The Infectious Diseases Society of America and the American Society for Microbiology have published a guide to help clinicians appropriately and accurately use laboratory tests for the diagnosis of infectious diseases.
Laboratory test results drive about two-thirds of physicians medical decisions, according to a news release. Laboratory diagnoses directly affect patient care and outcomes, hospital infection control, patients length of stay in the hospital, costs and laboratory efficiency.
Divided into sections on anatomic systems (including infections of the bloodstream, cardiovascular system, central nervous system, eyes, soft tissue of the head and neck, upper and lower respiratory system, gastrointestinal tract, abdomen, bone and joints, urinary tract, genitals and skin and soft tissues) and etiologic agent groups (tickborne infections, viral syndromes, blood and tissue, and parasite infections), the guide is designed to help clinicians decide what tests to request when they suspect specific agents are causing disease.
Published July 10 on the website of the journal Clinical Infectious Diseases, the guide also provides targeted recommendations and precautions regarding selecting and collecting specimens, detailing what is required for various cultures and tests and as the appropriate collection device, temperature and ideal transport time.
The guide suggests 10 tenets of specimen management that everyone involved — from physician to nurse to laboratory scientist — should follow for good patient care. These include:
• Specimens of poor quality must be rejected or results could be compromised.
• Physicians should not demand a report of “everything that grows” as doing so could result in an inaccurate diagnosis.
• Avoiding contamination of specimens is key, as is careful collection.
• The laboratory requires a specimen, not a swab of a specimen, which may not hold enough infected material to ensure an accurate diagnosis and may be easily contaminated.
• The laboratory must follow its procedure manual or face legal challenges.
• A specimen should be collected prior to administration of antibiotics, presence of which could lead to misleading results.
• Susceptibility testing should be performed on clinically significant isolates, not all microorganisms in the culture.
• Lab results should be accurate, significant and clinically relevant.
• The laboratory — not the medical staff — should be allowed to set technical policy. Good communication and mutual respect will lead to collaborative policies.
• Specimens must be labeled accurately and completely (for example: dog bite wound, right forefinger).
Guidance provided in the document is not intended to take the place of a physicians judgment, but rather to support the decision-making process, which must be individualized according to each patients circumstances, according to the news release.
Read the guidelines: http://cid.oxfordjournals.org/content/early/2013/06/24/cid.cit278.full.