I legit never would have expected even the faintest hint of beef between us and the microbio lab, so let's make sure we're actually understanding each other.
Let me paint a picture of what us taking cultures actually looks like. We get a patient in the office or ER, they have a bad corneal ulcer. Or they have endophthalmitis. This is potentially an emergent situation. We need to culture this first before starting topical antimicrobials. We go to the lab, get a series of plates, swab the lesion (or perform a tap), and immediately plate it directly onto the plates. I'm not sure how else it can be done. Unless you mean putting the specimen in a generic bacterial culture tube and/or viral transport media and letting the lab techs plate that out?
When you say slants, do you mean actual slants, like L-J or Middlebrook? Or is "slants" a lab shorthand for any type of plating?
Again, I'm not sure we're understanding each other. Exactly what part of this process do you take issue with, and what would you like to see changed?
Our textbooks universally recommend this practice. We ALL have been taught to do it this way in residency. Our specimens are extraordinarily precious - we cannot easily obtain the specimen again, and we are only able to obtain a tiny amount of specimen. We are the only ones who can swab - our techs absolutely cannot do it for us. And we need to swab right when we see the patient, because the the serious nature of their conditions usually means they need antibiotics for these conditions, like, yesterday.
To answer your other questions:
- Fastidious organisms - not often what we're looking for, but if I'm suspecting one, I communicate with the lab ahead of time about these about how they want me to do the culture
- Viral culture - for us, most commonly it's going to be HSV or VZV; sometimes CMV. It'll be either a swab or an aspirate obtained by needle aspirate from the eyeball, and it goes into viral transport medium for PCR
- Plate storage - all clinics have protocols for this. Fridge temps have external thermometers that are monitored. Often we're storing other critical temp-sensitive meds in there, so it has to be finely regulated
- Foreskins - if I'm understanding you correctly, this is where you actually break the surface of the medium when you plate? If so - even though this is the classic teaching, only one out of the dozens of hospitals I've worked at over the years actually wanted this. I typically streak
This is absolutely NOT the equivalent of the surgeon doing non-surgical tasks. This is ophthalmologists recognizing that the samples we get cannot be re-obtained and that we need to make sure the cultures are getting done how we need them to be done. It is absolutely a good use of our time - a LOT rides on the results of those cultures. Making sure our treatments are targeting the correct organism can mean the difference between permanent blindness and sight.
Again, I'm curious about exactly what part of this process you disagree with and exactly how you'd like to see it done differently. I'm open to recommendations on how we can improve our process, but I'm not interested in a flame war with the lab.. that would just be really weird. The hospital has enough of these useless "we know how to do this better, what is this service even thinking, these guys are so stupid" flexes, and I do not care for them one bit.
