Fall 2005 • Volume 16 • No. 2
In This Issue 1 TechniTopic • BBL™ CHROMagar™ O157 and MRSA – Valuable Screening Media in Clinical Situations
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BACTEC™ System News • BD BACTEC™ System Improves Sepsis Diagnosis • BACTEC™ 9000 Culture Club Product Highlights • BD EpiCenter™ Version 5: Expertised Data for Precise and Consistent Patient Reports • BD ProbeTec™ ET System Studies Presented • BD™ Universal Viral Transport System • This Is Your Season To Realize Great Savings on BD Respiratory Products • BD Directigen™ EZ Flu A+B • BD GasPak™ EZ Pouch With On Board Anaerobic Indicator • Color-coded Tube Labels a Big Hit!
11 Micro Happenings • BD and CMMB Join Forces in Zambia • Susan Morris Receives Gavel at ASCLS Annual Meeting • Dr. Lance R. Peterson Receives BD Award • Drs. Portaels and Salfinger Honored with the Gardner Middlebrook Award
13 FYI • Passport to Possibilities • TTC Hosts MRSA Webinars • New Triage Center a Success! • Have You Seen BD EpiCenter™ Version 5.0?
BD Lab•O Microbiology News & Ideas
BBL™ CHROMagar™ O157 and BBL™ CHROMagar™ MRSA as Valuable Screening Media in Clinical Situations Anthony F. Walsh, Ph.D. and Valerie Hoover, B.S., MT(ASCP)
patients be examined for E. coli O157 (in addition to other enteric pathogens).2 This was accomplished The emergence of Escherichia coli by inoculation of fecal specimens to O157 and methicillin-resistant a series of standard enteric media Staphylococcus aureus into the with the addition of a Sorbitol Machuman population has prompted Conkey Agar plate. A clinical laboratories to BBL™ CHROMagar™ O157 An outbreak of seek more reliable plate was also included. E. coli O157 methods to screen After incubation at 35°C, specimens for these occurred among plates were examined for organisms in patients visitors allegedly in sorbitol-negative colonies with overt infection or contact with carrier and these were tested for to detect carriers.1,2 animals on exhibit E. coli O157 with a specific test (ImmunoCard STAT® at petting zoos In recent months the E. coli O157 Plus, Meridian clinical laboratories at the Bioscience, Inc., Cincinnati, Ohio). The Orlando Regional Medical Center CHROMagar plates were examined for received two challenges in which it was necessary to screen patients more effectively for Escherichia coli O157 (E. coli O157) and methicillinresistant Staphylococcus aureus (MRSA).
E. coli O157 An outbreak of E. coli O157 occurred among visitors allegedly in contact with carrier animals on exhibit at petting zoos. The Florida Division of Health issued a bulletin to alert physicians and clinical laboratories of the outbreak. The laboratory protocol required that fecal specimens from clinically suspect
Continued on page 2
TechniTopic Valuable Screening Media in Clinical Situations Continued from page 1
light mauve to mauve colonies. Positive isolates were submitted to the Florida State Laboratory in Jacksonville, Florida for confirmation of identity and toxigenicity. The availability of BBL™ CHROMagar™ O157 allowed the early detection of potential E. coli O157 isolates within 18-24 hours with the development of easily observed mauve colonies, which were then tested for preliminary identification. All isolates submitted to the Florida State Laboratory were confirmed as Shiga-like toxin producing strains of E. coli O157. The ability to more easily recognize colonies of E. coli O157 on the
primary CHROMagar O157 medium made for earlier reports and isolation of patients. In addition, CHROMagar O157 has the advantage of increased specificity compared to Sorbitol MacConkey Agar plates. CHROMagar O157 relies on enzymatic CHROMagar O157 CHROMagar MRSA
reactions with chromogenic substrates rather than a sorbitol-negative reaction, which results in more efficient use of technologist time and a reduction
in the number of E. coli O157 Plus tests that need to be performed. A particularly unusual case from among the E. coli O157 patients was that of a young child with a history of animal contact. E. coli O157 (CHROMagar O157 positive) was isolated from a fecal sample and concurrently Clostridium septicum was isolated from a blood culture. This patient developed hemolytic uremic syndrome as a result of this rare, but previously reported dual infection.3 After a prolonged hospital stay the child recovered and was discharged to home. A recent review outlines the virulence factors involved in E. coli O157 infection.4
MRSA MRSA infection has become an acute concern in developed nations worldContinued on page 16
Anthony F. Walsh, Ph.D. Dr. Walsh has enjoyed a 55-year career in clinical laboratory science. He began his career as a Medical Technologist at Whipps Cross Hospital, London, England. He came to the United States in 1956 and held various positions as a clinical microbiologist. After settling in Florida, he earned B.S., M.S. and Ph.D. degrees from the University of Florida and obtained certification as a Specialist Microbiologist in
Valerie Hoover, B.S., MT(ASCP) Valerie Hoover received her Bachelor’s degree in Medical Technology from Michigan State University and subsequently became a certified Medical Technologist with the
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Public Health and Medical Laboratory Microbiology with the National Registry of Microbiologists of the American Academy of Microbiology. Currently, Dr. Walsh is Chief Microbiologist of the Clinical Microbiology Department at Orlando Regional Medical Center, Orlando, Florida. In addition to his laboratory responsibilities, Dr. Walsh is Clinical Associate Professor of Molecular Biology and Microbiology at the University of Central Florida where he received the Adjunct Faculty Excellence in Teaching Award in 1994. He also serves as a consultant to several local laboratories.
American Society of Clinical Pathologists. After working as a Medical Technologist for 20 years in both Michigan and Florida, Ms. Hoover became Supervisor of Microbiology and Immunology at Orlando Regional Medical Center, Orlando, Florida. She is a licensed Specialist Microbiology, Specialist Serology and Laboratory Supervisor by the Florida State Licensure. In addition, Ms. Hoover is a Laboratory Instructor with the Microbiology Department at the University of Central Florida.
BD BACTEC ™ System News Research Confirms – The BD BACTEC™ System Improves Sepsis Diagnosis A literature review, recently performed by Dr. Cesar Limjoco and Dr. Susan Whittier, has concluded that the BD BACTEC™ Blood Culture System with premium media produces a higher percentage of septicemia diagnoses compared to other blood culture systems. An excerpt from their study is presented below. For a copy of the entire article, mark the appropriate box on the reader response card.
system offered by TREK Diagnostic Systems; BacT/ALERT™ from bioMérieux; and BACTEC from BD. Although all of these systems offer advantages over manual blood cultures, some are more effective at identifying septicemia than others. A recent study presented at a meeting of the American Society for Microbiology focused on three diverse hospitals in
Improving Sepsis Diagnosis: Key to Better Patient Outcomes, Higher Reimbursement Cesar M. Limjoco, MD, CCS, and Susan Whittier, Ph.D., D(ABMM)
Early diagnosis and treatment of sepsis is associated with better patient outcomes. In 2003, the Academic Medical Center Consortium Sepsis Project Working Group published research identifying a wide variation in the way academic medical centers approach sepsis. Based on these observed differences in care and related outcomes, the study concluded that delay in appropriate antibiotic therapy is strongly correlated with higher patient mortality rates.1 Correctly diagnosing sepsis can also have positive financial results for hospitals. Patients with septicemia and other forms of sepsis typically require a high level of resource intensity and thus are very costly to the system. The diagnosis related group (DRG) for septicemia generates substantial payments that reflect the typical resources required for care and treatment of septic patients. The alternative diagnoses are often much less resource-intensive and result in lower-paying DRGs (see Table 1). Hospitals can choose from a number of blood culturing systems currently available on the market: ESP™ Culture
cent increase in positive blood cultures and a 35.4 percent to 51.4 percent increase in septicemia diagnoses (DRG 416), resulting in a $1.7 million increase in reimbursements.2 A 2003 study conducted by International Marketing Ventures (IMV) validated the findings of the Meridian Health system on a national level. IMV collected information from 1,388 hospitals, including blood culture instrument and media type used and annual blood culture testing volume. IMV integrated these data with hospital statistics on DRG 416 reimbursements for septicemia in order to calculate rates of septicemia detection per blood culture bottle. The data demonstrated that use of the BACTEC system with premium resin media was associated with
Table 1: Sample Reimbursement Rates Relative Weight
2005 Medicare
Septicemia
1.5982
$7,192
Fever of Unknown Origin
0.6021
$2,709
Septicemia
1.5982
$7,192
90
Simple Pneumonia w/o CC
0.6172
$2,777
416
Septicemia
1.5982
$7,192
321
Urinary Tract Infections w/o CC
0.5681
$2,556
DRG
Description
416 420 416
Note: These data are presented as a general guideline based on an average base rate of $4,500.
the Meridian Health system in New Jersey, each using a different blood culture system or media type. After consolidation of services and standardization of their microbiology laboratory systems to BACTEC and premium blood culture media, the hospitals conducted a retrospective analysis to determine the ability of all three blood culturing systems to detect septicemia. The study concluded that the BD system led to more septicemia diagnoses and higher reimbursement from third-party payors. Specifically, the study found that the BACTEC system, when compared to its competitors, offered a 2.6 percent to 3.4 per-
a 35.7 percent increase in sepsis diagnoses compared to the BacT/ALERT with FAN media and a 26.7 percent increase when compared to the TREK ESP system (see Table 2, page 4).3 These findings have significant implications for hospital reimbursement under a prospective payment system. As demonstrated in Table 1, the DRG for septicemia pays approximately $4,500 more than the DRGs for three common alternative diagnoses. In effect, every missed sepsis diagnosis costs a hospital $4,500. For every Continued on page 4
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BD BACTEC ™ System News The BACTEC™ 9000 Culture Club Has Five New Members! In the last issue of LabO™ we published an updated list of organisms that had been recovered from BACTEC 9000 series instruments and BACTEC media. Since that list was published, we have added five new members to the club! Why don’t you “join” the club? If you have an unusual organism isolated from any of the BACTEC 9000 series instruments (9240, 9120, 9050 and 9000MB), see if it is listed on the BACTEC 9000 Culture Club form enclosed in the Spring 2005 issue of LabO (Vol. 16, No. 1). If it’s not listed, complete the form and send it in to receive your
complimentary BD Portfolio! There is no limit to the number of forms that can be submitted. For more information on the BACTEC™ 9000 Culture Club or to obtain additional forms, call BD Technical Services at 800.638.8663.
Laboratory Site Covenant Medical Center Lubbock, TX
Underlying BACTEC Disease/Diagnosis Instrument
BACTEC Media*
Time to Detection
Organism Detected
Renal failure
9240
Plus Aerobic/F Standard Anaerobic/F
3 days
Leclercia adecarboxylata
FUO
9240
Peds Plus Aerobic
34 hours
Ralstonia (Pseudomonas) pickettii
Cartilage Transplant
9120
Lytic/10 Anaerobic/F
48 hours
Clostridium sordellii
FUO
9240
Plus Aerobic/F
Pneumonia
9240
Peds Plus Aerobic
Raritan Bay Medical Center Perth Amboy, NJ Rice Memorial Hospital Willmar, MN Valley Baptist Medical Center Harlingen, TX
48 hours Corynebacterium urealyticum 48 hours
Lactobacillus rhamnosus
*BD Diagnostics does not claim recovery of the isolates listed in the table with the associated media. See package inserts for the expected organism recovery.
The BD BACTEC™ System Improves Sepsis Diagnosis Continued from page 3
1,000 blood culture bottles, a hospital employing the BACTEC system with premium resin media potentially could collect $18,000 more in reimbursement than a facility relying on TREK ESP standard media and $22,500 more than a hospital using bioMérieux premium FAN media. Assuming an annual volume of 40,000 bottles, a hospital using the BACTEC system could potentially collect DRG reimbursements of $720,000 to $900,000 more than facilities using other blood culturing systems. With sepsis on the rise, it is more important than ever for hospitals to accurately diagnose and treat septicemia and other forms of this
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Table 2: DRG 416 (Septicemia) by Manufacturer and Media Media
Manufacturer
Sepsis Cases per Bottle Used
Standard Media
BD
0.015
Premium Media
BioMérieux
0.012
TREK
0.015
BD Resin
0.019
BioMérieux FAN
0.014
TREK*
NA
*TREK manufactures standard media only.
life-threatening condition. Choosing the most sensitive blood culturing system and media type helps clinicians make quick, precise diagnoses and initiate appropriate antibiotic therapy, resulting in better patient outcomes. A confirmed diagnosis of sepsis also allows hospitals to boost their revenues by billing third-party payors appropriately for the resource-intensive care required by septic patients.
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Yu, D.T., E. Black, et al. 2003. Severe sepsis: variation in resource and therapeutic modality use among academic centers. Crit. Care Med. 7:R24-R34. Whittier, S., M. Casey, et al. 2003. Financial impact of blood culture system consolidation and media selection. Study presented at: 103rd General Meeting of the American Society for Microbiology, Washington, DC. IMV CensusTrak. Profile of the hospital marketplace for blood culture instrumentation. February, 2004.
Product Highlights BD EpiCenter™ Version 5 Software: Expertised Data for Precise and Consistent Patient Reports In the previous issue of LabO™, we introduced BD EpiCenter Version 5 Software, BD’s microbiology data management system for the BD BACTEC™, BD BACTEC™ MGIT™ 960 and BD Phoenix™ microbiology systems. In this issue we describe in more detail the expert systems used by EpiCenter to ensure the production of precise and consistent ID/AST data using the Phoenix system.
can construct rules using any patient or facility demographic information combined with any ID/AST result information. To ensure success the first time the tool is used, rule authors have access to a library of common template rule types. In addition, a rule development tutorial is included in the system’s “Help” module.
Physicians and their patients benefit from having rapid and accurate ID/AST results. EpiCenter Version 5 Software provides not one, but two customizable expert systems to ensure efficiency and consistency in reporting of Phoenix ID/AST results providing laboratories with 24/7 staffing flexibility.
EpiCARE rule development is a two-step process. First, the rule logic is developed and second, the rule is validated using complementary rule validation systems – one using theoretical scenarios and one using real panel results:
The first expert system employed by EpiCenter is the BDXpert™ System. Based on CLSI standards and welldocumented knowledge from expert literature, BDXpert represents a “best practice” rules set. The BDXpert system expertises the full dilution MIC results produced by the Phoenix AST system. BDXpert rules can be configured on a rule-by-rule basis; i.e., each rule can operate in full automatic mode or be presented as a prompt to the microbiologist for activation. Furthermore, the system allows laboratories to communicate key clinical result messages that can be sent through the LIS to alert their physicians. The second expert system that may be employed by EpiCenter is the BD EpiCARE™ System (EpiCenter Clinical Application Rules Editor). This system is so unique that it has been submitted for patent. Using this system, laboratories can report additional results according to their institution’s specific quality assurance guidelines. Specifically, laboratories
BDXpert™ System
• The first validation system enables rule authors to challenge the rule, using a graphical interface, against theoretical data. Rules can have any number of parameters in their “If Statements” and the system uses color-coding to indicate correct rule performance. • The second validation system enables rule authors to identify historical patient results where the new rule would apply. These results are then sequestered in a “Test” environment where the new rule is challenged. Rule authors will quickly see if their newly created rule performs as designed.
BD EpiCARE™ System
The best news is that both the BDXpert and EpiCARE systems are “Pro-Active”. Technologists do not have to be actively reviewing results to be alerted to key clinical events. The EpiCenter software continually monitors results and when critical rules
are identified, the software can automatically activate a number of actions including alerting the technologists. So what are you waiting for? Contact your local BD sales representative today and learn more about the BD EpiCenter Microbiology Data Management System!
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Product Highlights BD ProbeTec™ ET System Studies Presented Evaluation of the BD ProbeTec Urine Preservative Transport (UPT) for Use with the BD ProbeTec ET Chlamydia trachomatis Amplified Assay. D. Fuller et al., Wishard Health Services (Indiana University School of Medicine), Indiana University School of Medicine, Louisiana State University Health Sciences Center, and University of Alabama. (CVS, S44)
This study examined the use of the UPT as compared to the current Urine Preservative Pouch (UPP) system for the detection of CT. A total of 956 urine specimens were tested with 131 confirmed positive for CT. The overall percent agreement (OPA) of the UPT compared to the UPP at refrigerated and ambient temperatures for each time interval of testing is summarized in the table below. 2-8°C
< 2 days Ambient
3-7 days Ambient
7-14 days Ambient
14-21 days Ambient
100% (122/122)
98.7% (533/540)
98.6% (214/217)
100% (73/73)
100% (4/4)
< 2 days
At the 21st Annual Clinical Virology Symposium held May 8-11, 2005, in Clearwater Beach, Florida, eight BD ProbeTec ET studies were presented on a variety of subjects including two studies on the BD ProbeTec Urine Preservative Transport (UPT) kit now under development. The UPT is being developed to increase the transport and storage stability of urine samples for use with the BD ProbeTec ET DNA Amplification System Assays for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Highlights of these studies are presented.
OPA
Evaluation of the BD ProbeTec Urine Preservative Transport (UPT) for Use with the BD ProbeTec ET Neisseria gonorrhoeae Amplified Assay. C. Aycock et al. University of Alabama, Wishard Health Services (Indiana University School of Medicine), Indiana University School of Medicine, and Louisiana State University Health Sciences Center. (CVS, S45)
This study compared the performance of the UPT to the Urine Preservative Pouch (UPP) system for the detection of GC. A total of 953 urine specimens were tested of which 70 were confirmed positive for GC. The overall percent agreement (OPA) of the UPT compared to the UPP at refrigerated and ambient temperatures for each time interval of testing is summarized in the table below. 2-8°C
< 2 days Ambient
3-7 days Ambient
7-14 days Ambient
14-21 days Ambient
98.4% (120/122)
99.8% (537/538)
100% (217/217)
100% (72/72)
100% (4/4)
< 2 days
OPA
*Product under development
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Product Highlights ANNOUNCING – BD™ Universal Viral Transport System Eliminate Transport on Ice, Reduce Sample Rejection We are pleased to introduce the BD Universal Viral Transport System, the only system providing room temperature transport of patient samples, while maintaining the viability of: •Viruses •Chlamydiae •Mycoplasmas •Ureaplasmas BD Universal Viral Transport can be stored and transported at room temperature or refrigeration, all in one formulation, which provides flexibility during sample collection and transport. BD Universal Viral Transport: 1. Eliminates the need to order and inventory two formulations.
2. Eliminates the need to train on two collection and transport methods, reducing sampling errors. 3. Eliminates sample rejection due to improper formulation and/or improper transport temperature. In addition, this one formulation also contains: • Sucrose, a cryoprotectant, for the preservation of viruses and chlamydiae when frozen • Antimicrobials to suppress bacterial and fungal contamination
BD Universal Viral Transport’s unique packaging design includes a flatbottomed conical tube that stands on the bench top, eliminating the need for tube racks and reducing the chance of biohazard spills. The conical tube is made of durable polypropylene, which provides safe transport of biohazardous patient samples. For more information on the BD Universal Viral Transport System or other BD Collection and Transport products, mark the appropriate box(es) on the reader response card or contact your local BD sales representative.
• A pH indicator to detect pH shift due to contamination
Cat. No.
Description
Qty/Pkg
220220
BD™ Universal Viral Transport, 3 mL vial
Pkg. of 50
220221
BD™ Universal Viral Transport Standard Kit; 3 mL vial with 2 sterile regular polyester-tipped plastic swabs with scored shaft
Pkg. of 50
220222
BD™ Universal Viral Transport Combo Kit; 3 mL vial with 1 sterile regular polyester-tipped plastic swab and 1 sterile wire/plastic polyester minitip swab with scored shafts
Pkg. of 50
220239
BD™ Universal Viral Transport Sterile Regular Polyester-tipped Swab with scored plastic shaft, 2 per pouch
Pkg. of 50
220240
BD™ Universal Viral Transport Sterile Polyester-tipped Swab, 1 minitip wire/plastic with scored shaft and 1 regular tip with scored plastic shaft, 2 per pouch
Pkg. of 50
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Product Highlights
To Realize Great Savings on BD Respiratory Testing Products As the respiratory season fast approaches, laboratories across the country are preparing their arsenals of rapid respiratory testing products. While there are numerous products to choose from, BD’s menu of respiratory testing
BD offers you six proven products to meet your respiratory testing needs: • BD Directigen™ EZ Flu A+B – New • BD Directigen™ Flu A+B • BD Directigen™ EZ RSV • BD Directigen™ RSV
products offers laboratories the best value for high quality rapid testing solutions for common agents of respiratory infections including RSV, influenza and group A Streptococcus.
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• BD Directigen™ EZ Strep A • BD Chek™ Strep A (CLIA waived) These products, based on the latest technologies, produce high quality results in less than 15 minutes. In addition, they can be stored
at room temperature, contain sufficient liquid controls to ensure QC compliance and include procedure cards and workstations for maximum ease-of-use. This year we are offering a special program, This is Your Season, designed to stretch your laboratory’s dollar. With this program, receive three free BD Respiratory Testing kits for every ten kits of the same catalog number purchased (the catalog number of the free products must be the same as the catalog number of the purchased products).
Key features of the This is Your Season program are: • Eligible Products – All six of the BD Respiratory Test products as listed (page 8). • Savings – Buy 10, Get 3 Free! Save as much as you like for the entire season. This offer has no limit and can be used for as many separate orders as you like. • Timeframe – Offer is valid until October 28, 2005 only. All orders must be placed by October 28, 2005, to receive free product.
Flu A+B Joins the BD Directigen™ EZ Family of Products BD is excited to announce that the BD Directigen EZ Flu A+B test has joined the BD Directigen EZ family of products, which also includes the BD Directigen EZ RSV and BD Directigen EZ Strep A tests. These tests are rapid chromatographic (lateral flow) immunoassays for the direct, qualitative detection of antigen in respiratory specimens. Some of the many benefits of the BD Directigen EZ Flu A+B test include great performance, improved laboratory efficiency and enhanced financial value.
Great performance: • Analytical testing demonstrates ability to detect H5N1 isolates and the A/California/07/2004 strain • High accuracy to ensure proper diagnosis: Accuracy*
Flu A Flu B 95.5% 96.8%
Improved laboratory efficiency: • Single device for both flu A and flu B • Proprietary reagent for making mucoid samples easy to test
• Easy to Participate – Order BD respiratory products through your regular BD distributor, then fax us a copy of your invoice to receive the free kits.
• Easy-to-read test line for rapid result determination • Results in only 15 minutes with simple-to-use workflow • Convenient room temperature storage
Enhanced financial value: • Separate test wells for flu A and flu B maximizes laboratory reimbursement • Compatible with a wide variety of transport media saving time and resources required for validation • Liquid positive and negative controls assists with CLIA QC compliance
Take advantage of this special offer and let this be your season of great respiratory solutions. Contact your local BD sales representative today for further details.
• Acceptable for use with multiple specimen types minimizing specimen incompatibility and rejection: • Nasopharyngeal washes
Cat. No. Description
• Nasopharyngeal aspirates
256050
• Throat swabs
Qty/Pkg
BD Directigen™ EZ Flu A+B 30 tests Containing devices, extraction reagent, positive and negative liquid controls, tubes and tips.
The speed and improved workflow of the BD Directigen EZ Flu A+B test make it applicable as a “STAT” influenza antigen detection test in any clinical laboratory setting, providing rapid, relevant information to assist with antiviral intervention and other clinical or support decisions. For more information on the BD Directigen EZ Flu A+B test, mark the appropriate box on the reader response card. *Accuracy based on nasopharyngeal wash and nasopharyngeal aspirate data.
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Product Highlights BD GasPak™ EZ Pouch With On Board Anaerobic Indicator The latest innovation from the inventors of disposable environmental generation systems BD Diagnostics is the original inventor of disposable environmental generation solutions for the microbiology laboratory. Since the inception of the first disposable anaerobic system, BBL™ GasPak™, BD has continually enhanced these products to increase laboratory efficiency and productivity. This history of innovation in product development has led to the newest advancement, the BD GasPak EZ Pouch with Indicator. To comply with quality control procedures, an atmospheric indicator is recommended when performing cultures on samples for anaerobic organisms. For your convenience, BD has attached
a dry anaerobic indicator directly to the BD GasPak EZ anaerobic pouch sachet. This improvement provides 100% assurance that the indicator is present in the pouch system and eliminates the need to re-culture or re-sample due to the absence of a QC indicator. With the indicator directly on the sachet, your laboratory will be able to save time, stock fewer ancillary products and process anaerobic cultures more efficiently. In addition, the indicator is provided without the need for any additional catalog numbers. For ordering purposes simply continue to request Cat. No. 260683, GasPak EZ Anaerobe Pouch System.
Color-Coded Tube Labels A Big Hit! Late last year we introduced color-coded labels for our highest volume tubed media including GN Broth, Lim Broth, Trypticase™ Soy Broth (TSB), and Thioglycollate Medium. We implemented colorcoded labels for these media to improve the efficiency of specimen processing (occasionally, customers inadvertently inoculated the wrong tube due to the similar appearance of these media). We are now pleased to report that customers are noticing and appreciating this improvement! Customers have found the color-coded tubes user-friendly, easily identifiable and most importantly,
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they have reduced errors in critical patient specimen processing. But the good news is we have more product and packaging enhancements on the way. In fact, we have just implemented our latest improvement – peel-off labels. All of our tubed media cartons now contain labels that can be peeled-off for easy insertion into quality control log books. Since each label contains the lot number, expiration date and a statement verifying that the medium meets CLSI and/or BBL testing requirements as applicable, laboratories can fulfill their quality control documentation requirements for each medium.
For more information on the BD GasPak EZ product line, mark the appropriate box on the reader response card.
Cat. No.
Description
Qty/Pkg
Label Color
221729
BBL™ GN Broth
10
Yellow
221730
BBL GN Broth
100
Yellow
292209
BBL™ Lim Broth
10
Orange
296266
BBL™ Lim Broth
100
Orange
10
Green
100
Green
10
Green
100
Green
10
Blue
100
Blue
10
Blue
100
Blue
221715 221716 221092 221093 221741 221742 221787 221788
™
BBL™ Trypticase™ Soy Broth, 5 mL BBL™ Trypticase™ Soy Broth, 5 mL BBL™ Trypticase™ Soy Broth, 8 mL BBL™ Trypticase™ Soy Broth, 8 mL BBL™ Thioglycollate Medium, 5 mL BBL™ Thioglycollate Medium, 5 mL BBL™ Thioglycollate Medium, 8 mL BBL™ Thioglycollate Medium, 8 mL
At BD, we are committed to increasing laboratory efficiency and improving medical outcomes. Please give us your suggestions for product improvements by contacting our BD Technical Services department at 800.638.8663.
Micro Happenings BD and CMMB Join Forces to Address the Challenge of HIV/AIDS Pandemic in Zambia In May of this year, ten BD associates from around the world traveled to Zambia to work with the Catholic Medical Mission Board (CMMB) at five rural healthcare facilities to assist in the fight against the deadly disease. More than 350 BD associates worldwide applied to participate in this effort; several of those selected were specialists with a laboratory background. During their two-week assignment, the volunteers performed various functions, including: Laboratory Trainer to focus on raising awareness and increasing best practices for routine lab and HIV/AIDS testing; General Assistants to teach basic skills to local residents; and Construction Workers to repair and renovate hospitals and clinics. “Currently, an estimated 16% of Zambia’s population is HIV positive. The average life expectancy is 37 and there is limited access to healthcare, especially in rural areas,” said Dr. Elizabeth Musaba, Country Director, Zambia, CMMB. “We are thankful to the BD volunteers.” BD hopes to be able to conduct additional volunteer programs in other locations in the future.
Susan Morris Receives Gavel at ASCLS Annual Meeting In recognition of her work, efforts and dedication as president of the American Society for Clinical Laboratory Science (2004-2005), Susan Morris was awarded a Past Presidents’ Gavel on July 27th at the Society’s 73rd annual meeting in Orlando, Florida. The award, which consists of a scale model of the official ASCLS gavel adorned with a silver nameplate
with the president’s name and year of service, was presented by Clement Darrow, a business director for BD Diagnostics. Susan Morris, MPH, CLS(NCA), is Director of Ancillary Services at the Magic Valley Regional Medical Center in Twin Falls, Idaho. She used her term as ASCLS President to encourage the active engagement and involvement of the younger
members at every level of the Society. Through her “President’s Message” essays published during the year in ASCLS Today, she emphasized relationship building and promoted the Hedgehog Concept for taking the ASCLS from good to great. Congratulations to Susan Morris on your award and thank you for your contributions to ASCLS at the state/local, regional and national levels!
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Micro Happenings Dr. Lance R. Peterson Receives BD Award for Research in Clinical Microbiology This year’s BD Award for Research in Clinical Microbiology was presented to Lance R. Peterson, M.D., of the Department of Pathology at Evanston Northwestern Healthcare, Evanston, Ill. The award was presented at the 105th General Meeting of the American Society for Microbiology in Atlanta, Georgia. Dr. Peterson is recognized as one of the leading clinical microbiologists and most accomplished researchers of the past two decades. He has been a leader in demonstrating the epidemiology of antibiotic-resistant bacteria, the impact of molecular
typing on healthcareassociated infections, the use of computer data mining to reduce nosocomial infection rates, and application of rapid molecular diagnostics to infection control. During his time as Director of Microbiology and Infectious Disease Research at Evanston Northwestern Healthcare, Dr. Peterson has mentored countless technologists, medical students, and fellows in clinical research and scientific writing. In
addition, he has published hundreds of scientific papers, presented abstracts at scientific meetings, and authored dozens of book chapters, letters, and brief reports. Dr. Peterson, an American Academy of Microbiology Fellow, was nominated by Richard B. Thomson, Jr., also of the Department of Pathology at Evanston Northwestern Healthcare.
Drs. Portaels and Salfinger Honored with the Gardner Middlebrook Award Dr. Françoise Portaels and Dr. Max Salfinger were the recipients of this year’s Gardner Middlebrook Awards presented at the 26th annual BACTEC™ TB Dinner held in conjunction with the ASM General Meeting in Atlanta, Georgia in June. The award is given annually in recognition of significant contributions in the field of mycobacteriology. Dr. Portaels received her Doctorate in Science from the University of Brussels. She is a Full Professor and Head of the Mycobacteriology Unit at the Institute of Tropical Medicine in Antwerp, Belgium. In addition, she is the Worldwide Coordinator of the WHO/IUATLD Supranational Reference Laboratory Network for Tuberculosis Drug Resistance Surveillance and Chair of the Subgroup
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on Laboratory Capacity Strengthening of DOTS Expansion Working Group. Dr. Portaels is the world authority on Mycobacterium ulcerans and she has devoted much of her research activities to Buruli ulcer, a disease caused by M. ulcerans. She has more than 220 peer-reviewed publications. Dr. Salfinger obtained his medical degree from Basel University. He served as Head of the Tuberculosis Laboratory at the Department of Medical Microbiology at the University of Zurich, which under his direction became the Swiss National Center for Mycobacteria in 1992. That same year Dr. Salfinger became Director of the
Clinical Mycobacteriology Laboratory at the State Health Department in Albany, New York, where he implemented the New York State Fast Track Program for Rapid TB Testing. This novel program received the Vision Award – Achieving Excellence in Public Health through Innovation – from the Association of State and Territorial Health Officials. During the last 10 years, the New York State TB Laboratory has hosted more than 50 fellows, interns, and visiting scientists from various countries and is committed to sharing its experience and expertise. Dr. Salfinger also serves as a volunteer with Doctors of the World and other organizations in the global fight against tuberculosis. Congratulations to Drs. Portaels and Salfinger from BD Diagnostic Systems!
FYI Passport to Possibilities If you visited BD’s booth at this year’s 105th General Meeting of the American Society for Microbiology held June 5-9 in Atlanta, Georgia, then you were transported on an unparalleled journey to enhanced productivity, and enhanced medical and financial outcomes. BD’s Passport to Possibilities theme offered seminars by leading microbiologists, state-ofthe-art product samples and demonstrations, and the latest information to help improve medical outcomes, enhance productivity, reduce expenses and increase revenue. But it wasn’t all business. Visitors to the booth were given BD Passports and were issued unique stamps at each of our 15 product stations. And after visiting just four product stations, they were treated to a canvas tote bag.
Laboratory Diagnosis of Vaginitis
In case you missed the meeting, you can still journey to our web site (http:// www.bd.com/ds/learningCenter/asm/ index.asp) and view all ten seminars:
The Importance of a Positive Blood Culture for Patients on Antibiotics
Screening for MRSA... Importance and Methods Karen C. Carroll, MD, The Johns Hopkins Medical Institutions
Impact of a Positive Blood Culture on a Prospective Payment System
Gerri Hall, Ph.D., Cleveland Clinic Foundation
Implementing the 2005 CLSI Recommendations for Antimicrobial Susceptibility Testing and Reporting Janet Hindler, MCLS, MT(ASCP), F(AAM), UCLA Medical Center
Microbiologic Support for Hospital Epidemiology Joan Hebden, RN, M.S., CIC, University of Maryland Medical Center
Regulations, Infectious Disease Trends, and Testing Richard Steece, Ph.D., ABMM, Association of Public Health Laboratories (APHL)
Diane C. Flayhart, M.S., MT (ASCP), The Johns Hopkins Medical Institutions
Microbial Specimen Transport: Overlooked and Underappreciated Paul Bourbeau, Ph.D., Geisinger Medical Center
Susan Whittier, Ph.D., Columbia University Medical Center
Respiratory Syncytial Virus: The Disease, Its Diagnosis and Its Therapy John DeVincenzo, MD, University of Tennessee
Lymphogranuloma Venereum (LGV): An Update Charlotte A. Gaydos, Ph.D., Johns Hopkins University
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FYI BD Diagnostics Service Organization News Technology Training Center Hosts Advances in the Identification of MRSA Webinars On July 12, 2005, the BD Diagnostics Technology Training Center (TTC), in conjunction with the Association for Professionals in Infection Control and Epidemiology, Inc., presented a webinar entitled Advances in the Identification of MRSA. Dr. Andrew Simor of Sunnybrook and Women’s Hospital, Toronto, Ontario and Janet Hindler of the UCLA Medical Center, Los Angeles, CA were the presenters. This was the second in a series of webinars on MRSA screening. The first webinar held in January drew over 588 participants worldwide, including participants from Brazil, Canada,
Israel, Puerto Rico, the United States, Trinidad and Tobago, Venezuela, Turkey, Peru, United Kingdom and Uzbekistan. If you would like to view past webinars, please visit our web site where you can find links to archived copies of webinars. Go to: http://www.bd.com /ds/learningCenter/ and click on the “Webinars” link. All of our webinars are accredited by ASCLS P.A.C.E.™, the State of California and the State of Florida for Continuing Education Units (CEU). For more information please contact the TTC at Technology_Training_
[email protected] or call us at 800.315.6004.
New Triage Center a Success! In an effort to provide you with more specialized service, BD Diagnostic Systems Technical & Informatics Services launched the Triage Center earlier this year. The Triage Center consists of five Service Assurance Representatives who respond “live” to all incoming calls on our technical support line, 800.638.8663. These Service Assurance Representatives are there to: • Help you with your non-technical issues or document requests • Direct you to the appropriate Technical Specialist to meet your specific technical and application needs Since the Triage Center’s launch in January, 2005, we have received positive feedback for this personal service. Many of you have been
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pleasantly surprised to find a “live” person at the other end of the line rather than a computerized “prompt” system. Not only are your inquiries resolved more personally and efficiently, you no longer experience the frustration associated with listening to a lengthy menu of options or “hitting the wrong prompt” button! Of course, if you prefer to communicate with us by e-mail, please send your inquiries Service Assurance Representatives (left to right): Sharon Chiodi, Amy Sanders, Kristen Stewart, Nancy Franco and Becky Stouffer.
to:
[email protected]. And for your convenience, Certificate of Analysis (C of A) and Material Safety Data Sheets (MSDS) are available online at www.bd.com/ds. Thank you for your feedback! We welcome your input and suggestions as we strive to continually improve our services to you.
Have You Seen BD EpiCenter™ Version 5.0? BD recently released the newest version of our EpiCenter data management software, Version 5.0. This new version, in large part targeted for BD Phoenix™ users, greatly expands the capabilities of EpiCenter. Elsewhere in this newsletter, you will find an article detailing BDXpert™ and EpiCARE™, the newest modules added to the EpiCenter data management system. In addition to these new modules, the adjacent table summarizes all of the EpiCenter Version 5.0 expanded capabilities. Key to implementation of these expanded EpiCenter capabilities is a comprehensive training program. The Technology Training Center (TTC) in Sparks, MD (north of Baltimore) is responsible for providing this training. When you purchase a new BD Phoenix ID/AST System together with a BD EpiCenter System, your training is provided in several phases, intended to get you ‘up and running’ as quickly as possible. The training consists of both onsite training in your laboratory and travel to the TTC at BD Diagnostic Systems headquarters, near Baltimore. At the TTC in Sparks, you will learn and work with instruments under the guidance of a BD Certified Training Specialist. And, on site, a BD Certified Application Specialist will provide additional system training and review, as well as assisting you in customizing your workflow to maximize the benefits of your new EpiCenter System. All of your trainers have passed a thorough and comprehensive certification curriculum. This program was implemented to insure that regardless of where the training takes place,
Module
New / Expanded Feature
Benefit
BD EpiCARE™
Clinical Application Rule Editor: A User-defined Expert System
• BD EpiCARE allows you to write your own expert rules, based on the specific needs of your institution. • Users can define “conditions” that will trigger an EpiCARE rule using any Phoenix result or patient demographic. When all of the rule conditions are met, EpiCARE can perform multiple automatic actions including proactively printing reports, generating audio alerts and on-screen messages, uploading results to the LIS, suppressing results and defining resistance markers. These capabilities improve result interpretation and automate supervisory review, thus providing consistent and more efficient reporting of lab results.
BDXpert™ System Extensive Best Practice Rules Set
• The BDXpert system works in concert with the Interpretation Rules Set (CLSI, SFM or DIN) to correctly interpret and/or act upon AST results. • BDXpert is designed to recognize and change special case results, including selection of Resistance Markers.
Data View 1. Routine Lab Tests Reorganized into 2. Microbiology: • Performance Functional Groups • Surveillance • Method • Specimen • Patient • Service • Nosocomial Infection • Like Patients • Nosocomial Report • Phenotypic Surveillance • Reporting to Surveillance Authorities 3. Epidemiology • Organism Incidence • Resistance Marker Incidence • Phenotypic Incidence • SIR Incidence • MIC Incidence • Method Based MIC Incidence 4. System
• EpiCenter provides the user with an extensive library of predefined queries and reports. In Version 5, this library has been reorganized into functionally related groups. This new organization will help your facility to gain efficiencies in utilizing these powerful EpiCenter tools.
New Data View • AST Time To Result Queries / Custom • ID Time To Result • Patient Surveillance Reports • Specimen Surveillance • Service Surveillance • Phenotypic Surveillance • Surveillance Report • Isolates with Similar ID/AST Results • Nosocomial Infection • Phenotypic Incidence • Distribution of MIC Values • MIC Trending • Instrument Status
• In response to user requests, we have included additional Data View Queries and have enhanced several existing Queries. • The EpiCenter report library provides users with the ability to access real-time, patient-focused epidemiology data designed to improve patient care. The new and enhanced reports provided by EpiCenter Version 5, demonstrates the BD commitment to providing your facility with the best tools possible. We welcome your suggestions to further enhance this library.
all of our users receive a complete, standardized training program. Additionally, all of our trainers have extensive clinical laboratory experience that allows them to understand your needs and the integration of our products into your laboratory.
Our programs are standardized and extensively documented. We are proud to have established training accreditation through ASCLS P.A.C.E.™, the State of California and the State of Florida for all of our training programs.
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TechniTopic Valuable Screening Media in Clinical Situations Continued from page 2
wide.5 It is no less a concern in the State of Florida and spares neither the community nor the hospital population. Infection control staff maintain constant vigil to reduce nosocomial infections caused by MRSA.6 In the course of data analysis by infection control personnel the possibility of nosocomial or communityacquired MRSA infection in the neonatal intensive care unit was suspect. The medical, nursing and infection control staff decided to perform nares cultures for colonization on all the patients in each of three units. This represented a patient population of some 100 neonates. Nares
LabO™ is published three times per year by BD Diagnostics, 7 Loveton Circle, Sparks, MD 21152, 410-316-4701. Editor: Mary Jo Zimbro, B.S., MT(ASCP). Send address changes and mailing list additions to the attention of Marketing Communications, Mail Code 634. For technical information, call Technical Services, toll free, at 800-638-8663. Visit our web site at http://www.bd.com/ds/.
BacT/ALERT is a trademark of bioMérieux, Inc. CHROMagar is a trademark of Dr. A. Rambach. ESP is a trademark of TREK Diagnostic Systems. P.A.C.E. is a trademark of The American Society for Clinical Laboratory Science. Unless otherwise noted, BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. ©2005 BD. BD Diagnostics is an ISO 9000 registered manufacturer. 0-2780
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cultures were plated to Sheep Blood Agar and BBL CHROMagar MRSA. Plates were incubated without CO2 for 18-48 hours at 35°C. Staphylococcus species colonies on Sheep Blood Agar were confirmed as Staphylococcus aureus by latex agglutination. Positive isolates were then plated to Oxacillin Screen Agar plates, which were incubated for 24 hours at 35°C. Growth on the screen was considered indicative of MRSA.7 CHROMagar cultures were examined for pink colonies, the typical reaction of MRSA on this medium, after 18-24 hours of incubation and again at 48 hours. Pink-colored colonies that occurred after 24 hours were checked by latex agglutination to establish their identity. MRSA isolates were sent to the Florida State Laboratory for pulsed-field gel electrophoresis studies to attempt to establish a point source. There was a total correlation between the results of Oxacillin Screen Agar plate cultures and the CHROMagar cultures in a comparison of 200 patient specimens. The majority of positive MRSA S. aureus cultures were detected on the CHROMagar MRSA plates within 1824 hours at the time of the first evaluation. The ability to identify the positive MRSA cultures earlier enabled a more rapid method to find colonized patients. This is advantageous as it provides an opportunity for earlier intervention, which could improve patient outcomes. In addition,
CHROMagar MRSA reduces the number of latex agglutination tests that need to be performed and eliminates the need to perform an E. coli Oxacillin Screen Agar plate. This provides more efficient use of valuable technologist time.
Conclusion BBL CHROMagar O157 and BBL CHROMagar MRSA, when used in accordance with the manufacturer’s instructions, provide reliable screening methods for any microbiology laboratory but particularly those laboratories not equipped for molecular methods to identify these two important pathogens. 1
Hsu, L. Y. et al. 2005. Community-associated methicillin-resistant Staphylococcus aureus, Singapore. Emerg. Infect. Dis. 11(2):341-342. 2 Centers for Disease Control and Prevention. 1994. E. coli O157: H7: Procedure for isolation and identification from stool specimens. Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, Georgia. 3 Barnham, M. and N. Weightman. 1998. Clostridium septicum infection and hemolytic uremic syndrome. Emerg. Infect. Dis. 4(2). 4 Ethelberg, S. et al. 2004. Virulence factors for hemolytic uremic syndrome, Denmark. Emerg. Infect. Dis. 10(5):842-847. 5 Monnet, D. et al. 2004. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen 1996 – 2000. Emerg. Infect. Dis. 10(8):1432-1440. 6 Regev-Yochay, G. et al. 2005. Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg. Infect. Dis. 11(3):453-456. 7 Swenson, J. M., J. A. Hindler and L. R. Peterson. 1995. Special tests for detecting antibacterial resistance, p. 1356-1367. In P. R. Murray, E. J. Baron, M. A. Pfaller, F. C. Tenover and R. H. Yolken (ed.), Manual of clinical microbiology, 6th ed., American Society for Microbiology, Washington, D.C.
Photo credits: Cover photo of S. aureus by Janice Carr. This page: Photo of S. aureus by Janice Carr and Matthew J. Arduino, DRPH, photo of E. coli by Peggy S. Hayes. All are provided courtesy of the CDC.
