siemens lab-trendz march 2013

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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



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

[email protected]

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!




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

[email protected]

• 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.




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 [email protected]

Ifyouhaveinterestingcasestobeshared,[email protected]

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, [email protected]

“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.”

siemens lab-trendz march 2013

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