8/28/2012

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

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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

BD Innova
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

Thanks to BD, bM, and Copan for providing pictures/slides

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 L sizes

bioMerieux Previ
The Previ Isola: Inoculates Streaks Labels

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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

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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 Prodhom. 2011. CMI. 17:651-655.

and Tomorrow

The Future will Include:

Automation Liquid Based Microbiology (LBM) Digital microbiology

The Players
bioMerieux Copan Kiestra (BD)

The Kiestra Solution

The 3 Solutions

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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

Sorting Units (6-40 different media)

Total Lab Automation

Assemble all components onto a single, continuous platform Incubator Units
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InoqulA
Strengths
Fast, approximately 500 inoculations per hour No consumables required Flexible
Inoculates: plates, slides, broths

InoqulA Full Automation

Unique
Can be implemented as:
Work cell automation Full lab automation

InoqulA

Uses magnetic bead to inoculate plates

InoqulA - up to 4 times more isolated colonies

vs. manual streaking (bead technology)
InoqulA Streaking

Manual Streaking

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Plates entering the incubator

Plates moved within the incubator on tracks

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Multi Imaging by ReadA Technology

Telebacteriology Lab overview

Reading Room

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Automating Identification
Biochemical Identifications
Lack of standardization between manufacturers makes automated set-up difficult

Maldi-Tofa

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

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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

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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

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. Each plate image is 15 Megapixels. 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

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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, 2012

2011 Kaiser Foundation Health Plan, Inc. For internal use only.

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Smart Incubator System

Smart Incubator System
Modular & Flexible Quality of Imaging Cost efficient solution

Smart Incubator System* Three Main Components

Incubation Chamber + Plate Imager
Automatically manage the incubation of plates (up to 1000 plates within O2 or CO2) 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).

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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

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Backlight

Digital Microbiology
Specific sorting criteria
Patient, Specimen, Growth / No growth.

Surface/Relief : P.Mirabilis / E.coli

Special lightning (B&W case) to enhance the colony aspect and elevation observation.
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IPS ID/AST preparation for McF & MS

Culture medium T1
MS spectra for ID

PREVI Isola and Smart Incubator System Modularity Flexibility

T2
A part of colony A few colonies added or sample diluted to reach 3ml saline Standard dilution 0,5ml transfer
AST card(s)

Standard dilution

AST AES results

1ml saline

Purity plate
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Workflow with VITEK MS

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!!

VITEK MS

VITEK 2

Myla server with MS-ID v1 database - Closed - CE-marked

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CP Computer with MALDI Solutions software

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Embrace change or it will embrace you.

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