scholarly journals 659. Evaluation of Four Chromogenic Agars for Urine Culture Including Time and Cost Savings Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S386-S386
Author(s):  
Eve Capistran ◽  
Simon Lévesque ◽  
Philippe Martin ◽  
Diane Girard ◽  
Marie-Eve Papirakis ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Susceptibility Testing ◽  
Urine Culture ◽  
Tertiary Care ◽  
Cost Savings ◽  
Turnaround Time ◽  
Microbiology Laboratory ◽  
University Center ◽  
And Performance ◽  
Time Required

Abstract Background With a volume of approximately 5000 urine culture specimens per month in our tertiary-care university center hospital’s microbiology laboratory, we wanted to evaluate methods aiming to improve workflow and performance while reducing turnaround time and potentially overall cost. Methods 310 urine culture specimens as well as selected less frequent pathogens (A. urinae - 26 strains, C. urealyticum - 4 strains) were plated on four chromogenic agars in parallel with standard protocol MacConkey (MAC) and blood agar (BA). Chromogenic agars evaluated were: UriSelectTM 4 (Bio-Rad), CHROMID® CPS® Elite (bioMérieux), BrillanceTM UTI ClarityTM agar Biplate (Oxoid) and BDTM CHROMagarTM Orientation (BD). Primary outcome was overall growth performance for frequent pathogens and for gram positives, where chromogenic agars were previously reported to underperform.The number of additional tests needed and the appreciation of different media by laboratory personnel were also assessed. A sub-analysis measured the total time required to plate and to read 50 consecutive specimens comparatively for the 4 chromogenic agars and for MAC/BA. Results Global performance was 90% for Uriselect, 88% for ChromID, 89% for Chromagar and 81% for Brillance compared to 84% for standard method. ChromID and Brillance supported the growth of more A. urinae and C. urealyticum than the other 2 chromogenic agars. All monoplate chromogenic agars were appreciated equally by technologists. In addition, for all chromogenic agars, working time was reduced by half as compared to MAC/BA. We estimated a time economy of approximately 80 hours per month in our laboratory, translating in a net annual economy. Conclusion All 4 chromogenic medias evaluated in our study had an acceptable performance, with specific strengths and weaknesses for each one. The choice of ChromID CPS Elite (bioMérieux) for our center was based on pre-established criteria including performance for more fastidious gram positives, best time and cost economy, and compatibility with current identification method and susceptibility testing platform. However, since the 4 chromogenic agars have been adequately verified in our laboratory, we consider that they could be interchangeable if needed. Disclosures All Authors: No reported disclosures

scholarly journals Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

2017 ◽  
Vol 4 ◽  
pp. 237428951773634
Author(s):  
Chelsea R. Mehr ◽  
Amrom E. Obstfeld ◽  
Amanda C. Barrett ◽  
Kathleen T. Montone ◽  
Lauren E. Schwartz
Keyword(s):  
Resident Education ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Primary Sources ◽  
Road Map ◽  
Academic Center ◽  
Organ Systems ◽  
Before And After ◽  
Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

scholarly journals Optimization of Turnaround Time for Group A Streptococcus PCR

2019 ◽  
Vol 57 (9) ◽  
Author(s):  
Thomas J. S. Durant ◽  
Jacob Merwede ◽  
Jesse Reynolds ◽  
David R. Peaper
Keyword(s):  
Tertiary Care ◽  
Night Shift ◽  
Diagnostic Testing ◽  
Final Analysis ◽  
Turnaround Time ◽  
Nucleic Acid Amplification ◽  
Microbiology Laboratory ◽  
Workflow Optimization ◽  
Group A

ABSTRACT The use of some nucleic acid amplification tests (NAATs) for the diagnosis of group A Streptococcus (GAS) pharyngitis allows laboratories to adopt single-tiered testing without reflex culture. However, centralization may delay the delivery of actionable information to the bedside, particularly in the outpatient setting. We describe two novel workflows at our institution and their effect on in-lab turnaround time (TAT) at a tertiary care microbiology lab. Laboratory records were extracted, and relevant data were analyzed after the implementation of qualitative in vitro diagnostic testing for GAS with the Xpert Xpress Strep A assay, performed using the GeneXpert Infinity-48s. Workflow optimization steps studied included: (i) direct specimen submission to the microbiology laboratory via the pneumatic tube system and (ii) autoverification of GAS NAAT results in the laboratory information system. Between April 2018 and October 2018, 2,595 unique specimens were tested for GAS by PCR. Of these, 2,523 were included in the final analysis. Linear regression established that the total in-lab TAT was significantly reduced by direct specimen submission to the microbiology laboratory, autoverification, and processing during the night shift. We describe two workflow optimization methods that reduced the in-lab TAT for GAS NAAT. Although microbiology labs historically use manual processes, the advent of total laboratory automation and the adoption of on-demand NAATs will allow for more streamlined processing of microbiology specimens. It may be beneficial to consider instrument interfacing and specimen processing optimization during the early phases of implementation planning for NAATs in the microbiology laboratory.

scholarly journals Real life turnaround time of blood cultures in the clinical microbiology laboratory: results of the first Italian survey, May 2015

2016 ◽  
Vol 31 (3) ◽  
Author(s):  
Fabio Arena ◽  
Marta Argentieri ◽  
Paola Bernaschi ◽  
Giacomo Fortina ◽  
Vesselina Kroumova ◽  
...  
Keyword(s):  
Molecular Identification ◽  
Susceptibility Testing ◽  
Real Life ◽  
Turnaround Time ◽  
High Rate ◽  
Clinical Microbiology Laboratory ◽  
Microbiology Laboratory ◽  
Italian Survey ◽  
Multiple Outcome ◽  
Reported Data

<em>Background and aims</em>: Blood culture (BC) results are essential to guide antimicrobial chemotherapy for patients with sepsis. However, BC is a time-consuming exam, which can take several days. Reducing BCs turn around time (TAT) could impact on multiple outcome parameters and TAT monitoring is an important tool for measurement of microbiology laboratory performance. The aim of this study was to provide an overview of BC TATs among Italian microbiology laboratories. <br /><em>Materials and methods</em>: Five laboratories collected and recorded, for a month period, date and time of the BC processing events. Cumulative TATs were analysed using the GraphPad software. <br /><em>Results</em>: Participating laboratories reported data from 302 sepsis episodes. The median time from when the BC system produced a positive signal until Gram-stain results were reported was 7.6 hours. A rapid molecular identification and antimicrobial susceptibility testing (AST) was performed in 26.5% of BCs. Mean TAT for identification report was significantly lower when a molecular approach was adopted (12 vs. 28.7 hours, P&lt;0.001). Similarly, results of the molecular AST were obtained more than 24 hours in advance compared with phenotypic AST (mean 13.2 vs. 47.6, P&lt;0.001). TATs from BC positivity of laboratories opened 7 days/week were not significantly lower than those of laboratories opened 6 days/week. <br /><em>Conclusions</em>: BC is a time-consuming exam, however, molecular identification and AST methods can drastically reduce time to results. The lack of difference between TATs observed for laboratories working 7 days/week and 6 days/week, coupled with a high rate of BCs turning positive during the night enable to conclude that the most urgent measure to reduce TATs is the expansion of laboratory regular duty hours.

scholarly journals Integrating Computational Design to Improve the Design Workflow of Modular Construction

2019 ◽  
pp. 165-172 ◽  
Author(s):  
Tom Greenough ◽  
Matthew Smith ◽  
Aaron Mariash
Keyword(s):  
Analytical Model ◽  
Cost Savings ◽  
Computational Design ◽  
Visual Programming ◽  
Worker Safety ◽  
Modular Construction ◽  
Programming Tool ◽  
Delivery Times ◽  
And Performance ◽  
Time Required

The construction industry’s productivity has stagnated since the 1960s while in the same period, manufacturing and technology industries have seen vast improvements. The construction industry is coming under increased pressure to provide better value through improved quality and performance and as a result developers and constructors are looking to alternative forms of construction. In a process that borrows concepts from the manufacturing and technology sectors, such as automation and 3D modelling, Prefabricated Volumetric Construction (modular construction) is a highly versatile approach with the potential to deliver substantial cost savings, faster project delivery times, higher quality construction with less waste and emissions, and an increase in worker safety. This paper will explore the integration of computational design into the design workflow of modular construction through several project examples. The following topics will be covered: creation and assembly of parametric modules in the Revit Building Information Model (BIM) software, using the visual programming tool Dynamo; the linkage of the BIM to the analytical model; and the extraction of results and the manipulation and display of data using Grasshopper, a visual programming language and environment plugin, for Rhinoceros a 3D modeler. This integration has been found to reduce the time required to develop the building model, the drawings, the analytical model and complete the design while improving the consistency and accuracy of all.

A New Fixed-wire, ‘Stent-on-a-wire’, Very-low-profile Stent Delivery System – Rationale, Design and Update

2010 ◽  
Vol 5 (1) ◽  
pp. 20 ◽  
Author(s):  
Tim A Fischell ◽  
Keyword(s):  
Delivery System ◽  
Cost Savings ◽  
Coronary Stenting ◽  
Bleeding Complications ◽  
Need For Closure ◽  
Procedural Cost ◽  
Low Profile ◽  
Direct Stenting ◽  
Coronary Artery Stenting ◽  
Time Required

Coronary artery stenting has evolved substantially since the first use of coronary stenting as an adjunct to balloon angioplasty in the early 1990s. The performance (and particularly the deliverability) of coronary stents has improved such that coronary stenting is now the primary mode of revascularisation for percutaneous coronary interventions (PCIs) in more than 95% of cases. The new Svelte™ stent-on-a-wire (SOAW) delivery system represents one of the first substantive innovations in stent delivery systems (SDS) in more than a decade. This SDS uses a shapeable ‘fixed wire’ as an integral part of the SDS. This allows a significant reduction in SDS profile (~0.029 inches) compared with conventional monorail or over-the-wire SDS. This SOAW SDS is intended to facilitate direct stenting. It has the potential to provide substantial procedural cost savings by eliminating the need for a coronary guidewire and balloon pre-dilatation and/or post-dilatation, and by reducing contrast use and the time required to complete the procedure. The SOAW system is compatible with 5Fr guiding catheters, and may reduce the need for closure devices, facilitate stenting via the radial approach and (potentially) reduce bleeding risks. In conclusion, the Svelte SOAW SDS represents a new very-low-profile balloon-expandable SDS that should promote direct stenting in PCIs. The efficiency and small profile of this SDS may allow procedural cost savings, a reduction in procedure time and a reduced risk of bleeding complications. These theoretical advantages will need to be demonstrated in clinical trials.

Rancang Bangun Alat Olahan Minyak Kelapa

2016 ◽  
Vol 10 (1) ◽  
pp. 70-77
Author(s):  
Jantri Sirait ◽  
Sulharman Sulharman
Keyword(s):  
Electric Motor ◽  
Performance Test ◽  
Production Capacity ◽  
Coconut Oil ◽  
Heating Time ◽  
Design Tool ◽  
Coconut Milk ◽  
Heating Process ◽  
And Performance ◽  
Time Required

Has done design tool is a tool of refined coconut oil coconut grater, squeezer coconut milk and coconut oil heating, with the aim to streamline the time of making coconut oil and coconut oil increase production capacity. The research method consists of several stages, among others; image creation tool, procurement of materials research, cutting the material - the material framework of tools and performance test tools. The parameters observed during the performance test tools is time grated coconut, coconut milk bleeder capacity, the capacity of the boiler and the heating time of coconut oil. The design tool consists of three parts, namely a tool shaved coconut, coconut milk wringer and coconut milk heating devices. Materials used for the framework of such tools include iron UNP 6 meters long, 7.5 cm wide, 4 mm thick, while the motor uses an electric motor 0.25 HP 1430 rpm and to dampen the rotation electric motor rotation used gearbox with a ratio of round 1 : 60. the results of the design ie the time required for coconut menyerut average of 297 seconds, coconut milk wringer capacity of 5 kg of processes and using gauze pads to filter coconut pulp, as well as the heating process takes ± 2 hours with a capacity of 80 kg , The benefits of coconut oil refined tools are stripping time or split brief coconut average - average 7 seconds and coconut shell can be used as craft materials, processes extortion coconut milk quickly so the production capacity increased and the stirring process coconut oil mechanically.ABSTRAKTelah dilakukan rancang bangun alat olahan minyak kelapa yaitu alat pemarut kelapa, pemeras santan kelapa dan pemanas minyak kelapa, dengan tujuan untuk mengefisiensikan waktu pembuatan minyak kelapa serta meningkatkan kapasitas produksi minyak kelapa. Metode penelitian terdiri dari beberapa tahapan antara lain; pembuatan gambar alat, pengadaan bahan-bahan penelitian, pemotongan bahan - bahan rangka alat dan uji unjuk kerja alat. Parameter yang diamati pada saat uji unjuk kerja alat adalah waktu parut kelapa, kapasitas pemeras santan kelapa, kapasitas tungku pemanas serta waktu pemanasan minyak kelapa. Rancangan alat terdiri dari tiga bagian yaitu alat penyerut kelapa, alat pemeras santan kelapa dan alat pemanas santan kelapa. Bahan yang dipergunakan untuk rangka alat tersebut  yaitu besi UNP panjang 6 meter, lebar 7,5 cm, tebal 4 mm, sedangkan untuk motor penggerak menggunakan motor listrik 0,25 HP 1430 rpm dan untuk meredam putaran putaran motor listrik dipergunakan gearbox  dengan perbandingan putaran 1 : 60. Hasil dari rancangan tersebut yaitu waktu yang dibutuhkan untuk menyerut kelapa rata-rata 297 detik, kapasitas alat pemeras santan kelapa 5 kg sekali proses dan menggunakan kain kassa untuk menyaring ampas kelapa, serta Proses pemanasan membutuhkan waktu ± 2 jam dengan kapasitas 80 kg. Adapun keunggulan alat olahan minyak kelapa ini adalah waktu pengupasan atau belah kelapa singkat rata – rata 7 detik dan tempurung kelapa dapat digunakan sebagai bahan kerajinan, proses pemerasan santan kelapa cepat sehingga kapasitas produksi meningkat dan proses pengadukan minyak kelapa secara mekanis. Kata kunci : penyerut, pemeras, pemanas,minyak kelapa,olahan minyak kelapa.

scholarly journals 649. Clinical Implementation of a Rapid Susceptibility Testing Procedure, Directly From a Positive Blood Culture Using the Vitek®2 System on Gram Negative Rods

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Charma Henry ◽  
Dustin Evans ◽  
Daniel Navas ◽  
Arleen Barker ◽  
Chonnapat Somyos ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Susceptibility Testing ◽  
Testing Procedure ◽  
Turnaround Time ◽  
National Average ◽  
Major Error ◽  
Clinical Implementation ◽  
Salmonella Spp ◽  
Gram Negative

Abstract Background The national average of identification and susceptibility for organisms isolated from positive blood culture to final susceptibility based on growth on solid media is 48 hours. The goal of this research was to prove that the Vitek®2 (bioMérieux, Inc.) system can provide an accurate and reliable susceptibility result directly from positive blood culture for Gram negative rods and reduce the turnaround time (TAT) from positive blood culture to the final susceptibility. Methods An FDA-modified validation procedure was performed on positive blood cultures directly from the bottle to the VITEK®2 System for susceptibility testing. The protocol tested and validated an aliquot of 50uL of blood directly from the positive bottle into 10 mL of saline (1:200). The solution was vortexed and 3mL were placed in the VITEK®2 test tube. This protocol was intended only for Gram negative rods using the AST-GN70, AST-GN81 & AST-GN801 cards. This protocol followed the CLSI M52 and M100 guidelines. Results 515 organisms from clinical blood culture samples from July 2018 to October 2019 were evaluated. Organisms included, but were not limited to: E. coli, K. pneumoniae, Enterobacter spp., and P. aeruginosa, Proteus spp., Salmonella spp., Acinetobacter spp., and S. maltophilia. There were 5,201 drug/bug combinations. AdventHealth Orlando achieved an essential agreement of 99.32% (n=5,166), minor error 0.74% (n=39) major error 0.02% (n=1) and very major error 0.49% (n=2). A 100% agreement was achieved on detection of ESBL, CRE, and MDR organisms. Conclusion Rapid direct blood culture protocol using the VITEK®2 System and the AST-GN cards is accurate, reliable and can be performed with less than 1 minute hands-on time. The protocol can be implemented in any laboratory at no additional costs or modification where the current VITEK®2 AST-GN panels are in use. This protocol was clinically implemented at AdventHealth Orlando on July 15, 2019. Compared with the national average of 72 hours, the TAT obtained during this study was 23 hours from positive blood culture to final susceptibility, a significant reduction of 25 hours. The authors encourage bioMérieux Inc. to evaluate and explore the opportunity to expand the use of the VITEK®2 system for this application with the appropriate clinical trial. Disclosures All Authors: No reported disclosures

scholarly journals Applicability and performance of EUCAST’s rapid antimicrobial susceptibility testing (RAST) on primarily sterile body fluids in blood culture bottles in laboratory routine with total lab automation

2021 ◽  
Author(s):  
Jasmin Kaur Jasuja ◽  
Stefan Zimmermann ◽  
Irene Burckhardt
Keyword(s):  
Blood Culture ◽  
Susceptibility Testing ◽  
Reference Method ◽  
Body Fluids ◽  
E Coli ◽  
Mueller Hinton ◽  
Mueller Hinton Agar ◽  
And Performance ◽  
Sterile Body Fluids ◽  
Better Than

AbstractOptimisation of microbiological diagnostics in primarily sterile body fluids is required. Our objective was to apply EUCAST’s RAST on primarily sterile body fluids in blood culture bottles with total lab automation (TLA) and to compare results to our reference method Vitek2 in order to report susceptibility results earlier. Positive blood culture bottles (BACTEC™ Aerobic/Anaerobic/PEDS) inoculated with primarily sterile body fluids were semi-automatically subcultured onto Columbia 5% SB agar, chocolate agar, MacConkey agar, Schaedler/KV agar and Mueller-Hinton agar. On latter, cefoxitin, ampicillin, vancomycin, piperacillin/tazobactam, meropenem and ciprofloxacin were added. After 6 h, subcultures and RAST were imaged and MALDI-TOF MS was performed. Zone sizes were digitally measured and interpreted following RAST breakpoints for blood cultures. MIC values were determined using Vitek2 panels. During a 1-year period, 197 Staphylococcus aureus, 91 Enterococcus spp., 38 Escherichia coli, 11 Klebsiella pneumoniae and 8 Pseudomonas aeruginosa were found. Categorical agreement between RAST and MIC was 96.5%. Comparison showed no very major errors, 2/7 (28.6%) and 1/7 (14.3%) of major errors for P. aeruginosa and meropenem and ciprofloxacin, 1/9 (11.1%) for K. pneumoniae and ciprofloxacin, 4/69 (7.0%) and 3/43 (5.8%) for Enterococcus spp. and vancomycin and ampicillin, respectively. Minor errors for P. aeruginosa and meropenem (1/8; 12.8%) and for E. coli and ciprofloxacin (2/29; 6.5%) were found. 30/550 RAST measurements were within area of technical uncertainty. RAST is applicable and performs well for primarily sterile body fluids in blood culture bottles, partially better than blood-based RAST. Official EUCAST evaluation is needed.

scholarly journals Catheter-Associated Urinary Tract Infections (CAUTIs) Reduction: A Multidisciplinary Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s154-s154
Author(s):  
Hanish Jain ◽  
Elizabeth Hartigan ◽  
Joseph Tschopp ◽  
Paul Suits ◽  
Kristopher Paolino
Keyword(s):  
Best Practice ◽  
Registered Nurse ◽  
Urine Analysis ◽  
Urine Culture ◽  
Care Center ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Culture Collection ◽  
Institutional Cost ◽  
Tract Infections

Background: CAUTIs remain one of the most common hospital-acquired infections (HAIs) accounting for prolonged hospital stay and increased healthcare costs. According to the NHSN, the standardized infection ratio (SIR) at our institution was 1.6 compared to national average of 0.84 in 2018. We highlight the interventions implemented in our institution to prevent CAUTIs. These interventions have shown a reduction in the rate of CAUTIs, the SIR, Foley catheter days, and institutional cost. Methods: In addition to standard CAUTI prevention practices, we hypothesized that we could decrease CAUTIs through the daily implementation of specific practices. We developed a comprehensive interdisciplinary team which included the staff or charge registered nurse (RN), the unit manager, an infection preventionist, an advanced practice registered nurse (APRN), a pharmacist with an antimicrobial focus, and a physician from the infectious disease department who would conduct daily rounds on different units in the institution for education and assessment of catheter indications. A detailed review and analysis of the urine culture orders for patients with a Foley catheter was performed. A nurse-driven Foley catheter removal protocol before urine culture collection was initiated. We implemented a Foley catheter bundle that has guidelines for Foley insertion, best practice competency, and urinary catheter best practice algorithm and advocated alternative use of male or female external catheter. We educated physicians about ordering a reflexive urine analysis test followed by urine culture instead of testing either individually after removal of a Foley catheter. Lastly, we performed a root-cause analysis on all reported CAUTIs. These policies were implemented in a 435-bed tertiary-care center in November 2018, and we present data from 1-year before and after the interventions. Results: At our institution, we had 71 CAUTIs, with an SIR of 1.6, a standardized utilization ratio (SUR) of 0.92, 27,621 Foley days, and institutional cost of $979,303 compared to 40 CAUTIs with an SIR of 1, an SUR of 0.88, 24,193 Foley days, and institutional cost $537,927 after implementing our interventions. Conclusions: CAUTIs can be reduced by implementing specific measures that include infection control team rounds, nurse-driven protocol, and the use of Foley catheter bundles. Measures should be undertaken to prioritize these practices as part of a protocol. We advocate further studies to evaluate these measures. Education programs for healthcare professionals concerning CAUTIs and its complications can be implemented to carry out the prevention methods efficiently.Funding: NoneDisclosures: None

Sign in / Sign up

Export Citation Format

Share Document