DEFINITION OF MEDICAL MICROBIOLOGY

A branch of medicine concerned for infectious diseases which include :

This field of science studies various clinical applications of microbes for the improvement of health

BRANCHES IN MEDICAL MICROBIOLOGY LABORATORY

MICROBIAL PHYSIOLOGY
The study of microscopic and submicroscopic details of microorganisms

MICROBIAL GENETICS

The study of how genes are organized and regulated in microbes in relation to their cellular functions

PARASITOLOGY

The study of investigations of parasites. The specimens are : Faeces, blood, urine, sputum and other samples The study of identification of viruses in specimens of blood, urine and cerebrospinal fluid

VIROLOGY

IMMUNOLOGY/SEROLOGY

The study of usage of antigen-antibody interaction as a diagnostic tool and determination of compatibility of transplanted organs

QUALITY ASSURANCE
Quality assurance (QA) may be defined as 'all the planned and systematic activities put in place to ensure quality requirements for a product or service will be fulfilled QUALITY ASSURANCE

QUALITY CONTROL
- Monitor, detect and correct working practice, equipment and reagents continuously

QUALITY IMPROVEMENT

Quality control program

Quality of the specimen

Procedure manual
Media

Personnel

Instruments

Reagent

Quality assessment / Proficiency testing

Internal audit

Quality of the specimen

Monitoring the specific nursing unit, education and health care compromised by
inappropriate specimens.

-submission of contaminated specimens -delay in specimen delivery -viral culture without transport media collection of specimens from inappropriate body sites

Procedure manual
Must contain all test methods performed by the laboratory. Have to follow the guidelines provided by :
- College of American Pathologists (CAP) - Clinical Laboratory Improvement Act 88 (CLIA88)

Personnel
People working in the system have to actively participated and are required to meet quality standards and continuously improve performance. The employees personnel records have to contain: - Qualification and experience - Performances on tasks and procedures - Education activities (attend some training program or workshop) - Regular meeting

Media
Media produced in microbiology department has to perform acceptable standard, allowing optimum growth of specific organisms. The test program is based on :
- Physical characteristics. Eg: colour, clarity, pH, sterility

- Microbiological performance.
Nutrient medium must be tested the growth of one or two organisms. Selective medium should be tested the growth of organisms which expected to grow and not to grow.

Instruments
Daily checking & record the data (chart) Daily & monthly maintenance program must be established Additional control measure must be performed as a preventive maintenance program. Eg: oiling and cleaning. Replacing filters.

Equipment is cleared or approved by Food and Drug Administration (FDA)

Reagents
Daily reagents should be tested each day of use with both positive & negative controls

Weekly reagents that are documented to have consistent & dependable results may be tested less frequently.
Eg: Gram stain. Examples of reagents that undergo Quality Control : All stains, Bacitracin, Beta-Lactamase, Catalase, Hippurate, Optochin.

Internal audit
The objective is to monitor the performance of the whole procedures.
A few procedures are included: Laboratory activities were examined Standards were set using laboratory standard operating procedures The findings were discussed The measured performance was reviewed An explanation for any deficiencies were sought

Proficiency testing/ quality assessment

Both of these schemes work as guidelines of the effectiveness of internal quality control program. Three advantages of external quality assessment : Obtain stable specimen Chance to differentiate individual performance with other participants Provision of wide variety of organisms

Standard operating procedures

The medical microbiology laboratory helps health care providers find and treat infections. Therefore, the laboratory workers perform testing on potentially infectious materials and some very dangerous organisms. There are four major aspects :

Reagent performances
The quality and performance characteristics of equipment for microbiological testing vary widely. When purchasing equipment it is important to examine the specifications in detail to ensure that they deliver the anticipated quality of test result After use, the glassware in microbiology laboratories requires intense decontamination, cleaning and sterilization prior to reuse. The cleaning and preparation of the glassware for reuse may take more than a day. Some of the glassware, such

as culture tubes and petri-dishes, may become available for use again only after a week. Adequate stocks of glassware
are necessary in a microbiology laboratory for uninterrupted operations. Some of the examples are :Burette borosilicate 50 mL, burette stands, Measuring cylinders graduated, 10 ml, Measuring cylinders graduated, 100ml, Measuring cylinders graduated, 500 ml, Measuring cylinders graduated, 1000 ml .

Equipment performance
Most equipment (incubators, water baths, and autoclaves) is subject to standard validation practices of incoming
qualification, operational qualification, and performance qualification. Additionally, periodic calibration (generally annually) is commonly required. New equipment, critical to the operation of the laboratory, should be qualified according to a protocol approved by the quality assurance unit (QAU).

Instruments (pH meters and spectrophotometers) used in a microbiology laboratory should be calibrated on a regular schedule and tested to verify performance on a routine basis. The frequency of calibration and

performance verification will vary based on the type of instrument and the importance of that equipment to the
generation of data in the laboratory.

Types of samples
In medical microbiology laboratory, many different types of samples are present and can be categorised into three major parts. -Samples for pathology testing including fluids, secretions and biopsies. -Samples for food safety or quality testing. -Samples for environmental testing. The common samples are :

Blood (whole blood, plasma, serum)

Urine

Faeces

Mucus/ sputum

Cerebrospinal fluid

sweat

semen

hair

Nail fragments

References
http://en.wikipedia.org/wiki/Microbiology http://simple.wikipedia.org/wiki/Medical_microbiology http://www.hpa.org.uk/ProductsServices/MicrobiologyPathology/QualityAssurance/

http://www.drugfuture.com/Pharmacopoeia/USP32/pub/data/v32270/usp32nf27s0_c1117.html
http://durack.moodlesites.com/pluginfile.php/2441/mod_imscp/content/1/laboratory/personalstudy/psMicrobiologi calSampleTypes.htm Sherris Medical Microbiology;5th Edition, Kenneth Ryan, C.George Ray, Nafees Ahmad, 2010.