Lab-trendz

Sharing ideas and best practices in laboratory science Issue 02 / March 2013 www.siemens.com/healthcare

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Microbiology 3 Siemens Solutions Comparison of Inducible clindamycin results by Disk Diffusion Vs MicroScan your critical 4 Advance care testing with trusted

1 Introduction Siemens Healthcare

Solutions HCS
New

Performance in a 2 Improving High-Volume Lab VersaCell Solutions by Siemens

technology: Siemens Blood Gas analyzers

Quiz #2

Siemens Healthcare Solutions (HCS)

Assessing your Operations Today, Preparing your Business for Tomorrow
Optimal resource and laboratory equipment utilization to improve patient care Expert help to streamline laboratory processes Improve manpower utilization to enable multitasking Laboratory design consultancy Are you as a laboratory director or manager confronted with these challenges? Well, Siemens has the answers. Siemens has been busy creating solutions by introduction of newer assays, faster analyzers and solutions for total automation. We however found that much could be done with just improving processes to manage inventory, testing and TAT (turn around time) in most laboratories. What is HCS?

New

Dear Reader, The overwhelming response we received for our first issue of Lab-trendz, did start our New Year on a healthy note. I would like to thank you all for the encouragement and support extended. For every laboratory, the most critical aspect is the TAT (turn around time). This issue has thus focused on how Siemens unique products and solutions help improve TAT. I would like you to read about our exclusive service of HCS that helps a laboratory to optimize, grow and be competitive. I would also like to thank Indraprastha Apollo Hospitals, New Delhi, SRL Ltd., Mumbai and Frontier Lifeline Hospital, Chennai for sharing their clinical experiences in this issue. It gives me immense pleasure to inform you that we have launched quite a few initiatives to serve you better, for instance, Lab Store-online store for your laboratory needs, new warehouse for improved supple chain, hi-end customer training center, 24X7 strengthened hotline support and implementation of Siemens Remote Service for timely, proactive trouble shooting of your analyzers. Hearty congratulations to all our quiz winners we were truly impressed with the number of entries received. Lastly, I would appreciate your feedback by writing to us at labtrendz. in@ siemens. com. It keeps us motivated and strengthens our focus of increasing clinical awareness among the healthcare industry. Sushant Kinra Vice President South Asia Diagnostics Division Healthcare Sector, Siemens Ltd.

Siemens Healthcare Solutions (HCS) is a team of experienced professionals trained to study workflow patterns, analyze workload, implement the concepts of LEAN and improve processes to enhance productivity. HCS can provide design and improve processes, both in small laboratories with standalone analyzers or large workflow units. What HCS can do for you? HSC offers consulting services in the following areas: Laboratory operations: Manpower utilization Resource utilization Logistics management Operational management

Time management: Reducing wait time in lab Improving TAT in lab Technology and Design Planning and Integration Educational Services

Time Management

Laboratory Operations

The end-to-end solutions provided by our dedicated team at HCS provide you the competitive edge. For scheduling an HCS study at your lab, please call our toll free customer care hotline on 1-800-419-7478 or reach us on labtrendz. in@ siemens.com.

Technology & Design Planning and Integration

Educational Services

Lab-trendz

Issue 2 / 2013

Improving Performance in a High-Volume Lab VersaCell Solutions by Siemens

Dr. Abha Gupta
Senior Consultant and Head, Department of Biochemistry Indraprastha Apollo Hospital, NewDelhi agag1507@yahoo.com She is also the faculty member for Apollo Hospitals Educational and Research Foundation, and a member of Ethics Committee on Clinical Trials.

check program. The laboratory tests range from routine to specialized for all these patients. With VersaCell in place, test results are released the same day facilitating review of patients by physician within 24 hours. In the days prior to VersaCell, there was a lag time of two days since samples had to be segregated. Technologist redeployment The operation of the VersaCell system is so simple that only one technician is needed to operate the two analyzers, compared to two technicians required earlier. Also, human error is reduced, as the technician does not have to program the tests to be done. This information is already contained in a barcode on the tubes when they arrive at the lab. Cost advantage: A broader automated testing menu from fewer tubes Since the VersaCell System can run most of its tests from a single tube, there is a reduction in the volume of blood drawn and the number of tubes used. Aliquoting of samples for multiple tests is also reduced. This has reduced error rate due to improper labeling. The introduction of VersaCell system at Indraprastha Apollo Hospital, Delhi has resulted in happy patients due to reduced blood draw, happier doctors with timely reports and happiest hospital as the patient care is enhanced. VersaCell: One tube, one point-of-entry, one operator, one report VersaCell is a unique sample-management system with versatile chemistry and immunoassay system configurations to optimize a labs menu, workflow and throughput needs for improved patient care. Many laboratories find, one of the largest contributing factors in TAT delays is moving a sample from one system to another or making multiple aliquotts. The VersaCell system consolidates sample management into a single workstation eliminating these delays and frees the technologist to concentrate on value added tasks.

The Biochemistry laboratory at Apollo Delhi handles about 2million tests per year including both routine and specialized test parameters. Streamlining Laboratory Operations: The turn around time (TAT) for laboratory tests is very crucial, especially in an intensive care setting of a busy tertiary care hospital. Timely delivery of results positively impacts the patient care. At Indraprastha Apollo Hospital, the blood samples for ICU are collected between 4.00 a.m. and 6.00 a.m. If the results are ready by 8 a.m., the patient discharge can be planned and thereby saving patient stay in the hospital. Hence, the laboratory staff is stretched to ensure that the TAT is met. This challenge was satisfactorily addressed with the installation of Siemens VersaCell automation system, which was completed in January 2010. Now almost 100 percent of patient reports from the ICU reach on time, as they should. Why I chose VersaCell? After a decade spent in evaluating various track-based, full automation systems, I closed in on the VersaCell system, as it seemed like a compact way to achieve consolidation and has since proven its worth. The department has always been limited by the physical space available. The Siemens ADVIA 1800 chemistry analyzer and ADVIA Centaur immunoassay analyzer linked to VersaCell have a broad menu of tests ranging from routine to specialized. ADVIA 1800 chemistry analyzer is an open system and offers the user to test analytes of their choice. The Immunoassay analyzer has a broad panel of tests that include Vitamin D Total assay, cancer markers, cardiac panel including Ultra TnI, fertility profile, thyroid panel, sepsis and many more. I was completely satisfied with the performance and service that I chose the second ADVIA 1800 instrument as a backup analyzer in January 2012. Benefits of VersaCell Quicker TAT The installation of VersaCell led to a remarkable improvement of TAT for routine biochemical tests from 6 hours to under 2 hours. Indraprastha Apollo Hospitals also gets about 100 patients a day as part of its health

Siemens has the largest installed base of analytical automation in the world!

Lab-trendz

Issue 2 / 2013

Siemens Microbiology Solutions Known for quality and accuracy

We at SRL Ltd., Goregaon are the proud users of MicroScan WalkAway - 40 SI, automated Microbiology analyzer from Siemens for past 5 years. At our laboratory, we have done many clinical studies using this system and have incorporated those in our quality improvement program. In this issue, we would like to share one such abstract published by us in Maharashtra Microcon (Mahamicrocon) 2012. Comparison was made between Inducible Clindamycin results by disk diffusion vs MicroScan and observation was 100% correlation between the two. Dr. Vidya Nerurkar Section Head-Microbiology, EIA & Serology SRL Ltd., Goregaon, Mumbai vidya.nerurkar@srl.in Methicillin resistance in Staphylococcus aureus is an important aspect in the treatment of staphylococcal infections. Macrolide- lincosamide- streptogramin (MLSB) family of antibiotics is an option to treat such infections. Clindamycin is the preferred agent due to excellent pharmacokinetic properties. Widespread use of MLSB antibiotics has resulted in resistance of staphylococcal strains to these antibiotics. Strains with inducible clindamycin resistance appear erythromycin resistant and clindamycin sensitive in-vitro when not placed adjacent to each other hence difficult to detect in the lab. In such cases, in-vivo therapy with clindamycin may select constitutive erm mutants leading to clinical therapeutic failure.

Evaluation of a Commercial Broth Microdilution Method for Detection of Inducible Clindamycin Resistance in Staphylococci, as an alternative to D-Zone Disk Diffusion Test
Authors: Nerurkar Vidya, Fernandes Nividha, Babu Roopesh, Kattungal Sushma, Bhatia Simi CLSI M100S22 guidelines have listed two methods for detection of inducible clindamycin (ICd) resistance in staphylococci: D-zone disk diffusion and broth microdilution. Being relatively easy to perform, D test is more commonly used in laboratories. Recently, the commercial MicroScan Positive Breakpoint Combo Panel Type 29(PBC29) (Siemens, USA), intended for antimicrobial susceptibility testing for Gram positive cocci, has been incorporated with a well containing 4g erythromycin and 0.5g clindamycin, for simultaneous detection of ICd resistance. The purpose of this study was to evaluate the PBC29 panel for its accuracy in detecting ICd resistance, vis-a-vis the D test Methods: Between January 2012 to May 2012, 93 clinical staphylococcal isolates (53 strains of S. aureus and 40 strains of Coagulase negative staphylococci), found to be Erythromycin-resistant Clindamycin-Susceptible, were simultaneously tested for ICd resistance, by both methods, i.e. D-zone test and MicroScan PBC29 panels (Broth Microdilution).The PBC29 panels were incubated and read, using the MicroScan Walkaway SI System. Results: 29/93 isolates (31.1%) were positive i.e. they possessed inducible resistance to clindamycin. Our study demonstrated 100% concordance between results of both methods. D test ERY-R CL-S, D test positive (inducible clindamycin resistance) ERY-R CL-S, D test negative 29 MicroScan Icd 29 Thus, a 100% correlation was observed between D test results and ICd well results of MicroScan panels. Conclusions: Our study establishes excellent correlation between the MicroScan Positive Breakpoint Combo Panel Type 29 panel and D-zone disk diffusion test, for detecting ICd resistance to clindamycin in staphylococci. Thus, incorporation of this broth microdilution based test into the gram positive antimicrobial susceptibility panel facilitates routine testing and reporting of ICd resistance and obviates the need to perform an additional D test.

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Issue 2 / 2013

Advance your critical care Quiz #2 testing with trusted technology: 1. Siemens RAPIDPoint 500 Blood Gas Analyzer suitable Siemens Blood Gas analyzers for medium volume sites, delivers accurate, laboratoryWith over 45 years of experience in blood gas testing, Siemens has a broad portfolio of performance based laboratory and point of care solutions that have been providing efficient ways to assist in diagnosis, monitoring and management of critically ill patients. Siemens Rapid Systems family of blood gas analyzers offers a comprehensive portfolio in critical care testing, delivering results near a patients bedside or supporting the demands of high throughput of a clinical laboratory. Siemens blood gas analyzers are most reliable and very easy to use. The test menu ranges from diagnostics for blood gases, pH, electrolytes, metabolites including glucose, lactate and CO-oximetry including, nBillirubin, total hemoglobin, etc. Some of our blood gas analyzers can directly measure parameters on dialysis fluid concentrate. The results are delivered in just 60 seconds. With the latest addition of RAPIDPoint 500 system suitable for medium volume sites, Siemens now has a complete range of products suited for sites with varied volumes ranging from low through medium to high. Siemens state-of-the-art cartridge technology simplifies operator maintenance and eliminates the need for individual reagent bottles, gas tanks and pump tubing to maximize the overall system availability for patient analysis. With a hands-free sample port, automated sample aspiration, self cleaning probe and clot detection features, this system preserves sample integrity and improves safety. Accuracy is ensured with automatic QC and calibration systems. Seamless integration with our RAPIDComm Data Management System and connectivity system ensures that your blood gas analyzers results reach the right people, at the right location, in real-time. Siemens RAPIDComm connectivity solution resides on the hospital network, streamlining the flow of critical blood gas test information and providing time-sensitive results to clinicians when and where they need them. Dr. R. Sai Babu Sr.Consultant Clinical Laboratory & Transfusion Medicine Frontier Lifeline Hospital, Chennai translab@frontierlifeline.com Technologists at Frontier Lifeline have imbibed the best training from Siemens and their commitment and dedication to technical advice is highly exceptional. The Blood Gas RAPIDLab 348 is functional for almost 7 years and the RL 1265 Analyzer for over a period of 4 years and these equipments have given us the best results for accurate Blood Gas Analysis and reporting. quality test results for a comprehensive menu of critical care parameters in approximately _____ seconds. The test menu ranges from pH and blood gases, electrolytes, glucose, lactate, plus fully integrated CO-oximetry, including neonatal Bilirubin (nBili) and Total Hemoglobin (tHb), all from a single, whole blood sample. a) 10 seconds b) 60 seconds c) 180 seconds 2. How does VersaCell system optimize a labs menu, workflow and throughput needs for improved patient care? a) By its unique sample-management system with versatile chemistry and immunoassay system configurations b) By eliminating the need for multiple samples or aliquots c) By delivering fast, predictable TAT for time-critical analysis d) All of the above 3. Siemens Healthcare Solutions (HCS) offers services in following areas - Laboratory Operations, Time Management, Technology and Design Planning and Integration; Educational Services. True False

Please send your answers along with your contact details and the lucky five will receive a special prize. E-mail to labtrendz.in@siemens.com If you have interesting cases to be shared, please e-mail us at labtrendz.in@siemens.com Lab-trendz Issue#1 Nov12 Quiz 1 Answers: a, c, true Winners Mr. Gaurav Gupta, Dr. Bharat Bhushan Laboratory, Dinanagar - Gurdaspur Dr. Rahul Pandey, Dr. Ajay Shahs Pathology Lab, Dahisar - Mumbai Dr. Deepak Kakade, Kasturba Hospital, Valsad Dr. Asif Ahmed, Tata Main Hospital, Jamshedpur Dr. CN Srinivas, MIOT Hospitals, Chennai

Technological innovations spur new clinical applications. This gives the medical community an edge in diagnosis and helps detect / treat diseases at an early stage. This in turn will help the society at large. These are the primary objectives with which we developed Lab-trendz. We would like to know how we can make this initiative more valuable for your practice and the wellbeing of patients.
Intended for use by Registered Medical Practitioners or Pathologists or Laboratory or Hospital Staff only. The medical information in this newsletter is for individuals of the healthcare community and not for general public. The information and reference materials contained here are intended solely for the general information of the reader and is neither intended to dictate what constitutes reasonable, appropriate or best care for any given health issue, nor is it intended to be used as a substitute for the independent judgment of a pathologist or physician for any given health issue.

2013 by Siemens Ltd., India All trademarks are properties of Siemens AG or associate companies. Third-party trademarks are properties of their respective companies. The content of this publication does not necessarily reflect the opinion of the publisher. Reproduction of articles in whole or in part requires the permission of the editorial office. This also applies to storage in electronic databases and on the internet.

Compiled by Clinical Marketing Team, Healthcare Sector, Siemens Ltd., Enkay Centre, 5th Floor, Vanijya Nikunj, Udyog Vihar, Phase V, Gurgaon - 122 016. Customer Care No.: 1-800-419-7478. Fax: 91-124-4760162. www.siemens.com/healthcare Consulting Editor: Dr. Rani R, Hitech Diagnostic Centre, Chennai