1.
A
CSF sample collected in the ward by lumbar puncture, does not reach
the lab for processing for bacterial culture immediately and was kept
in the fridge overnight. Discuss the correct decision and the
appropriate actions to be taken.
Ans: CSF is a precious sample cannot be rejected like other
samples .it will be processed after informing that it can affect the
results. The physician also should be informed regarding this.
Explanation: The CSF sample once collected, it must be immediately
transported to the laboratory and processed without much delay.
The health care worker involved in collection of the sample must be
made aware of the importance in transporting the sample as early as
possible and if any delay in transportation is anticipated, the sample
should be stored at room temperature and should not be
refrigerated. Maintain a track record of the details of the staff
involved in collection and transportation from the prime location to
the laboratory and the details of the staff receiving it.
2. If
the urine sample for bacterial culture, collected by the patient is
submitted to the lab next day, is it acceptable. Discuss the correct
decision and the appropriate actions to be taken.
Ans: If urine has been stored in the refrigerator for less than 24
hours it can be accepted . If left outside in the room temperature, the
sample will be rejected.
Explanation: Since urine sample is a good medium for the growth of
bacteria and the indigenous flora may overgrow. Hence such
samples should be refrigerated and if there is a delay certain
preservatives need to be added (for less than 24 hours ). The patient
must be educated on the areas of sample collection and transport by
the staff attending the patient. Re-enforce the HCW about providing
instructions to the patients clearly regarding sample collection and
transportation
3. A Swab is collected from an abscess in the ward. The details of the
patient on the sample container do not match those on the request form.
Discuss the correct decision and the appropriate actions to be taken.
Ans: Since there is a mismatch sample will be rejected. Inform the doctor
about this and ask for a freshly collected sample.
4. A blood culture in unlabeled Bact/ Alert bottle reached
Microbiology lab for bacterial culture & sensitivity with properly filled
request form. Discuss the correct decision and the appropriate action to
be taken.
Ans: Unlabeled samples will be rejected and documented.
Samples for investigation should be sent properly labeled on the sample
container and must be accompanied by a duly filled test requisition form
after verification.
Explanation: In this scenario, the concerned staff who was involved in
sample collection must be informed about the situation and should be
educated regarding the importance of proper labeling of the sample,
filling the requisition form and its relevance in accurately diagnosing the
causative agent.
5. RTPCR samples for Covid 19 testing from a peripheral health centre
reached molecular lab without maintaining a proper cold chain. Discuss
the correct decision and the appropriate action to be taken.
Ans: The sample can be rejected ideally as per the checklist criteria.
Also the hospital setting can be made aware about the importance of
maintaining a cold chain system necessary for maintaining the viability of
the microorganism
6. Tissue specimen in formalin from a patient with chronic localized
abscess was sent to Microbiology lab for bacterial culture & sensitivity.
Discuss the correct decision and the appropriate action to be taken.
Ans: The sample is rejected after informing the treating surgeon about
the issue. Formalin will compromise the cell integrity and inhibit the
growth of bacteria. A fresh sample should be aspirated if possible and
sent to the lab prior to starting antibiotics. The HCWs should be made
aware about the appropriate microbiology sample transport protocol.
7. A urine sample for bacterial culture & sensitivity reached micro lab in an
unsterile container. Discuss the correct decision and the appropriate actions to
be taken.
Ans: The sample should be rejected and the same should be informed to the
clinician or the concerned staff. The HCW must be educated about the sterile
containers appropriate for each sample type.
8. Sample from the respiratory tract, received for ZN stain is found to be
mainly saliva. Discuss the correct decision and the appropriate actions to be
taken.
Ans: The sample should be rejected as it is a salivary sample.
The HCW involved in the collection of sample must be made aware of the
proper sample collection procedure and proper instructions should be given to
patients regarding sputum collection.
9. A CSF sample was received in the microbiology lab without a requisition
form. How will you manage this situation?
Ans: As it is a precious sample we will not reject the CSF sample.
From the details obtained from the labeled CSF sample, we will contact the
consultant or doctor in charge of the concerned location either ward or ICU.
Ask them to identify the patient with the credentials labeled in the CSF
container and will tell them to send the properly filled request form with
proper history and investigations needed based on the clinical symptoms.
We have to reinforce the importance of sending the samples with request form
to all the consultants, junior doctors and staff nurses of concerned
departments.
10. Left over patient sample getting used for research without informed
consent. Justify your opinion
Ans: Informed consent from the patient either written or verbal and its proper
documentation is necessary before taking up patient sample for additional
procedures. The patient needs to be explained on the benefits of doing
research on their sample and should be assured on maintaining the
confidentiality of the reports. The treating consultant can also be made aware
of this. The act of publishing any patient related data without a proper consent
is unethical and illegal.
11. Undue delay in testing and reporting of a sample of emergency testing.
Justify.
Ans: Analyze the reason behind the delay. It might be due to 2 reasons
a) Delay in transporting the sample from the site of collection to the area
processing. OR
b) Delay in processing the sample due to increase in the sample load OR
c)Sample not labeled as emergency
The issue can be avoided in future by
a. Proper communication by the physician with the laboratory regarding the
urgency of testing the sample.
b. Laboratory technicians should regularly review the requisition forms and
samples for any emergencies and should prioritize testing those samples
marked urgent.
c. To avoid confusions due to delay in transportation of samples, proper
documentation should be done about the time of sample collection and
receipt of the sample and details of the person transporting it.
