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Diary of the "mad" med-lab techs.

Bug studies 101

Medical microbiology--and by this, I mean "bug study" as it appears to be conducted by medical practitioners (except for lab folk)--generally remains a mystery, right up there with computer billing and the purported thinking of politicians.

With few sometimes-scary exceptions, does and nurses are generally content to rely on the reports that come out of the mysterious laboratory printer. This is most interesting as they receive much more education in microbiology than they do in blood banking--and they are all experts in that field (but that is another story).

There are two problems that many of them still fail to grasp: the first is that bugs grow at their own rate. (I once had an intern sit in my lab for a half hour; he asked if he could wait for the blood culture result. I told him, "Sure, have a seat." He eventually figured it out.).

The second problem is that there is a reason we do sensitivities. Not all bugs are equally sensitive or resistant, but we do provide antibiograms to let docs and nurses know what are the most likely magic pills (or juices) for what are the "local bugs du jour" How many actually use these solutions is another matter (you can lead a horse to water ...).

--Chuch Millstein, MBA, MT(ASCP), CLDir(NCA), Retired

Throat cultures: First, do no harm

It scares me to see so much diversity in the reporting of throat cultures. A nurse at a busy practitioner's office called me. She chastised me for not giving her a full throat-culture report like the one she got from the "other lab." Our report only stated "No Group A Streptococcus pyogenes recovered." I asked her what she would do if we reported out Haemophilus influenzae or Staphylococcus aureus or Streptococcus pneumoniae. She said they would treat it.

Haemophilus influenzae epiglottitis is a clinical diagnosis substantiated by culture. Other than that unique syndrome, it does not contribute to pathogenic processes in the throat.

Arcanobacterium hemolyticum and Group C Streptococcus can cause severe pharyngitis, and antibiotics may shorten the course of disease--but they are not known to cause serious sequelae clearly associated with Group A Streptococcus. Antimicrobials are given to prevent advancement into more serious disease, not necessarily to treat self-limiting infections. There is no scientific evidence that S aureus causes a sore throat. There is evidence, however, that colonization of the pharynx with S aureus increases after antibiotic therapy.

Interesting story: I did the microbiology for several outside locations. One of our urgent-care facilities was sending us throat cultures on standard transport media. By the time we received them into our lab, they could be anywhere from eight to 24 hours old. Around 80% of these cultures grew out S aureus so luxuriously that it overwhelmed everything else on the plates.

I started to rethink my opinions about the organism, toying with the idea that there may be a virulent strain epidemic in that area. After brief detective work, I discovered that the staff was storing the collected specimens on top of their refrigerator where the temperature was close to 35[degrees]C! The problem was solved when they kept them in the refrigerator. Transport media has its limitations.

Why do you think we have to screen sputum specimens so stringently for acceptability? Sputum passes through the upper respiratory tract, which is teaming with bacteria. Almost all bacterial pneumonias are caused by aspiration of normal pharyngeal (throat) flora down into the sterile lower respiratory tract. What is normal in the pharyngeal mucosa (e.g., S pneumoniae, H influenzae, S aureus, Moraxella catarrhalis) can be deadly in the lower respiratory tract.

If we do not screen sputum specimens carefully, we are giving out erroneous information. And if we are not selectively reporting throat culture results, we are definitely going to contribute to antibiotic overuse.

--Colleen K.gannon, MT(AMT) HEW the "Nancy grace" for labs

True dedication

The staff at Falmouth Hospital Laboratory in Falmouth, MA, recognizes and appreciates the extraordinary talent of Medical Technologist Pat (Muriel) Mullen in 2010. What makes this accolade so special is that she just celebrated her 80th birthday in March.


Pat has been a med tech since the early 1950s. Her first job was at Astra Pharmaceutical in Worcester, MA. She went on to work at Memorial Hospital and Worcester City Hospital, where she was in charge of the med-tech training program. In 1976, Pat moved to Falmouth and has worked at Falmouth Hospital ever since.

Her skills, endurance, expertise, and professionalism keep her younger co-workers on their toes. She not only works two to three days a week in a regular part-time position as a generalist, she is one of the first to volunteer as a substitute for sick and vacation needs.

We at Falmouth Hospital Laboratory find Pat an indispensable part of our lab family, if not the key member. We wish her many more happy lab birthdays to come.
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Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Apr 1, 2010
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