A 2-Year Study of Gram Stain Competency Assessment in 40 Clinical Laboratories

Goodyear, Nancy; Kim, Sara; Reeves, Mary; Astion, Michael L.

doi:10.1309/40wd3015ch1ryh58

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…False-negative Gram stains could occur due to inadequate specimen or smear preparation or failure to examine an adequate number of fields. In addition, training and maintenance of proficiency for Gram staining remain challenging (5,20). The consolidation of clinical microbiology laboratories has left many community hospitals with limited laboratory capacity.…”

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confidence: 99%

Multicenter Assessment of Gram Stain Error Rates

et al. 2016

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Gram stains remain the cornerstone of diagnostic testing in the microbiology laboratory for the guidance of empirical treatment prior to availability of culture results. Incorrectly interpreted Gram stains may adversely impact patient care, and yet there are no comprehensive studies that have evaluated the reliability of the technique and there are no established standards for performance. In this study, clinical microbiology laboratories at four major tertiary medical care centers evaluated Gram stain error rates across all nonblood specimen types by using standardized criteria. The study focused on several factors that primarily contribute to errors in the process, including poor specimen quality, smear preparation, and interpretation of the smears. The number of specimens during the evaluation period ranged from 976 to 1,864 specimens per site, and there were a total of 6,115 specimens. Gram stain results were discrepant from culture for 5% of all specimens. Fifty-eight percent of discrepant results were specimens with no organisms reported on Gram stain but significant growth on culture, while 42% of discrepant results had reported organisms on Gram stain that were not recovered in culture. Upon review of available slides, 24% (63/263) of discrepant results were due to reader error, which varied significantly based on site (9% to 45%). The Gram stain error rate also varied between sites, ranging from 0.4% to 2.7%. The data demonstrate a significant variability between laboratories in Gram stain performance and affirm the need for ongoing quality assessment by laboratories. Standardized monitoring of Gram stains is an essential quality control tool for laboratories and is necessary for the establishment of a quality benchmark across laboratories. C linical microbiology laboratories have undergone dramatic changes with the implementation of novel technologies, yet traditional techniques, such as the Gram stain, still play key roles throughout the diagnostic process (1-3). Gram stains are initially used as a preanalytical indicator of specimen quality and acceptability for culture. They also give the clinician preliminary information regarding the nature of potential pathogens present in the patient specimen and thus serve to guide empirical therapy. Although the Gram stain has been the staple of clinical microbiology laboratories for over a century, it is still considered a high-complexity procedure by the Clinical Laboratory Improvement Amendments (CLIA) program. The manual nature of the staining process and the subjectivity of Gram stain interpretation contribute to the incidence of errors (4-7). Inappropriate specimen sampling, specimen processing, smear preparation, and prior antibiotic therapy are all factors that can have an adverse impact on Gram stain result. The inherent nature of some organisms may also produce misleading results; for example, Acinetobacter spp. may stain Gram positive, while Bacillus spp. species may appear Gram negative. In addition, staining practices, such as use of cytospin and ...

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confidence: 99%

Multicenter Assessment of Gram Stain Error Rates

et al. 2016

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“…This can be based on the importance or impact the procedure may have on a patient's clinical management and the potential for serious harm. Microscopy and Gram stain competency assessment is often cited as being one of the more important areas to evaluate because Gram stain misinterpretation can lead to significant patient safety concerns (16). In fact, survey respondents indicated that the most common competency issue requiring remediation was associated with Gram staining and interpretation.…”

Section: Discussionmentioning

confidence: 99%

“…Competency evaluation of staff members should include measures that allow determination of what the individual knows, what the individual can do, and if the individual actually follows policies and procedures or uses the "know-can-do" approach (10,16). Determining what individuals know and can do is usually straightforward and assesses what they have learned and whether or not they can apply that knowledge.…”

Section: Discussionmentioning

confidence: 99%

Competency Assessment of Microbiology Medical Laboratory Technologists in Ontario, Canada

Desjardins

Fleming

2014

J Clin Microbiol

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dAccreditation in Ontario, Canada, requires that licensed clinical laboratories participate in external quality assessment (also known as proficiency testing) and perform competency evaluation of their staff. To assess the extent of ongoing competency assessment practices, the Quality Management Program-Laboratory Services (QMP-LS) Microbiology Committee surveyed all 112 licensed Ontario microbiology laboratories. The questionnaire consisted of a total of 21 questions that included yes/no, multiple-choice, and short-answer formats. Participants were asked to provide information about existing programs, the frequency of testing, what areas are evaluated, and how results are communicated to the staff. Of the 111 responding laboratories, 6 indicated they did not have a formal evaluation program since they perform only limited bacteriology testing. Of the remaining 105 respondents, 87% perform evaluations at least annually or every 2 years, and 61% include any test or task performed, whereas 16% and 10% focus only on problem areas and high-volume complex tasks, respectively. The most common methods of evaluation were review of external quality assessment (EQA) challenges, direct observation, and worksheet review. With the exception of one participant, all communicate results to staff, and most take remedial action to correct the deficiencies. Although most accredited laboratories have a program to assess the ongoing competency of their staff, the methods used are not standardized or consistently applied, indicating that there is room for improvement. The survey successfully highlighted potential areas for improvement and allowed the QMP-LS Microbiology Committee to provide guidance to Ontario laboratories for establishing or improving existing microbiology-specific competency assessment programs.

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“…Only appropriate auditing of results and quality control can ensure continued accuracy of the Gram stain methodology in practice [31]. Goodyear et al [32] used a computer-based competency assessment tool for Gram stain interpretation based upon 40 multiple choice questions and assessed the performance of 278 staff from 40 laboratories. The questions proved to be reliable (KR-20 coefficient, 0.80) and the overall mean score was 88% (range, 63-98%).…”

Section: Quality Controlmentioning

confidence: 99%

Role of Gram stain in microbiological laboratories with limited resources

Wang

2011

Reviews in Medical Microbiology

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Despite recent advances in automated laboratory systems, the Gram stain is still one of the most important tools in clinical microbiology, especially for laboratories with limited resources. With the development of molecular techniques and rapid immunological methods, it now seems that less attention has been paid to the Gram stain compared with before. This review describes the role that the Gram stain plays in the rapid presumptive diagnosis, quality evaluation of clinical samples, and antimicrobial management. Some discussion is also presented in relation to the interpretation of Gram stain and the quality control of Gram staining method.

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A 2-Year Study of Gram Stain Competency Assessment in 40 Clinical Laboratories

Cited by 12 publications

References 11 publications

Multicenter Assessment of Gram Stain Error Rates

Multicenter Assessment of Gram Stain Error Rates

Competency Assessment of Microbiology Medical Laboratory Technologists in Ontario, Canada

Role of Gram stain in microbiological laboratories with limited resources

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