The Laboratory 3

“Here we are, Jaded Julie, back in Microbiology to continue our tour of the laboratory.”

“Before you forget everything, Curmudge, please tell me some of the things that you have already learned from the tour.”

“Do you remember the 1967 movie, The Graduate, in which Dustin Hoffman was advised to go into ‘plastics’?”

“The movie was before my time, but everyone knows the story.”

“Well Julie, this tour is teaching me that appropriate advice for today’s graduate would be to go into biology or perhaps automation. I’m becoming convinced that microbiology is an extremely powerful science. ‘So, Mary, continue the tour and teach me more.’ “

“Let’s move to the next area in Microbiology and see on the left an instrument that is used for Lyme disease testing. On the right is a small instrument for fetal fibronectin testing that helps tell whether a mom is at risk of early labor. You may also see the Newborn Screen cards that are sent to the State Lab to help detect more than 25 congenital conditions on all newborns, before they can affect the child. Ahead is a large table with four technologists looking at the culture media plates that were set up the day before and put in that CO2 incubator. They check each plate for growth and if there is something, they must decide whether it is important to know what it is. (Some bacteria are normally present in some areas, so they are not the 'bad guys' or pathogens.) If they need to identify some possible 'bad guy' bacteria, they might do some quick biochemical tests, or they might put the bacteria on the Vitek instrument that can perform a whole panel of tests and produce the name of the organism. This instrument will also put the bacterial organism with some dilutions of antibiotics and test what antibiotics will likely be effective in treating that infection. These identification and antibiotic results may be available in 5-12 hours. The results are passed to the Meditech computer system by an interface from the instrument. You will notice several microscopes in this area, since determining if bacteria are gram positive ( blue) or gram negative(red), or shaped like rods or round cocci is the important first step toward identification.

Across the room is another large incubator to keep the culture media and other tests warm for 2-7 more days. Next to that is a large Plexiglas box with a side chamber and access door. This is the anaerobic chamber. Some important bacteria called anaerobes are unique from other bacteria and do not like to be in the presence of oxygen. This chamber removes most of the oxygen and replaces it with a high nitrogen gas mixture that makes them happy. Cultures from deep systemic areas of the body may be checked for anaerobic bacteria. The specimens are put to special culture media and incubated in the anaerobic chamber for many days. The technologist puts their hands into the box through portholes with sleeves and examines the cultures. If anaerobes are present, they have certain growth characteristics that help identify them.

Off to the back is a small closet-like room, called the dark room. There is a fluorescent microscope in there, which is best used in a dark surrounding. Special fluorescent stains are used here to detect ANA antibodies, Cryptosporidia, and Giardia.

Let’s go out the back door and across the hallway to the very clean (smell the bleach) Molecular room. Here is where DNA amplification and target signal amplification are used to detect Chlamydia, Gonorrhea and HPV. In the next room is the area where Parasitology and Mycology (fungus) work is done. There is also a large laminar flow hood in this area for the fungus culture work to keep the fungus spores away from the people. So that fungus is not among us! A smaller incubator contains the fungus cultures; they require a lower temperature and special media for optimal conditions to grow.”

“As I was saying, Julie, microbiologists do really important work. They are certainly more than ‘little biologists.’ When I was a kid, microbiology might not have been part of a clinical lab, if such labs even existed then. Of course, it didn’t require a microbiologist to diagnose the ugly impetigo sore on my knee.”

“You told me that years ago engineers in industry used simple microbiology to identify the filamentous bacteria that hampered the operation of waste treatment plants. The science has come a long way since then.”

“And we’ll go a short way out the door and to the right. The next room on the right is the pathology transcription area. You will find two transcriptionists who handle the clerical work for the Cytology and Histology departments. They transcribe dictated reports from the pathologists, register client patients, and order tests.

The next room is the office for the two laboratory information system coordinators. They handle problems and changes to the lab computer module, some lab billing issues, and lab quality matters across our lab system.”

“Speaking of pathology, that’s the part of the lab that we’ll visit next week. Don’t forget to come, Julie.”

Affinity’s Kaizen Curmudgeon