Reduction in sample rejections at the preanalytical phase - Impact of training in a tertiary care oncology center.

CONTEXT: Major clinical decisions are based on the laboratory test results where preanalytical errors are an important cause of repeat collections in patients. Identification of problem areas and continuous training of phlebotomy staff are important tools in reducing these errors. AIMS: In this study, we looked at the most common causes of sample rejection in our setting and the efficacy of the corrective measures and training processes for staff in reducing preanalytical errors. SETTINGS AND DESIGNS: This prospective study was conducted at the laboratory diagnostic services of a tertiary care oncology center, with a hematopoietic stem cell transplant unit during the period of 2012-2017 in two phases. Sample rejections from various wards were analyzed for types of rejections. MATERIALS AND METHODS: In the first phase, we analyzed the problem areas (year 2012). Following a root cause analysis, current practices of training were altered. In the second phase (2013-2017), we studied the effects of these measures. STATISTICAL ANALYSIS USED: The percent variation and P value for significance in sample rejections were calculated. RESULTS: During the year 2012, 0.36% samples were rejected by laboratory. Following interventions in the period from 2013 to 2017, samples rejected dropped to 0.19% (P < 0.0001), 0.09% (P < 0.0001), 0.09% (P = 0.8387), 0.05% (P = 0.0004), and 0.05% (P = 0.329), respectively. The reduction was significant from surgical oncology ward (P = 0.0107) and intensive care unit (P = 0.0007). From 2013 to 2017, errors significantly reduced to 0.015% for hemolyzed samples (P = 0.0001), 0.005% for contaminated samples, 0.036% for clotted samples, and 0.019% for labeling errors. CONCLUSION: Intervention in the form of targeted training helps reduce errors and improves the quality of results generated and contributes to better clinical outcomes.

Challenges in the Laboratory Diagnosis and Management of Dengue Infections.

Dengue fever is considered the most important arthropod-borne viral diseases in terms of morbidity and mortality. An accurate and efficient diagnosis of dengue plays an important role in case confirmation. The virus may be isolated during the viremic phase (within day 5 of illness), from serum, plasma and peripheral blood mononuclear cells. Enzyme linked immunoassay (ELISA) has demonstrated the presence of high levels of dengue NS1 antigen and tests may be performed by enzyme-immunoassays (EIAs) or immune-chromatographic (ICT) methods. These assays are specific with respect to different flaviviruses. Conventional and real time RT PCR, nested PCR, multiplex PCR and Nucleic acid sequence based amplification (NASBA) have been described as sensitive and relatively rapid method of detecting the virus during the early viremic phase. Other tests used include assay of anti-dengue specific IgM and IgG ELISA. Currently no curative treatment in terms of anti-viral drugs is available for dengue and patients are managed with rest and aggressive supportive therapy. Management may be done at home or in the hospital depending on the severity of the illness. Hospital management includes fluid therapy, blood component transfusion and other modalities of treatments like steroids, recombinant factor VII and management of complications. Various vaccines are in trial stages and may become available in the near future.

Postmortem findings in HIV/AIDS patients in a tertiary care hospital in rural South Africa.

South Africa has the largest number of people living with HIV/AIDS, and various associated infectious and noninfectious conditions contribute towards mortality. The objective of this study was to determine the important post-mortem findings in HIV-infected individuals in a high HIV burden rural area in South Africa. The patient population included HIV patients who died at the tertiary care hospital, from 2000-2008. Autopsies were performed according to standard protocols and diagnoses were made with additional laboratory investigations wherever required. A total of 86 patients were autopsied (30 males, 56 females). The major postmortem findings were related to infections, with 38% of the patients having had some form of tuberculosis, followed by pyogenic infections--pneumonias (21.5%), meningitis (10.1%) and septicemias (5.1%). Other important infections included opportunistic fungi like cryptococcosis (7.6%) and pneumocystis pneumonia (8.9%). Among the noninfectious conditions, the findings seen were predominantly related to liver (10.1%) and cardiac involvement (10.1%).

Bacteriological Profile and Antibiogram of Aerobic Burn Wound Isolates in Mthatha; Eastern Cape; South Africa

Burn wound colonisation and infection is not only associated with delayed wound healing and scar formation; but may also lead to sepsisrelated mortality. A wide variety of microorganisms; like staphylococcus aureus; Pseudomonas aeruginosa; and Enterobacteriaceae-like Klebsiella pneumoniae and Escherichia coli; are involved. Resistance is generally increasing; with reports of multidrug-and pan-resistant isolates. This study was conducted to determine the common aerobic bacterial isolates in our setting and describe their antimicrobial susceptibility. This retrospective; descriptive study was carried out on 243 patients; from whom 312 burn wound specimens were received by the Nelson Mandela Academic Hospital microbiology laboratory of the National Health Laboratory Service; Mthatha. All samples were processed according to standard laboratory protocols; isolates were tabulated according to age and gender of the patients; and their percentage susceptibilities to relevant antibacterials were computed. A total of 229 patient specimens showed growth on culture. The total number of isolates was 629; out of which 269 were Gram-positive cocci and 360 were Gram-negative bacilli. The commonest organism was S. aureus (27.7); followed by K. pneumoniae (13.4); Proteus mirabilis (12.4); Group D streptococcus (9.4); P. aeruginosa (8.9) and E. coli (6.2). A generally high level of resistance was observed in many organisms. Methicillinresistant S. aureus accounted for 57.5 of the S. aureus. Resistance among the Gram-negative bacilli was; in general; least to imipenem; amikacin and ciprofloxacin. The common organisms causing burn wound infections in our setting include staphylococci; Klebsiella; Proteus and Pseudomonas and there is a high level of resistance against commonly used antimicrobials. Regular surveillance of burn wound organisms and their antimicrobial resistance patterns will help in determining empirical antibiotic therapy for subsequent related septic events