostics. The cost-effectiveness-ratio may be optimised mainly in patients with less severe infections and in regular care. The number of microbiological surveys and expenditures in ICU patients appeared adequate as compared to the individual benefit.
AIMS: To establish the microbiological quality of cold ready-to-eat sliced meats and pâté from catering and retail premises, and investigate links hypothesized between foodborne Campylobacter infection and the consumption of cold sliced meats. METHODS AND RESULTS: A total of 4078 cold meat and pâté samples were collected and examined according to a standardized protocol. Comparison with published microbiological guidelines revealed that most ready-to-eat meat and pâté samples (75%) were of satisfactory/acceptable microbiological quality and 25% were of unsatisfactory/unacceptable quality. Two cold meat samples (<1%) were of unacceptable microbiological quality because of the presence of Campylobacter jejuni in 25 g and Listeria monocytogenes at 3.4 x 104 CFU g-1. CONCLUSIONS: Acceptable microbiological quality was associated with premises where the management was trained in food hygiene and those that had hazard analysis in place. Poor microbiological quality was associated with storage above 8 degrees C, presliced meats, infrequent cleaning of slicing equipment and poor control of practices that may lead to cross contamination. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides important information about the microbiological quality of cold ready-to-eat meats and pâté. It also assists caterers, retailers, enforcement officers and policy makers to understand how different food safety practices affect microbiological quality.
The importance of microbiology to the dairy industry has been demonstrated by recent outbreaks of foodborne illness associated with consumption of milk and dairy products that had been contaminated with pathogenic organisms or toxins. Undesirable microorganisms constitute the primary hazard to safety, quality, and wholesomeness of milk and dairy foods. Consequently, increased emphasis has been placed on the microbiological analysis of milk and dairy products designed to evaluate quality and to ensure safety and regulatory compliance. The focus of dairy microbiology, however, remains largely on conventional methods: plate counts, most probable numbers, and dye reduction tests. These methods are slow, tedious, intensive in their requirements for material and labor, and often not suitable for assessing the quality and shelf-life of perishable dairy foods. With the exception of coliforms, Salmonella, and Staphylococcus aureus, isolation and characterization of various organisms occurring in milk and milk products are seldom a part of the routine microbiological analysis in the dairy industry. Recent emphasis on the programs based on HACCP (Hazard Analysis and Critical Control Points) for total quality management in the dairy industry and increased demand for microbiological surveillance of products, process, and environment have led to increased interest in rapid methods and automation in microbiology. Several methods for rapid detection, isolation, enumeration, and characterization of microorganisms are being adapted by the dairy industry. This presentation reviews rapid methods and automation in microbiology for microbiological analysis of milk and dairy products.
Microbiology is the last of the major labor-intensive sections remaining in the clinical laboratory; other large, previously labor-intensive areas--chemistry and hematology--were automated over the last two decades. Only in recent years has technology been developed to permit automation of microbiology techniques. This assessment describes the historical development and technological aspects of automated microbiology systems. Patient care can be improved by earlier treatment and reduced lengths of stay when clinicians use the rapidly reported information provided by automated microbiology systems. Automated systems may reduce the cost of microbiology testing; whether savings are realized depends both on the manual methods to which the automated technology is compared and also on the particular automated system under consideration. Some studies indicate that the technology is cost saving when used on a large scale; other studies show that, while automated microbiology technology extends laboratories' capabilities, the technology can increase laboratory testing costs. Since automated microbiology systems cannot result in cost savings in every application, it is a technology that should be carefully evaluated in its intended setting, before a decision is made to acquire such a system. Adoption of the technology in hospital laboratories has been relatively limited; problems in perfecting the technology have slowed its acceptance. In states with prospective payment systems in place prior to 1983, hospitals' acquisition of automated microbiology systems has been even more limited.
OBJECTIVES: The biosafety level (BSL) practiced in microbiology laboratories in Korea according to the laboratory biosafety manual published by the World Health Organization (WHO) was evaluated using the data obtained by a survey. METHODS: Under the advise of Clinical Laboratory Physicians, 144 types of microorganisms were screened based on the guidelines of biosafety in microbiological and biomedical laboratories published by the US Center for Disease Control and Prevention and classified into 1-4 risk groups. A questionnaire containing 21 questions in 5 areas was developed using the biosafety manual by published WHO. Of the 1,876 different organizations sent the survey, 563 responded to the survey (response rate: 30.0%). The species of microoganisms handled by as well as the biosafety level in microbiology laboratories were analyzed. RESULTS: There were 123 species of microorganisms handled in microbiology labs in Korea. The BSL required in 512 microbiology labs was answered by the survey responders as the first grade in 33 labs (6.4%), 2nd in 437 (85.4%), 3rd in 42 (8.2%), and 4th in none. The average number of items satisfied was 12.2, showing only a 57.9% satisfactory rate and normal distribution. CONCLUSIONS: The state of overall observance of BSL in most microbiology labs of Korea was evaluated as lagging compared with the standard set up by WHO. Therefore, the Korean government need to produce and distribute a biosafety manual in microbiology laboratories and make efforts to prevent this threat through measures such as training in biosafety in microbiology labs.
The Infectious Diseases Clinic (IDC) discussed serves adults who are seropositive for human immunodeficiency virus. The authors reviewed the outpatient and inpatient microbiology tests of a three-month period during 1989 for a systematic sample of IDC patients. The 249 patients in the sample had 682 microbiology tests performed during the period (mean 2.7 tests per patient). Tests most frequently requested were mycobacterial culture, routine blood culture, and cryptococcal antigen determination. Patients with acquired immunodeficiency syndrome (43% of IDC patients) accounted for 63% of the requested IDC tests. IDC patients comprised about 2.4% of patients served but accounted for 3.9% of the requested microbiology tests and 6.6% of the microbiology work load for reported tests. Using Centers for Disease Control case projections, the authors estimated that services to IDC patients in 1993 would comprise 6.6% of all microbiology tests and 10.6% of the microbiology work load. The implications of these data for microbiology probably also apply to other laboratory testing and emphasize the need for more efficient ways to use and perform diagnostic studies required by patients with HIV infection.
Clinical microbiologists and microbiology laboratories are experiencing changes due to evolving views on 'healthcare delivery' as an economic activity, due to changes in the medical environment and the demographics of the workforce, and technical evolution. Cost-effectiveness of laboratory procedures has been achieved through consolidation and integration of laboratories. Consolidation offers economy of scale and reduction in numbers of on-site staff, but also leads to separation of microbiologists from their clinical colleagues. Integration puts different laboratory disciplines under a single management, and leads to reorganisation of laboratories along common work-lines. Cost-savings combined with on-site availability of laboratories are achieved at the expense of a reduction in the influence of microbiologists in the daily running of the laboratory. Medically, there is growing emphasis on evidence-based diagnostics. Because of time-delays inherent in culturing, microbiology through rapid testing is mandatory. There is an increasing shortage in Europe and the USA of trained microbiology laboratory technicians and microbiologists. This reinforces the trend towards more automation and integration. Technological advances, particularly in molecular diagnostics, offer the possibility of rapid reporting and improvement of the impact of clinical microbiology on patient management. Molecular tests, however, fit perfectly the concept of an integrated laboratory and may further loosen the link between microbiologist and microbiology tests. The challenge for clinical microbiology will be to use new techniques to improve its cost-effectiveness and impact on infectious disease management. The future organisation of microbiology laboratories must support this but is itself of secondary importance. The training of future microbiologist must prepare them for this changing environment.
The usefulness of post-mortem microbiology in the assessment of sudden unexpected deaths in infants and children has been debated by many pathologists. In our centre, microbiological investigations have been part of the post-mortem protocol for investigation of sudden deaths in infants and children for the past 12 years. The objective of this study was to review the microbiological findings for infants and children examined by our unit during the past 4 years in relation to gross and histological findings of the autopsy and the medical and social histories of the children. We reviewed 57 consecutive sudden deaths in infants and children examined by our Referral Centre between November 1994 and October 1998. These 57 sudden deaths were aged from 1 day to 4 years and 9 months including 40 cases of sudden infant death syndrome (SIDS) and 17 non-SIDS deaths. Results of the microbiological investigations of tissues and body fluids were assessed during the case review with reference to histological shock signs, severe gastric aspiration, and signs of acute thymic involution. Bacteria alone or in association with viruses were identified in 45/57 (79%) cases including 34/40 (85%) SIDS. The most frequent bacterial isolate was Escherichia coli (27), and the virus identified most frequently was enterovirus (8). C-reactive protein was increased in 10 out of the 42 cases tested including 8/32 (25%) SIDS. Significant gastric content aspiration was found in 17/57 (29.8%) including 13/40 (32.5%) SIDS. Histological signs of shock were present in 33/55 (60%) cases including 22/39 SIDS (56.4%). The microbiological findings were positive for 27/33 (81.8%). We conclude that post-mortem microbiology is essential in sudden death investigation. The conclusion that a death is unexplained if no microbiology was done is not valid, even if in some cases it may be difficult to know precisely in what way the pathogen contributed to the death.
Infectious diseases were rife during the early years of the Singapore Medical College, which was established in 1905. The current Department of Microbiology in the National University of Singapore (NUS) has its historical roots in the Departments of Bacteriology and Parasitology, which were established in 1925 and 1950 respectively. With the achievements since its inception, and with its present research focus on Infectious Diseases, Immunology, Applied and Environmental Microbiology, it is poised to face the microbiological challenges of the 21st century. Over the decades, the structure of the medical microbiology course in NUS has modernised, culminating in the current emphasis on its practical utility in clinical practice. Coordinated by the Department of Microbiology, the Microbiology and Infectious Diseases module and the Immunology module both adopt integrated multidisciplinary approaches that aim to introduce students to the language and fundamental concepts in microbiology, infectious diseases and immunology.
The purpose of clinical microbiology is to provide accurate information about microorganisms in a given specimen. This information is of significance to the patient as well as to the clinician. In this symposium, we discussed ways in which the microbiological laboratory has contributed to controlling infectious diseases as well as the advanced technology needed in the laboratory of the to future to quickly identify suitable chemotherapy. First, Dr. Kudo reviewed the past activities of microbiological laboratories. Then Dr. Machida, Dr. Okada and Dr. Kanno discussed the current situation and existing problems in clinical microbiology. Following that, Dr. Inamatsu presented a paper on the clinician's view of which microbiological examinations are useful inpatient treatment. Lastly, Mr. Sugahara discussed advanced technology in the field of clinical microbiology, and Dr. Kobayashi described the activity of microbiological laboratory as a part of an infection control unit in the hospital.
BACKGROUND: Microbiological standard for air in plenum ventilated operating theatres are not defined. The aim of this study was to analyze the microbiological contamination of air in HUSC theatres and to establish standards of reference. METHODS: 408 air samples (80 l/sample) were taken from air intake and center of the theatres in three surgical areas, throughout five consecutive years (1991-1995). RCS air sampler was used. Media of microbiological counts were compared using the ANOVA and the Kruskall-Wallis tests. Microbiological standards were established based on upper limit of confidence interval of counts, when the degree of contamination was similar in two consecutive years. RESULTS: A falling trend of microbiological counts was observed, with statistical significance between counts found in 1992 and those found in 1994 and 1995 (p < 0.01). There was no difference between results of the three surgical areas, but there was a significant difference between counts from air intake and center of theatres, regardless the year or the surgical area (p < 0.01). During this time a significant decrease in the percentage of samples with presence of fungi (p = 0.001) was produced. The results of years 1994 and 1995 were taken for establish the microbiological standards. CONCLUSIONS: This control program allowed to evaluate and improve the hygienic conditions in the operating theatres and to establish a microbiological standards of reference for plenum ventilated theatres.