Development of a Mobile Laboratory for Sudden Onset Disasters

ABSTRACT Objectives: Clinical diagnostics in sudden onset disasters have historically been limited. We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type 2 emergency medical team (EMT) field hospital. Methods: Available diagnostic platforms were reviewed and selected against in field need. Platforms included HemoCue301/WBC DIFF, i-STAT, BIOFIRE FILMARRAY multiplex rt-PCR, Olympus BX53 microscopy, ABO/Rh grouping, and specific rapid diagnostic tests. This equipment was trialed in Katherine, Australia, and Dili, Timor-Leste. Results: During the initial deployment, an evaluation of FilmArray tests was successful using blood culture identification, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) hemoglobin values were compared on Sysmex XN 550 (r = 0.94). HemoCue WBC DIFF had some variation, dependent on the cell, when compared with Sysmex XN 550 (r = 0.88-0.16). i-STAT showed nonsignificant differences against Vitros 250. Further evaluation of FilmArray in Dili, Timor-Leste, diagnosed 117 pathogens on 168 FilmArray pouches, including 25 separate organisms on blood culture and 4 separate cerebrospinal fluid pathogens. Conclusion: This mobile laboratory represents a major advance in sudden onset disaster. Setup of the service was quick (< 24 hr) and transport to site rapid. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostic capability.

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Development of a Mobile Laboratory for Sudden Onset Disasters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19000670 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s24-s24

Author(s):

Ian Marr ◽

Dianne Stephens ◽

Rob Baird ◽

Josh Francis ◽

David Read ◽

...

Keyword(s):

Sudden Onset ◽

Clinical Diagnostics ◽

Cold Chain ◽

Major Advance ◽

Mobile Laboratory ◽

Rt Pcr ◽

Field Hospital ◽

Diagnostic Laboratory ◽

Pcr Multiplex ◽

Timor Leste

Introduction:Clinical diagnostics in sudden-onset disasters (SOD) has historically been limited. With poor supply routes, lack of a cold chain, and challenging environmental conditions, many diagnostic platforms are unsuitable.Aim:We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type II emergency medical team (EMT) field hospital.Methods:Available diagnostic platforms were reviewed and selected against infield need. Platforms included HemoCue301/WBC DIFF, i-STAT, BioFire multiplex RT-PCR, Olympus BX53 microscopy, ABO/Rh Grouping, and specific rapid diagnostic tests (RDT). This equipment was trialed in Katherine, Australia and Dili, Timor-Leste.Results:During the initial deployment, validation of FilmArray rt-PCR multiplex tests was successful on blood culture, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) haemoglobin values were compared on Sysmex XN 550 (r = 0.94). Analysis of HemoCue WBC DIFF samples had some variation when compared to Sysmex XN 550, (neutrophils r = 0.88, lymphocytes r = 0.49, monocytes r = 0.16, eosinophils r = 0.70, basophils r = 0.16). i-STAT showed non-significant differences for CHEM4 (n=10), CG8 (n = 10), and TnI (n = 5) against Vitros 250. A further trial of BioFire rt-PCR testing in Dili, Timor-Leste diagnosed 117 causative pathogens on 168 FilmArray test cartridges.Discussion:This mobile laboratory represents a major advance in SOD. Setup of the service was quick (<24hr) and transport to site rapidly. Training was simple and performance consistent. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostics.

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Faculty Opinions recommendation of Clinical evaluation of the FilmArray blood culture identification panel in identification of bacteria and yeasts from positive blood culture bottles.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718131495.793498601 ◽

2014 ◽

Author(s):

Stan Deresinski

Keyword(s):

Blood Culture ◽

Clinical Evaluation ◽

Positive Blood Culture ◽

Identification Of Bacteria ◽

Culture Identification

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Diagnostic accuracy of the BioFire FilmArray blood culture identification panel when used in critically ill patients with sepsis

Journal of Microbiological Methods ◽

10.1016/j.mimet.2021.106303 ◽

2021 ◽

Vol 189 ◽

pp. 106303

Author(s):

Roxanne Rule ◽

Fathima Paruk ◽

Piet Becker ◽

Matthew Neuhoff ◽

Julian Chausse ◽

...

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Critically Ill ◽

Critically Ill Patients ◽

Culture Identification

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Film Array Blood Culture Identification

Biomedical Safety & Standards ◽

10.1097/01.bmsas.0000751212.40631.e3 ◽

2021 ◽

Vol 51 (9) ◽

pp. 70-70

Keyword(s):

Blood Culture ◽

Culture Identification

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Assessment of Time to Clinical Response in Patients with Sepsis Treated Before and After Implementation of a Matrix-Assisted Laser Desorption Ionization Time-of-Flight Blood Culture Identification Algorithm – ERRATUM

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.209 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1134-1134

Keyword(s):

Blood Culture ◽

Laser Desorption ◽

Identification Algorithm ◽

Laser Desorption Ionization ◽

Ionization Time ◽

Desorption Ionization ◽

Before And After ◽

Culture Identification ◽

Matrix Assisted Laser ◽

Matrix Assisted Laser Desorption

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Evaluation of the BioFire® FilmArray® Blood Culture Identification Panel on positive blood cultures in a regional hospital laboratory in KwaZulu-Natal

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i1.411 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 4

Author(s):

Mokshanand Fhooblall ◽

Fikile Nkwanyana ◽

Koleka P. Mlisana

Keyword(s):

Blood Culture ◽

Antimicrobial Susceptibility ◽

Reference Method ◽

Blood Cultures ◽

Combination Methods ◽

Single Organism ◽

Hospitalised Patients ◽

Short Run ◽

Culture Identification ◽

Study Laboratory

Background: There are presently many non-culture-based methods commercially available to identify organisms and antimicrobial susceptibility from blood culture bottles. Each platform has its benefits and limitations. However, there is a need for an improved system with minimal hands-on requirements and short run times.Objectives: In this study, the performance characteristics of the FilmArray® BCID Panel kit were evaluated to assess the efficiency of the kit against an existing system used for identification and antimicrobial susceptibility of organisms from blood cultures.Methods: Positive blood cultures that had initially been received from hospitalised patients of a large quaternary referral hospital in Durban, South Africa were processed as per routine protocol at its Medical Microbiology Laboratory. Positive blood cultures were processed on the FilmArray BCID Panel kit in parallel with the routine sample processing. Inferences were then drawn from results obtained.Results: Organism detection by the FilmArray BCID panel was accurate at 92.6% when organisms that were on the repertoire of the kit were considered, compared to the combination methods (reference method used in the study laboratory). Detection of the antimicrobial resistance markers provided by the panel and reference method demonstrated 100% consistency. Blood cultures with a single organism were accurately identified at 93.8% by FilmArray, while blood cultures with more than one organism were identified at 85.7%.Conclusion: The FilmArray BCID Panel kit is valuable for detection of organisms and markers of antibiotic resistance for an extensive range of organisms.

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CAPD Fluid Examination using the Bactec 460

Peritoneal Dialysis International ◽

10.1177/089686088600600104 ◽

1986 ◽

Vol 6 (1) ◽

pp. 9-11 ◽

Cited By ~ 5

Author(s):

Maurice Terence Dalton ◽

Eva Prevost

Keyword(s):

Pilot Study ◽

Blood Culture ◽

Culture System ◽

Work Load ◽

Major Advance ◽

Blood Culture System ◽

Fluid Analysis ◽

Number Of Patients ◽

Daily Sampling ◽

Stage Renal Disease

In the microbiological laboratory CAPD fluid analysis is an unstandardized and sometimes a labor intensive procedure. This pilot study was set up to demonstrate the value of in-place technology -the Bactec 460 blood culture system, in reducing the work-load. Our results indicate that it is at least as effective as other, more tedious conventional methods. Since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has proved to be a major advance in the management of end-stage renal disease (I). Despite refinements in technique over the years leading to more widespread use of CAPD, the major hazard remains peritonitis and other infections (2). Also peritonitis is a major cause of failure of CAPD (3,4). Because CAPD allows more freedom of movement, several laboratories receive the postdialysis effluents from the same patient; furthermore there is no widely recognized, single method for the examination of these fluids (2, 5). Some centers recommend daily sampling for microbiological studies and while this is ideal for patient management, it imposes a significant workload on the microbiology laboratory, particularly in a larger centre (2). Currently it appears that the number of patients on CAPD will continue to increase for the foreseeable future and so will the numbers of specimens to be examined. To facilitate these examinations, we carried out a five-month pilot study using the Bactec 460 blood-culture system to examine CAPD fluids. We compared these results with a conventional method used previously in our laboratory.

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