Laboratory manager

APPENDIX IX - Reagents for QC Bench On-Receipt

1. 
   ALA discs
   

2. 
   API 20E strips
   

3. 
   API CORYN strips
   

4. 
   API 20NE strips
   

5. 
   API NH strips
   

6. 
   API STAPH strips
   

7. 
   API STREP strips
   

8. 
   Arabinose discs
   

9. 
   Beta glucuronidase (MUG) discs
   

10. 
    Bacitracin discs
    

11. 
    Catalase (hydrogen peroxide)
    

12. 
    Cefinase discs
    

13. 
    Cryptococcal Antigen Latex kits
    

14. 
    DENKA kits
    

15. 
    Desoxycholate (Bile solubility) droppers
    

16. 
    E. coli O157 Test kits
    

17. 
    Eosinophil Stain
    

18. 
    Ferric Chloride
    

19. 
    Indole spot reagent
    

20. 
    LAP discs
    

21. 
    Optochin
    

22. 
    Oxidase droppers
    

23. 
    Phadobact kit
    

24. 
    PYR kits
    

25. 
    Staph-Plus Pastorex kits
    

26. 
    Strep group Prolex Reagents 1,2,3, ABCDFG
    

27. 
    Tributyrin discs
    

28. 
    Tube coagulase
    

29. 
    VITEK cards
    

30. 
    Xylose discs
    

31. 
    ZN Stain kits
    

APPENDIX X - Registering Antibiotics

1. 
   Upon receipt of Kirby-Bauer discs, go to micqc registration.
   
2. 
   Choose Reagents.
   
3. 
   A (add)
   
4. 
   Under reagent id type k. F2.
   
5. 
   Search the list to find the antibiotic.
   
6. 
   Type in the lot number.
   
7. 
   If the lot has been received previously, add a letter “A” on the end of the number. If this lot has also been received previously, try “B” etc.
   
8. 
   Put in the expiry date.
   
9. 
   Enter. Enter.
   
10. 
    Choose a label printer.
    
11. 
    For number of copies, choose the number of cartridges for the lot number you are receiving, plus one extra for each box received (to be used to label the outside of the box.)
    
12. 
    F12.
    
13. 
    Affix one of the labels to the top left hand corner of the lid of each box. Using a magic marker, write the expiry date on top right hand corner of the lid of each box.
    
14. 
    Paperclip the remaining labels to the front of the box (to be affixed to the cartridges when put into use.)
    
15. 
    Check the inventory in the freezer to see if there are any other boxes of that particular antibiotic in stock. If so, and they will outdate before the new lot, attach a pink slip “This lot not currently is use. Use lot __________ first” using an elastic band. Place the box behind the currently used box in the freezer.
    
16. 
    Retrieve the green index card from the clear envelope on the Antibiotic freezer that is labeled “These Items Have Already Been Ordered” and place it back in position behind the yellow index card inside the freezer.
    

1. 
   Upon receipt of Etest strips, go to micqc registration.
   
2. 
   Choose Reagents.
   
3. 
   A (add)
   
4. 
   Under reagent id type e. F2.
   
5. 
   Search the list to find the Etest strip.
   
6. 
   Type in the lot number.
   
7. 
   If the lot has been received previously, add a letter “A” on the end of the number. If this lot has also been received previously, try “B” etc.
   
8. 
   Put in the expiry date.
   
9. 
   Enter. Enter.
   
10. 
    Choose a label printer.
    
11. 
    For number of copies, choose the number of strips for the lot number you are receiving, plus one extra for each box received. (to be used to label the outside of the box.)
    
12. 
    F12.
    
13. 
    Affix one of the labels to the top left hand corner of the lid of each box. Using a magic marker, write the expiry date on top right hand corner of the lid of each box.
    
14. 
    Cut the remaining labels lengthwise midway through the barcode and just above the expiry date. Affix this narrow strip lengthwise to the front of each individual Etest strip.
    
15. 
    Check the inventory in the freezer to see if there are any other boxes of that particular antibiotic in stock. If so, and they will outdate before the new lot, attach a pink slip “This lot not currently is use. Use lot __________ first” using an elastic band. Place the box behind the currently used box in the freezer.
    
16. 
    Retrieve the orange index card from the clear envelope on the Antibiotic freezer that is labeled “These Items Have Already Been Ordered” and place it back in position behind the orange index card inside the freezer.
    

APPENDIX XI - Weekly Susceptibility QC

1. 
   Generate labels for saline tubes and purity plates in Soft from the receiving work list QCVTS (QC VT weekly sensi).
   
   • 
     Press “A” to mark all.
     
   • 
     F7.
     
   • 
     R.
     
   • 
     Pick a label printer.
     
   • 
     F12.
     
   • 
     F12
     

2. 
   Label one saline tube for each of the 9 accession numbers that print. (Use the small non bar coded label as it specifies the ATCC strain.)
   

1. 
   E. coli 25922
   
2. 
   E. coli 35218
   
3. 
   P. aeruginosa 27853
   
4. 
   E. faecalis 29212
   
5. 
   E. faecalis 51299
   
6. 
   E. coli 35218
   
7. 
   S. aureus 29213
   
8. 
   E. faecalis 29212
   
9. 
   S. aureus 29213
   

3. 
   Label 9 Blood agar plates 1 through 9. Put a dividing line on each plate. Mark one half of each plate 1 and the other half 2. (Use the large non barcoded label as it specifies the ATCC strain.)
   

4. 
   Affix one of large non barcoded labels printed above to the midline point of each plate.
   

5. 
   Check the lot numbers of the AST NO20, AST P536, and the AST P532 cards in the display fridge and on the media cart to ensure that they are the same as those being used in the blood culture area. Check the sticker on the box that shows the date that the box was received. Jot down the date on the sticker. It is possible that there are multiple shipments of the same lot number. The first time a lot is QC it is referred to as isolate 1. Any subsequent shipments of the same lot number are identified as isolate 2, 3, 4 etc. respectively. The sticker date will help identify which shipment they belong to and which isolates they are. In order to ascertain that the correct lot numbers are in use, take one of each of the cards types and the dates you have jotted down for each with you to the Vitek 2 computer.
   

6. 
   At the Vitek 2 instrument, click on Utilities.
   
   • 
     Click “Quality Control”
     
   • 
     Click “Load List”
     
   • 
     Click “Test Type” column header. A box will drop down with the various card types.
     
   • 
     Choose the card types to be tested. To highlight more than one card type, hold down the CTRL key while clicking and highlighting each card type.
     
   • 
     Click “Apply”
     
   • 
     Click “Sort By” “Test Type” (in lower left hand corner of screen.) (Items in the load list will be in order)
     
   • 
     Click “Lot Number” column header. A box will drop down with the various lot numbers. To highlight more than lot number, hold down the CTRL key while clicking and highlighting each lot number. (This is where you refer to the dates jotted down for each lot to ensure you have QC the correct shipment.)
     
   • 
     Click “Apply”
     

• 
  Click icon to print selected load list.
  

7. 
   Make 0.5 McFarland suspensions of each ATCC strain using the Densichek.
   

8. 
   Label one Vitek 2 smart carrier QC Machine 1 and one Smart Carrier QC Machine 2.
   

9. 
   Place the inoculated Vitek 2 salines in positions 1, 3, 5, 7, 9, 11, 13 of the first smart carrier as outlined in the loadlist. Place an empty Vitkek 2 tube in positions 2, 4, 6, 8, 10, 12 and 14. (There is a template on the Smart Carrier Station near the QC bench. It outlines the position in the smart carrier in which to place each inoculum tube.)
   

10. 
    Place the remaining two inoculated Vitek 2 salines in the second carrier with the corresponding empty Vitek 2 tubes as per the template.
    

11. 
    Remove all lids from tubes.
    

12. 
    Load the first Smart Carrier onto the Smart Pad.
    

13. 
    Use the “Vitek 2 Weekly Sensi Template” to wand the barcode for the Accession ID for each organism as outlined in the load list. (It is probably easier to use the wand in the “Handheld Mode” for this purpose.) Note: The Smart Pad automatically defaults to Isolate 1, but you need to check the Load List printout to see if there are any lots that are not “isolate 1”. If there are, you must arrow up and put in the appropriate isolate number. Wand the barcode on the sensitivity card. Do this for each isolate.
    

14. 
    Once complete, press F3 on the smart pad and ensure that everything is correct i.e. according to the load list.
    

15. 
    Put the 2 smart carriers in each of the Vitek instrument readers according to the label on each.
    

16. 
    Once the cards have finished processing, and the smart carriers return to the loading dock, make the appropriate purity plates from the sensitivity inoculum tube and then discard it.
    

17. 
    Exchange the labels of the two smart carriers and repeat steps 7-16.
    

APPENDIX XII - Rarely Used Antibiotic Discs

APPENDIX XIII - QC Antibiotic Inventory

Record of Edited Revisions

PROCEDURE MANUAL

UNIVERSITY HEALTH NETWORK \ MOUNT SINAI HOSPITAL MICROBIOLOGY DEPARTMENT

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