8/28/2012. Total Lab Automation in Microbiology: Much Closer than You Might Think September 6, Microbiology Yesterday

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1 Total Lab Automation in Microbiology: Much Closer than You Might Think September 6, 2012 Paul Bourbeau, Ph.D. Director, Microbiology Laboratory Microbiology Yesterday Microbiology too complex to automate Specimen Diversity Collection Device Diversity Diversity of Techniques Diversity of Media The human element Technologists are faster than machines Humans are capable of thinking, machines are not Humans are flexible Automation considered too expensive Small volumes Only the large labs can automate The Industry is Changing Specimens increasing on average 10-15% per year Laboratory consolidation Reimbursement Workforce Fewer students choose Medical Technology: reduction of 30-50% Pay for technologists is substandard Quality Physicians are demanding more services, in less time Traceability 1

2 Today Automation / mechanization: Flexible solutions Open architecture Expandable Embrace the human element Use technologist knowledge for highly complex tasks Selecting colonies for further work-up Increase safety Embrace specimen diversity Many specimens can be completely automated, others cannot Standardize processing Microbiology Processing Instruments BD Innova bm Previ Copan WASP Thanks to BD, bm, and Copan for providing pictures/slides Containers are loaded into instrument as they arrive in lab (bar-coded, lid/cap intact) able to continuously load specimens 5 specimen drawers each holds up to 20 large containers or 40 small containers can accept glass tubes Universal Decapper decaps/recaps different sized containers without any manual adjustment Specimen trays are adaptable to accommodate different sized containers for added versatility Maximum capacity up to 200 containers BD Innova BD Innova Fresh plates loaded into input carousel (6 stacks) Different agar can be loaded into each stack or all stacks can hold same type of agar Streaked plates are ejected into output carousel (5 stacks) Plates can be organized in output stacks by groups so that no sorting is required after streaking Each stack holds up to 45 plates Input carousel capacity = 270 plates Can accommodate bi-plates Reusable ni-chrome loops 1, 10, 30 µl sizes biomerieux Previ The Previ Isola: Inoculates Streaks Labels 2

3 biomerieux Previ biomerieux Previ Throughput: 180 plates/hour Standardized result that is not user dependent Increased number of isolated colonies per plate Assurance of quality new applicator used for each plate Plates labeled and sorted by environment HEPA filter manages instrument exhaust for added safety and security Not limited to batched sampling; can manage varying specimen types at one time Copan WASP Evolution of the WASP Universal decapper and docking station Sort out stacker Side Labeler Automatic loop changer Double-loops for faster streaking of bi-plates Improved image analysis Loop cleaner 3

4 Factors to Consider When Selecting A Specimen Processor for Your Lab Broth inoculation, subculture, and labeling Advanced air purification system Slide-preparation module All electric Reliability Accuracy Capacity Technical support Flexibility Specimen types; loops; protocols; media options; LIS issues Modularity Cost-initial, any required disposables, and operational labor Greub and Prod hom CMI. 17: and Tomorrow The Future will Include: Automation Liquid Based Microbiology (LBM) Digital microbiology The Players The Kiestra Solution biomerieux Copan Kiestra (BD) The 3 Solutions 4

5 The Kiestra Solution Work-cell Automation Sorting and coding of plates Set-up of plates Transport of plates Incubation Plate Imaging Reading Plates MALDI spotting/identification Susceptibility testing Total Lab Automation Assemble all components onto a single, continuous platform Sorting Units (6-40 different media) Incubator Units 26 InoqulA Strengths Fast, approximately 500 inoculations per hour No consumables required Flexible Inoculates: plates, slides, broths Unique Can be implemented as: Work cell automation Full lab automation Uses magnetic bead to inoculate plates InoqulA InoqulA Full Automation InoqulA - up to 4 times more isolated colonies vs. manual streaking (bead technology) InoqulA Streaking Manual Streaking 5

6 Plates entering the incubator Plates moved within the incubator on tracks Multi Imaging by ReadA Technology Telebacteriology Lab overview Reading Room 33 Automating Identification Maldi-Tofa Biochemical Identifications Lack of standardization between manufacturers makes automated set-up difficult Mass Spectrometry Standardized to two manufacturers and one matrix Need for traceability Remove subjectivity from identification Reduce the need for subculturing Decrease laboratory turn-around Results available within 5-10 minutes using direct smear method 6

7 The Copan Solution Copan WASP LAB What is It? A barcode driven and conveyor-connected specimen processing system. What does it do? It utilizes robotic plate management to automate specimen workup in microbiology. What are the implications for our labs of the use of a system such as this? It could revolutionize the way that clinical microbiology is performed. Copan WASP Prototype Instrument 7

8 Robotic Incubation Upon completion of planting and streaking by WASP, plates travel by conveyor to the appropriate incubator designated by the bar code. Plates are scanned using photographic image analysis and loaded into the incubator. Protocol determines plate incubation time and number of scans. Culture images are stored in the patient specimen record file. Robotic Incubation and Storage Double incubator - storage capacity of 1,400 to 2,044 plates Barcode reading and auto indexing Robotic loading and unloading Random access to plates Automatic invertion of the plate prior to incubation Imaging capability whenever requested or scheduled Variable incubation time as desired Conveyor track connection Works with all media manufacturers Plate Image Analysis Each plate image is 15 Megapixels. Plates are scanned using photographic image analysis and loaded into the incubator After incubation, plates are removed individually and scanned for growth Image analysis software compares before and after growth alerting lab staff to positive growth results. WASPLab software may be set to conduct multiple plate scans during incubation enabling early detection and reporting of positive growth Bar code index Digital Colony Targeting for Additional Workup Bar code index X / Y / Z coordinates Plate Image Analysis: Topography 8

9 Plate Image Analysis: Topography Plate Image Analysis: Topography How will this technology change microbiology? Quality of microbiology results Turn around times Quality of patient care Impact on the laboratory workforce and the working day The biomerieux Solution Plate Management PREVI Isola Maximizes bacteria colony isolation Standardizes plate streaking Streamlines laboratory workflow 53 August 28, Kaiser Foundation Health Plan, Inc. For internal use only. 54 9

10 Smart Incubator System Smart Incubator System* Three Main Components Smart Incubator System Modular & Flexible Quality of Imaging Cost efficient solution Incubation Chamber + Plate Imager Automatically manage the incubation of plates (up to 1000 plates within O 2 or CO 2 ) Integrating technologies in optics to provide the best image quality according to the most appropriate light conditions. User interface Myla will monitor and pilot the Smart Incubator System remotely. Dispatcher To manage the transportation of the plates around incubation chambers according to the plate workflow settings. Avoid unnecessary plate handlings & prepare the work for next steps (e.g. ID/AST management). 56 SIS Smart Incubator System SIS will get rid of negatives plates in a totally automated fashion (could represent a significant # of plates) SIS will allow an early warning of positives, pre-sorting them out, and making it immediately available for technicians to keep with the ID/AST processes -Time To Results will dramatically decrease With a fully automated Microbiology Lab, the proposal is that the concept of shifts will vanish no matter the time the sample arrives to the lab, it will be moved along the workflow chain including Identification and AST on a 24/7 basis Plate Imaging System biomerieux indicates they are focusing on high quality optics Vertical Inversed top Direct light Edge lightening Backlight Digital Microbiology Specific sorting criteria Patient, Specimen, Growth / No growth. Surface/Relief : P.Mirabilis / E.coli 59 Special lightning (B&W case) to enhance the colony aspect and elevation observation

11 IPS ID/AST preparation for McF & MS PREVI Isola and Smart Incubator System Modularity Flexibility Culture medium T1 MS spectra for ID A few colonies added or sample diluted to reach T2 3ml saline A part of colony Standard dilution 0,5ml transfer Standard dilution AST AES results AST card(s) 1ml saline Purity plate Workflow with VITEK MS VITEK MS Myla server with MS-ID v1 database - Closed - CE-marked VITEK 2 Implications for Implementation Potential for significant labor savings. Electronic specimen tracking. Flexibility in plate reading schedules. Potential for tele-microbiology. Digital microbiology provides audit trail. Much as has occurred with chemistry and hematology, microbiology lab planning/renovations/construction will require planning for optimal use of automation. Revolutionary!! CP Computer with MALDI Solutions software Embrace change or it will embrace you. 11