Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Assignment Topic:

Laboratory automation in clinical bacteriology; what

system to chose

Submitted To:

Dr. Sir Ali Nawaz

Submitted By:

Sania Sahreen

Roll no & Session:

0233-BH-MB-2015

Class & Semester:

B.Sc.(Hons) & VI

Course Title:

Clinical bacteriology

Course Code:

Micbio3205

1
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Table of contents Pg. No.

Introduction ---------------------------------------------------------------------------------- 03

How to choose the ideal equipment ------------------------------------------------------- 05

 Instrument characteristics-----------------------------------------------------------05
a) Innova----- -------------------------------------------------------------------05

b) Previ Isola--------------------------------------------------------------------06
c) InoqulA FA/MI---------------------------------------------------------------------------06
d) WASP-------------------------------------------------------------------------06
 Characteristics of the laboratory---------------------------------------------------08
 Other specific issues-----------------------------------------------------------------09
 Conclusion -----------------------------------------------------------------------------10
 References -----------------------------------------------------------------------------10

2
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Introduction

Today, due to very high rate of disease and infection, most of clinical bacteriology laboratories
are suffering due to the problem of large number of samples to be processed per day. But due
to low human resources, they are also going through the strong financial pressure and resource
shortage (3). There comes the concept of laboratory automation, particularly for sample
inoculation that is considered a fastidious yet a repetitive process. Although laboratory
information systems (LISs) and numerous use of bar coding for sample tracing has been helpful
in recent years for the pre-analytical sample handling. However, there is still need of advanced
automated systems in laboratories to reduce the time spent on sample reception, inoculation
and gram staining.

Not more than 20 years ago, first generation of plate streakers were came into view, but
automation was still very limited e.g. Inoculab (Dynacon). Later, second generation Inoculab
LQH system (Dynacon) were developed which can process sample which starts from a single
container i.e. sterile urine container and had a limited capacity of 38 inoculated plates in a
single silo. Both first and two generations include the following steps;

 Selection of an appropriate petri dish

 Efficient inoculation of sample
 To get well spread bacterial colonies on agar plates, spread the inoculum carefully
 Accurate labeling of each incubated sample for a good record

To overcome the restriction offered by these two generations, third generation of instruments
came into market which summarized the name of these instruments; WASP (Copan), Previ‐
Isola (BioMerieux), Innova (Becton‐Dickinson) and Inoqula (KIESTRA) systems (1) and
PreLUD(12A) (4). Out of all automated systems of third generation , only two BD Kiestra and
Copan supports an extended system containing specimen processors, conveyors, incubators
and digital imaging Fig. 1.

3
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Fig.1 Levels of automation

BD Kiestra and Copan has two level of automation 1) partial lab automation which includes
the Work Cell Automation (WCA) of BD Kiestra and the WASPLab of Copan and 2) complete
lab automation (Total Lab Automation (TLA) of BD Kiestra). Both levels are further composed
of specimen processors and incubators with digital imaging that are connected by a conveyor
system Fig. 2 (4).

Fig.2 System workflow: both partial and complete lab automation

Currently, the biggest challenge for clinical bacteriologist is the choice of best/ ideal automated
system for his/ her laboratory. An automated system can be chosen w.r.t type, number and the

4
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

variety of samples are processed every day in a laboratory. A simple guideline is provided here
for the optimal choice of an automated system (table 1) with aim to compare between different
systems as well as highlight the parameters important while choosing an automated system.

Table 1: Instrument characteristic

How to Choose the Ideal Equipment?

A) Instrument characteristics
Instruments/equipments included in third generation system are different in their capacity,
working and efficiency in a number of ways (1). A brief description of all is given here.

Innova.

5
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

It has 5 specimen drawers, and has a holding capacity of 40 containers, with total maximum
capacity of 200 drawers. At any time only 1 single sided test tube be can be placed in a drawer.
It also has 6 input stacks of capacity 45 plates each which make it 270 plates for all 6 input
stacks (Fig.3).

InoqulA FA/MI

The InoqulA FA/MI (full automation/manual interaction) can be used for automated
inoculation of liquid sample as well as for manual plating of other type of samples such as
wound swabs. With the use of a magnetic rolling bead, streaking is done, and only 5 inoculated
plates can be struck out at one time, thus total yield is of 400 plates in an hour. Instrument also
has the capacity to hold 30 types of plates along with 7 types of tubed media (fig.4).
Previ Isola
It holds racks of 5 different sizes, and each one size is specific for 5 different diameter specimen
tubes. There is a precaution to place all samples uncapped in the instrument. It also has 5 input
cassettes which has the capacity of 30 plates in each stack leading to 150 plates in total (fig.5).

WASP.

The WASP (walk-away specimen processor) has different-sized pallets with different-diameter
tubes to load and unload a sample in this instrument it contains 9 medium sized silos with total
capacity of 342 to 370 plates. Each silo can hold a single type of medium only (fig.6) (2).

Fig. 3 Innova specimen processor Fig. 4 InoqulA specimen processor

6
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Fig. 5 Previ Isola specimen processor Fig. 6 WASP

The basic main difference in all four WASP, Previ‐Isola, Innova and Inoqula instruments is
the solution which is used for sample inoculation (table 2). That is why WASP, Previ-Isola ,
and Inogula use sterile loops, combs or beads respectively. Innova also use sterile loops. Use
of different applicator means streaking is also done differently (fig.7).

Table 2 comparison of four different third generation automated system currently available in
market

7
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Fig. 7 Agar plates inoculated (a) with Previ-Isola, (b) with WASP, (c) withInoqula, and (d)
manually.

Other differences include the plate throughput per hour, the robustness of the robotic system,
the level of automation (including capping/uncapping and selection of plates), and the
connections of the instruments with the LIS.

B) Characteristics of the laboratory

For the ideal choice of an automated system, laboratory conditions and characteristics are also
important. For example, some large laboratories only use automation for urine samples only.
Here only cost of consumables and number of plates per hour will affect the decision needed
to be taken regarding the ideal choice of an instrument. But for a laboratory who intend to use
automation for most of the samples, it makes matters difficult especially w.r.t cost. Diversity
of samples is another issue here, which put a restraint on the choice of the system. Proportion
of samples which come in liquid form (which are easily processed) is more of value than
diversity of samples as well the proportion of swabs, stools, and tissues for which solution vary
from one manufacturer to another. For example, about 34% of samples were from swab in in
clinical bacteriology located in Lausanne’s university hospital (table 3), as swab allow
accurate, easy release of the sample as well as it is can easily transferred in liquid format.

8
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Table 3: Properties of different main types of specimens used in clinical bacteriology lab of
Lausanne’s university hospital

All laboratories follow variety of protocols per day which also effect the choice of automated
system such as WASP can only provide nine different agar plate input silos in contrast to Previ-
Isola which currently provide only five silos. The number of samples processed everyday also
matters in choice of a particular machine. Most importantly, the number of agar plates that are
supposed to be incubated per hour is actually not the number of agar plates which are inoculated
in a median working day i.e. about 1000 plates/day in Lausanne’s university hospital
laboratory divided by 24 h which gives 42 plates per hour or it can be divided by 9 h for a
laboratory which opens only from 8 a.m. to 5 p.m. giving 111 plates/h but should ideally be
the maximum number of plates that need to be inoculated during activity peaks, i.e. about
220 plates/h (fig.8).

Fig.8 Partition in percentage of the arrival of specimen for processing (working hours 08:00-
17:00)

C) Other specific issues

9
Laboratory automation in clinical bacteriology; what system to choose Clinical Bacteriology

Other important issues regarding the choice of an automated system include biosafety. Some
companies sell their instruments by involving a third party. Which leads to the question whether
this third party is really objective and will provide an unbiased opinion or not to the consumer.
The final choice is also complicated by the fact that automated system cannot be tested on the
site due to complexity of computer connections between the instruments and the LIS.

Conclusion

In conclusion, the challenge of choosing the ideal automated system for clinical bacteriology
laboratories can best achieved by considering all facts related to laboratory characteristic,
instrument capacity, type of sample, number of sample, variety of the sample etc. (1)

References

1. Greub, and G. Prod’hom. 2011. Automation in clinical bacteriology: what system to

choose? Clin Microbiol Infect. 17(5): 655 – 660.
2. Bourbeau, P. P. and N. A. Ledeboer. 2013. Automation in clinical microbiology. J.
Clin. Microbiol. 51(6): 1658-1665
3. Dauwalder et al.2016. Does Bacteriology laboratory automation reduce time to results
and increase quality management? Clin Microbiol Infect. 22(3):236-43.
4. Croxatto, A. et al. 2016. Laboratory automation in clinical bacteriology: what system
to choose? Clin Microbiol Infect. 22(3): 217 – 235.

10