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Analysis and Solutions of the cause of unqualified microbiological specimens
Through the quality control to ensure the accuracy of laboratory test results, has reached a consensus at home and abroad. Modern laboratory medical management proposes to divide quality control into three stages: pre-analysis, analysis, and post-analysis. Pre-analytical quality control is difficult to control due to the large number of departments involved, and the pre-analytical error is often caused by the irregularity of specimen collection, storage and transportation. The pre-analytical control is directly related to the results of bacterial culture and drug susceptibility test. Accuracy, therefore, it is important to pay attention to the quality before analysis.
Analysis of the causes of microbial unqualified specimens:
In the domestic microbiology laboratory, the number of sputum and urine specimens is the largest, and the problem of unqualified is the most serious.
The main reasons for the unsatisfactory sampling of cockroaches are as follows:
(1) Factors of medical staff: Since most patients' sputum collection requires the patient's own cooperation, many older patients do not know how to properly take sputum, so clinical nurses need to arrange face-to-face supervision sampling with the patient. In actual work, often due to the lack of nursing unit personnel, no face-to-face guidance.
(2) Patient factors: the nursing staff lacks education or some new care workers themselves do not understand the meaning of the correct retention of the culture specimens, allowing the patients to randomly collect specimens; or the patient's own cultural level is limited, can not understand the correct retention The method of specimens requires the caregiver to guide the patient in person to complete the action of taking the sputum.
(3) Self factors: When coughing, it is easily contaminated by bacteria in the oropharynx, which reduces the authenticity of culture. Therefore, how to eliminate the contamination of the oropharynx bacteria when taking the sputum specimen is the key to the real result of sputum culture.
The main reasons for the failure of urine specimens are as follows:
(1) Common causes of contamination in urine culture are the use of containers;
(2) Failure to clean the vulva during urine retention, some workers lack the sense of sterility, and the sterile containers are not kept as required;
(3) The selection of the container is incorrect.
These situations often occur in new internships and fellows, mostly because the staff did not read the specimen collection manual carefully, or the responsibility was not strong, and the patient was not clearly explained.
How should we respond?
(1) Establish pre-analytical quality control and close the connection between patients and medical staff
Microbial collection has high requirements for the time, location, method, and specimen transportation and preservation of specimen collection. Therefore, it is necessary to carefully handle each link to establish a pre-analytical quality control system.
(2) Training in various ways to improve the knowledge level of medical staff
Training is an important way to ensure that doctors and nurses operate according to quality requirements. The laboratory staff prepared the clinical specimen collection manual and publicized it to the clinical medical staff in paper and electronic versions to facilitate their study and inspection, prompting the medical staff to carefully treat and process each clinical specimen carefully, and some common problems. Distribute medical staff by making small cards such as microbiological test instructions.
(3) Optimize specimen processing
Bacterial culture specimens must be submitted for inspection in a timely manner. In order to ensure that the specimen can be sent for inspection in time, the laboratory's LIS system and the hospital HIS system are docked to monitor the specimen in real time.
(4) Close clinical communication
Strengthening clinical communication is an effective means to reduce unqualified specimens for microbiological testing. When assessing and accepting specimens, the unqualified specimens are fed back to the clinic at the first time, and analyzed together with the clinical staff to give correct specimen collection, preservation and transportation recommendations. For key departments, the laboratory staff should collaborate with the director of the clinical department and the head nurse to find out the reasons, formulate solutions, and enhance the emphasis of the clinical department on the specimens.
To do a good job of pre-analytical quality control of microbiological testing, it is necessary to fully understand the causes and links of pre-analytical errors, thereby reducing the number of unqualified specimens and jointly promoting the overall improvement of clinical microbiological testing quality.
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