Automation in Clinical Microbiology
ABSTRACT Historically, the trend toward automation in clinical pathology laboratories has largely bypassed the clinical microbiology laboratory. In this article, we review the historical impediments to automation in the microbiology laboratory and offer insight into the reasons why we believe that we are on the cusp of a dramatic change that will sweep a wave of automation into clinical microbiology laboratories. HISTORICAL IMPEDIMENTS TO AUTOMATION IN MICROBIOLOGY Several real or perceived factors have contributed to the current dearth of automation in clinical microbiology labs. These include the ideas that microbiology is too complex to automate, no machine can replace a human in the microbiology laboratory, automation is too expensive for microbiology laboratories, and microbiology laboratories are too small to automate. Spotting of target plates and extraction of proteins can be standardized for most organisms and, when combined with automation, can be performed with minimal staffing. Embracing the human element focuses microbiology technologists on the performance of the most complex tasks, such as selecting colonies for further workup while removing these personnel from tasks, such as plating, that can be performed by an instrument, operated by a less trained individual. Microbiology must move as much as is practical to liquid-based transport devices to facilitate automated plating. In reviewing the current options available for automation in microbiology laboratories, we have chosen to divide the automation solutions into two groups: instruments that function primarily as specimen processors and systems that offer total microbiology laboratory automation solutions. MICROBIOLOGY SPECIMEN PROCESSORS Historically, some laboratories, mainly large reference laboratories, have utilized specimen-processing instruments, such as the inocuLAB for plating of urine specimens. MICROBIOLOGY TLA SOLUTIONS There are currently 3 microbiology TLA solutions in use or in development: Kiestra TLA, full microbiology laboratory automation, and the WASPLab. Because medium is not sitting on a workbench waiting to be read, there is continuous incubation of plated media, rather than intermittent periods of incubation, as traditionally occurs in microbiology laboratories. MICROBIOLOGY AUTOMATION RESEARCH NEEDS The scientific literature assessing the benefits of microbiology automation is sparse. While the benefits of microbiology automation can often be inferred, well-performed studies are needed to accurately assess the financial, operational, and clinical impacts of incremental or total laboratory automation in microbiology laboratories. Dr. Bourbeau is a past chairman of the clinical microbiology division of the American Society for Microbiology and currently serves as an associate editor for the Journal of Clinical Microbiology. His research interests include microbiology automation, molecular microbiology, specimen transport, clinical microbiology methods, and organization of microbiology testing in integrated health care systems.
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