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Mechanisms To Assess Gram Stain Interpretation Proficiency of Technologists at Satellite Laboratories

Wheaton Franciscan and Midwest Clinical Laboratories, Wauwatosa, Wisconsin 53226,¹ College of Health Sciences, University of Wisconsin—Milwaukee, Milwaukee, Wisconsin 53201,² Wisconsin State Laboratory of Hygiene,³ Departments of Bacteriology,⁴ Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin 53706⁵

Received 15 August 2007/ Accepted 16 August 2007

To address Gram stain interpretation proficiency in a satellite/centralized microbiology laboratory paradigm, two programs were devised. In quality assurance program 1, nonmicrobiology technologists at satellite laboratories were required to interpret standardized Gram-stained specimens of clinical material prepared by an experienced microbiologist at a central laboratory. In quality assurance program 2, clinical Gram stains prepared and read by the satellite laboratorians were reviewed by experienced microbiologists at the central laboratory. Satisfactory performance (94%) was achieved in quality assurance program 1. In contrast, quality assurance program 2 had a significantly lower overall performance (89%; P < 0.0001) due to poorer identification of host cells (93%) and bacteria (84%). A variety of intervention mechanisms, including continuous monitoring, resulted in overall performance improvement (P 0.006). While a technologist challenge has educational merit, having a microbiologist review previously read slides is a better indicator of the technologist's Gram stain interpretation proficiency.

Published ahead of print on 29 August 2007.