Bacteriology

Proficiency course
Yogyakarta
28th September 2015
 The clinical laboratory context
and role
Brett Crawley
28th September 2015
 Clinical presentation of infection?

Like many other diseases, infectious diseases

present with a variety of symptoms:
Locally or disseminated (generalised).
Usually linked to different organs:
Respiratory tract -Eye
Urinary tract -Skin
Alimentary Chanel -Heart
Central Nervous System -Joint
 What is the origin of an infection?

Possible sources of organisms:

Exogenous:
From other people
From the environment
From animals (zoonosis)
Endogenous:
From own flora
 By aerosols

Cough with hand

covering the mouth
 Clinical diagnosis: role of laboratory

Microbiological laboratory aims at identifying

germs and test their sensitivity for therapy:
However: “Garbage in, garbage out”
Communication with clinicians is essential:
Quality of material -Transportation
Diagnostic support -Structural
Patient oriented advice -Treatment
Result Reporting System -Speed
 The diagnostic process
The company

The process: Pre-consultation

- Collection
- Transportation
material collection
Laboratory:
- Bacteriology
transport material
- Virology
- Serology
examination
- Molecular
- microbiology
analytic results

Quality report and advice

 Collection
The company

The process: Important data:

- Collection
- Transport
Patient name
Laboratory: Patient sex
- Bacteriology Patient d.o.b.
- Virology Name doctor
- Serology
Correct material
- Molecular
Time of collection
- microbiology
Relevant clinical information
Quality
 Laboratory-departments
The company

The process:
BACTERIOLOGY
- Collection
- Transportation
VIROLOGY
Laboratory:
- Bacteriology
- Virology SEROLOGY
- Serology
- Molecular MOLECULAR MICROBIOLOGY
- microbiology

Quality
 Inoculation
The company

Het proces:
The process:
- Afname
Collection
- Transportation
Transport

Laboratoria:
Laboratory:
- Bacteriology
Bacteriologie
- Virology
Virologie
- Serology
Serologie
- Molecular
Moleculaire
- microbiology
microbiol.

Kwaliteit
Quality
Multiplication
of bacteria
 Examination of culture plates
Het bedrijf
The company

Het proces:
The process:
- Afname
Collection
- Transportation
Transport

Laboratoria:
Laboratory:
- Bacteriology
Bacteriologie
- Virology
Virologie
- Serology
Serologie
- Molecular
Moleculaire
- microbiology
microbiol.

Kwaliteit
Quality
 Clinical microbiology history

Microbes as pathogens

Louis Pasteur (1822-1895)

Contradicted the dominant theory until

then “generatio spontanea”: living
animals can raise from nothing
– Example: from dirty laundry and old grains
mice can be created
 Microbiology
history

Microbes as germs
1862: gave evidence for the germ theory
(research on caterpillars)
Furthermore:
Degrading of food by microbes in the air
Pasteurisation: milk or beer heated to 55ºC
some minutes: micro-organisms killed,
product unspoiled
Base for desinfection during surgery
Per 100,000/jr
 The 20th century

Century of important discoveries

Maintainance strict hygienic measures

Aseptic techniques in surgery
Development of chemotherapeutics
Development of penicillins (et.al.)
Vaccination on world scale
Drug design and molecular biology
In 1979, the Surgeon General of the United States said,

"We can close the books on infectious diseases...."

In 1979, the Surgeon General of the United States said,

"We can close the books on infectious diseases...."

(He spoke too soon. Infectious diseases are back,

and many of them are resistant to antibiotics.)
Is the problem really important?

e.g.:
•Malaria
•Tuberculosis
•Diarrhoea
VS: 1999
Profesionnal profile medical-microbiologist

Laboratory diagnosis
Inter-collegue consultation
Laboratory management
Health policy development and
development of guidelines and protocols
Surveillance of infectious diseases.
hospital epidemiology and hygiene
Public Health
Information, education and training
Scientific research
Profesional profile medical-microbiologist

Laboratory diagnosis
– Technicians
– Laboratory equipment, available tests
– Support: transport service, administration etc.
– Examinations: culture/serology etc.
– Reporting of culture and sensitivity results
– State of the art technology (introduction of tests)
– Quality Proficiency System (accreditation)
– Scientific research
Profesional profile medical-microbiologist

Intercollegial consultation
´Patient oriented advise on infections
– Possible clinical diagnosis
– Laboratory diagnosis including corrections
– Treatment options
– Preventive measures
Incidental
Structural
Profesional profile medical-microbiologist

Laboratory management
Profession and management can not be
separated
Tasks partly delegated (e.g. superior
technicians)
Final resonsibility: clinical-microbiologist
Profesional profile medical-microbiologist

Health policy development and

development of guidelines and protocols
Diagnosis
Treatment
Prevention
 Profesional profile medical-microbiologist

Surveillance of infectious diseases and hospital

epidemiology and hygiene

Hospital hygiene: all activities aimed at prevention of

(cross)contamination of patients and hospital staff.
Supervision & support hospital hygienist
Infection committee
Epidemiology: prevalence of infectious diseases
Profesional profile medical-microbiologist

Public Health

Activitities/collaboration PH Dept
Joint activities with Centre Disease Control
Coordination report of notificable diseases
Profesional profile medical-microbiologist

Information, education and training

Technicians
Stagiaires
Nurses
Midwives
Interns
Medical specialists