Microbiology Section Pathology Resident Self Assessment Checklist. 2. Proper collection and specimen handling procedure.

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1 PLANTING/PROCESSING STATION 1. Review Planting Manual 2. Proper collection and specimen handling procedure. 3. Proper handling of improperly collected, unacceptable, unlabeled, or mislabeled specimens. 4. Observe LIS entry and ordering of specimens 5. Be aware of SREQ: special request, transport container, etc. 6. Process specimens: select, inoculate, and incubate media. 7. Prepare slides for gram, fungal or other stain 8. Observe daily temperature checks, gas tank levels and daily QC. 9. Understand purpose of printed specimen Master logs. 10. Able to answer questions using MISYS & on-line lab manual 11. Understand proper handling of unusual requests (reading required): a. Slow-growing fungi (observe) b. Brucella c. Bartonella d. Actinomyces e. Francisella 12. Proper handling of research specimens and Surveillance cx 13. Be aware of GOL pan culture handling and procedures - 1 -

2 GRAM STAINS 1. Review Gram Stain Procedure 2. Fix and stain gram smears 3. Read and record gram smears for presence of organisms with proper quantitation. 4. Interpret sputa smears by using the evaluation criteria for an acceptable culture. 5. Able to score vaginal smears using the Nugent criteria. 6. Observe or read about interpretation of India Ink test. 7. Complete On-line competency program and test - 2 -

3 WORKUP OF BLOOD CULTURES 1. Review Blood Culture Manual. 2. Location of Bactec Manual for basic troubleshooting 3. Be aware of processing of (smear, plant and call) positive blood cultures 4. Be able to identify blood pathogens 5. Be familiar with daily operating procedure of the Bactec 6. Read about processing of blood from other systems (e.g., Isolator system, BacTAlert) 7. Be aware of safety procedures and disposing of blood culture bottles, processing positive cultures in Biological Safety Cabinet (BSC). 8. Be familiar with SBE, Alert and Brucella CX (reading required). 9. PNA FISH principle, procedures and interpretation - 3 -

4 WORKUP OF AEROBIC CULTURES 1. Review procedure manuals. 2. Identify pathogens from sterile sties. a. Body fluids b. Tissues c. Catheter tips d. Eyes 3. Differentiate potential pathogens from normal flora in: a. CF patients cultures b. Genital (cervical, urethral) cultures c. Legionella cultures d. Respiratory cultures e. Stool/Rectal cultures f. Throat cultures g. Urine cultures h. Wound cultures 4. Perform and interpret simple biochemical tests a. Catalase test b. Staph Antigen test and tube Coagulase c. Oxidase test d. Spot Indole test e. Bile Esculin test and PYR test - 4 -

5 f. Bacitracin (taxo A) and Optochin (taxo P) g. Quad Plate for Haemophilus species h. Wet prep, hanging drop & motility i. Campy Smear and QC j. Sodium Hippurate test and QC i. Bile solubility test and QC 5. Perform/Interpret Antigen/Antibody typing, including reagent QC. a. Beta Strep Grouping b. Ecoli 0157 typing c. Gonogen 6. Select, perform and interpret biochemical test systems. a. Rapid One ID b. API 20E c. Rapid NF+ d. API 20NE e. Rapid NH f. Coryne API g. Rapid Yeast ID h. API 20C i. Rapid Strep 7. Be familiar with reporting communicable diseases to State Dept of Health Laboratory. 8. Be familiar with paperwork and procedures for sending an isolate to a reference lab. Note: If procedures are not observed, reading about the procedures is recommended

6 ANAEROBIC CULTURES 1. Review Anaerobic Culture Procedure Manual. 2. Be familiar with colonial and microscopic morphology. 3. Observe and be able to interpret a. Aerotolerance test b. Fluorescence test c. LKV/BBE plate d. Rapid ANA ID e. Presence of Spores 4. Use of Anaerobic Chamber and Monitoring Gas. 5. Use of Holding Jars and Gaspak Jars - 6 -

7 ANTIMICROBIAL SUSCEPTIBILITY TESTING (AST) 1. Review Sensitivity (Susceptibility) Manual. 2. Review susceptibility testing standards (CLSI) 3. Select, perform and interpret AST methods. a. Kirby-Bauer testing and QC: manual read & BioMIC b. Routine and Fastidious MIC tests and QC c. ETEST: Aerobic, Anaerobic and QC d. Beta Lactamase testing and QC e. D Zone test for Staph f. ESBL confirmation test g. Modified Hodge test 4. Be familiar with handling susceptibility discrepancies on Bug-Drug combination (i.e., Proteus and FM, TET, or PSAR and SXT, CRO). 5. Be familiar with suppression rules for Antibiotics. 6. Be familiar with ESBL, VRE, MRSA, VRSA Protocols

8 AFB STATION 1. Review AFB Manual Be familiar with the hazards of working with AFB specimens and understands all safety procedures, including use of Biological Safety Cabinet (BSC). Observe, (perform), and/or read about safe handling and processing of specimens using Digestion-Decontamination Procedures. a. Respiratory b. Skin lesions, Aspirates, Abscesses c. Urine d. Gastic Lavage Fluid e. Stools f. Contaminated fluids and tissues Be aware of safe handling & processing specimens from sterile sources. Be familiar with CSF processing protocol. Be aware of staining, interpretation and reporting of AFB Smears and QC using Fluorochrome Stain. Be aware of staining, interpretation and reporting of AFB Smears and QC using Kinyoun Stain. Be familiar with reporting and recording of positive AFB smears and cultures. 9. Understand how to examine/workup AFB Cultures, including significance of findings. 10. Observe (and/or perform) DNA Probe IDS. 11. Be aware of shipment regulations, using proper paperwork, for AFB specimens. 12. Follow AFB maintenance procedures and record actions. 13. Understand principles and observe operation of MGIT automated system: a. Routine maintenance and QC b. Loading tubes, unloading positives & negatives 14. Oxalic acid decontamination for P. aeruginosa

9 MYCOLOGY STATION 1. Review Mycology Manual. 2. Be familiar with the hazards of working with fungal specimens & safe handling procedures, including use of Biological Safety Cabinet (BSC). 3. Examine and interpret Fungal Cultures. 4. Perform (or observe) and interpret Fungal Smears and QC using KOH-Calcofluor White procedure 5. Perform (or observe) and read about the interpretation of: a. Murex C. Albicans test b. Microscopic characteristics on CMA with Tween Agar c. Rapid Yeast ID d. API 20C Yeast ID 6. Be aware of how to setup of slide cultures on PDA and CMA with Glucose. 7. Perform, interpret and record scotch tape preps using a Lactophenol Cotton Blue Wet Mount (LPCB). 8. Perform and interpret slide cultures using a Lactophenol Cotton Blue Wet Mount. 9. Perform and interpret the results of modified AFB Stain for Nocardia and QC. 10. Examine and work-up of Nocardia cultures: a. Lysozyme b. Casein c. Xanthine - 9 -

10 QUALITY CONTROL 1. Review Quality Control manual and QC results sheets 2. Be aware of biochemical QC procedures 3. Review AST (Antimicrobial Susceptibility Testing) QC requirements 4. Review CAP, CLIA, and CLSI requirements for microbiology procedures 5. Understand the importance of Quality Control and Quality Assurance 6. Describe how quality control is related to quality assurance

11 SEROLOGICAL TESTS 1. Cryptococcal Antigen (CRAG) Test. a. Review the Cryptococcal Antigen Test Procedure b. Perform (and/or observe), interpret, and record testing for the Cryptococcal Antigen Test and QC 2. Strep Antigen Test a. Review procedure for Rapid Strep Antigen Test b. Perform (and/or observe), interpret and record testing for the Rapid Strep Antigen Test and QC SPECIAL PROCEDURES 1. Read about Special Procedure Protocols for the following organisms. a. Bordetella Pertussis (send out test) b. Bartonella c. Quantitative Tissue Culture d. MIDI Automated gas chromatography system