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Sharing ideas and best practices in laboratory science
Issue 02 / March 2013
www.siemens.com/healthcare
Dear Reader,
The overwhelming response we receivedfor our rst issue of Lab-trendz, didstart our New Year on a healthy note.I would like to thank you all for theencouragement and support extended.
For every laboratory, the most criticalaspect is the TAT (turn around time). Thisissue has thus focused on how Siemens’unique products and solutions helpimprove TAT. I would like you to readabout our exclusive service of HCS thathelps a laboratory to optimize, grow andbe competitive. I would also like to thankIndraprastha Apollo Hospitals, NewDelhi, SRL Ltd., Mumbai and FrontierLifeline Hospital, Chennai for sharingtheir clinical experiences in this issue.
It gives me immense pleasure to informyou that we have launched quite afew initiatives to serve you better, for
instance, Lab Store-online store for yourlaboratory needs, new warehouse forimproved supple chain, hi-end customertraining center, 24X7 strengthenedhotline support and implementationof Siemens Remote Service for timely,proactive trouble shooting of youranalyzers.
Hearty congratulations to all ourquiz winners – we were trulyimpressed with the number of entriesreceived. Lastly, I would appreciateyour feedback by writing to us atlabtrendz. in@ siemens. com. It keeps usmotivated and strengthens our focus of
increasing clinical awareness among thehealthcare industry.
Sushant KinraVice President – South Asia Diagnostics Division Healthcare Sector, Siemens Ltd.
Lab-trendz
1 •Introduction
•SiemensHealthcare
Solutions – HCS Ne w
2 •ImprovingPerformanceinaHigh-Volume Lab –VersaCell® Solutions bySiemens
3 •SiemensMicrobiologySolutions
•ComparisonofInducibleclindamycin results by DiskDiffusionVsMicroScan®
4 •Advanceyourcriticalcare testing with trustedtechnology: Siemens BloodGas analyzers
•Quiz#2
Siemens Healthcare Solutions (HCS) Ne w
Assessing your Operations Today, Preparing your
Business for Tomorrow
Optimal resource and laboratory
equipmentutilizationtoimprove
patient care
Expert help to streamline laboratory
processes
Improvemanpowerutilizationto
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?
Siemens Healthcare Solutions (HCS) is a
team of experienced professionals trained
to study workow patterns, analyze
workload, implement the concepts of
LEAN and improve processes to enhance
productivity. HCS can provide design
and improve processes, both in smalllaboratories with standalone analyzers or
large workow 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
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.
TimeManagement
LaboratoryOperations
Technology &
DesignPlanning andIntegration
EducationalServices
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2 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, New Delhi
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.
The Biochemistry laboratory at Apollo Delhi handles about
2 million 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 ICUreach 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 prole, thyroid panel, sepsis and many more.
I was completely satised with the performance and
service that I chose the second ADVIA 1800 instrument
as a backup analyzer in January 2012.
BenetsofVersaCell®
QuickerTAT
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
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.
Technologistredeployment
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.
Costadvantage:Abroaderautomatedtestingmenufrom
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 withversatile chemistry and immunoassay system congurations
to optimize a lab’s menu, workow and throughput needs
for improved patient care. Many laboratories nd, 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.
Siemens has the largest installed base of analytical automation in the world!
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3 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 difcult 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 TestAuthors:NerurkarVidya,FernandesNividha,BabuRoopesh,KattungalSushma,BhatiaSimi
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
4µg erythromycin and 0.5µg 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 MicroScan®Icd
ERY-R CL-S, D test positive
(inducible clindamycin
resistance)
29 29
ERY-R CL-S, D test negative 64 64
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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4 Lab-trendz Issue 2 / 2013
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
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.
© 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 reect the opinion of the publisher. Reproduction of articles in whole
or in part requires the permission of the editorial ofce. This also applies to storage in
electronic databases and on the internet.
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.
Quiz #2
1. Siemens RAPIDPoint 500 Blood Gas Analyzer suitablefor medium volume sites, delivers accurate, laboratory-quality test results for a comprehensive menu of criticalcare parameters in approximately _____ seconds. The
test menu ranges from pH and blood gases, electrolytes,glucose, lactate, plus fully integrated CO-oximetry, includingneonatal Bilirubin (nBili) and Total Hemoglobin (tHb), allfrom a single, whole blood sample.
a) 10 seconds b) 60 seconds c) 180 seconds
2. How does VersaCell® system optimize a lab’s menu,workow and throughput needs for improved patient care?
a) By its unique sample-management system with versatilechemistry and immunoassay system congurations
b) By eliminating the need for multiple samples or aliquots
c) By delivering fast, predictable TAT for time-criticalanalysis
d) All of the above3. 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 thelucky ve will receive a special prize.
E-mail to labtrendz.in@siemens.com
Ifyouhaveinterestingcasestobeshared,pleasee-mailusatlabtrendz.in@siemens.com
Lab-trendzIssue#1Nov’12Quiz1
Answers:
a, c, true
Winners
Mr. Gaurav Gupta, Dr. Bharat Bhushan Laboratory,
Dinanagar - Gurdaspur
Dr. Rahul Pandey, Dr. Ajay Shah’s Pathology Lab,
Dahisar - Mumbai
Dr. Deepak Kakade, Kasturba Hospital, Valsad
Dr. Asif Ahmed, Tata Main Hospital, Jamshedpur
Dr. CN Srinivas, MIOT Hospitals, Chennai
Advance your critical care
testing with trusted technology:
Siemens Blood Gas analyzers
With over 45 years of experience in blood gas testing, Siemens
has a broad portfolio of performance based laboratory and pointof care solutions that have been providing efcient 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 patient’s 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 uid 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 simplies 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 ManagementSystem and connectivity system ensures that your blood gas
analyzer’s results reach the right people, at the right location, in
real-time. Siemens RAPIDComm connectivity solution resides on
the hospital network, streamlining the ow 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, Chennaitranslab@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.”