VALIDATION, IMPLEMENTATION AND ROUTINE WORK WITH TOTAL LAB-AUTOMATION BD-KIESTRA : A TWO-YEAR EXPERIENCE AT THE UNIVERSITY HOSPITAL OF LIÈGE, BELGIUM

Background: Automation in Bacteriology is a major revolution in clinical microbiology laboratories. At the university hospital of Liège (Belgium), a BD-Kiestra Total Laboratory Automation (BD-K-TLA) system has been installed in September 2015. Here, we describe the validation process achieved for the implementation of the BD-K-TLA system, and our two-year experience in the daily practice of the laboratory.
Materials/methods: We present the validation plan (i.e. all the parameters that have to be checked before TLA-BD-K implementation) established by the Key User Group BD-Kiestra. In order to evaluate some of the added-value of this system compared to full-manual bacteriology, we measured two parameters for two similar period, before (February 2015) and after (February 2017) implementation of the BD-K-TLA: (1) the positivity rate (%), defined as the number of significant positive cultures among the total of samples analyzed and (2) the time-to-result (TTR), defined as the time (in hours) between reception of a specimen in the microbiology laboratory and the isolation of a significant pathogen in this sample. All specimens were included, except respiratory samples and blood cultures.
Results: Validation plan included the checking process of each of the modules of BD-K-TLA: BarcodA, InoqulA, ProceedA, ReadA Compact and ReadA Browser. Furthermore, specimens were tested in parallel, on the BD-K-TLA and with full-manual bacteriological techniques: a minimum of 95% agreement was observed for qualitative and semi-quantitative assessment of Gram stain and cultures. The positivity rate went from 19,7% (pre-implementation – 1169 of 5941 samples analyzed), to 21,8% (post-implementation – 1391 of 6381 samples analyzed). Mean TTR for the specimens was of 26,95 h in February 2015, while it was 26,83 h in February 2017. Looking at these two measures, no significant time saving is currently observed. However, TLA-BD-K allows traceability through the whole process, quality of inoculation, fixed incubation times and better biological validation by clinical microbiologists thanks to remote pictures review.
Conclusions: Working with BD-K-TLA allows a better quality and traceability of the bacteriological results, with a major benefit of remote pictures review. In order to observe time saving with BD-K-TLA, a well-considered configuration of the instrument and major reorganization of the workflow are mandatory.