CHRF provides laboratory services to the people for diagnosis of diseases of all age group. We have large spectrum of test facilities in our lab. Currently we are running to Diagnostic in Dhaka and Mirzapur.
DEPARTMENT OF MICROBIOLOGY, DHAKA SHISHU HOSPITAL
Department of Microbiology of Dhaka Shishu Hospital (DSH) started its journey in 1983 with very limited resources in the corridor of the Department of Pathology. However, lack of space and limitation of resources were taken as a challenge, and that was the driving force to move forward.
As a whole, DSH is a resource poor organization. However, commitments are enormous and priorities are many. There is staggering number of issues to be addressed and so it is not easy to decide on the priorities to be addressed. The priorities of DSH start from providing free beds to ‘no cost’ investigation facilities, through free food for the mothers and the children of more than 50% of in-patients. Considering this fact, the department, since its commencement, aimed to collect its major supplies, capital equipments, etc. from external sources, so the hospital can use its limited resources for other competing priorities.
Although the department primarily started with the responsibility to give services to the hospital by building its diagnostic capacity, research came in a passive way as an intrinsic component of basic science. Department of Microbiology, therefore, aimed to do the best in both — diagnostics and research. These two components are complementary to each other as we always prioritize those research topics which have implications in improving the diagnostic microbiology and influencing the child health policy matters. This small brochure will describe different components of the department including its capacity, activities, achievements, contributions and so on.
The laboratory receives clinical specimens from the wards at the reception area or in the laboratory. Processing of the specimens starts at real time, specifically for cerebrospinal fluid (CSF) and blood culture. Other specimens, if not processed instantly, are kept in the cool box or refrigerator to minimize the impact of time gap.
In this department, improvement of laboratory procedures and techniques is a continuous process. The advancements in processing the specimens and improvement of diagnostic capacity are coming from the experiments and findings of this laboratory, and published literature from the other laboratories.
Once the specimens arrive in the Department of Microbiology, they are handled with care following standard operation procedure (SOP), depending on type of specimens.
Specimens like cerebrospinal fluid (CSF) are handled with high priority. cytology, Gram stain and antigen detection tests are done and reported at real time.
Bacteriological culture is the main service of the whole department. The specimens are processed in aerobic and micro-aerophilic conditions. Since 2001 to April 2007, 58,900 specimens have been cultured and 52% of them were from paying patients.
Among the cultures, blood (31%), CSF (24%) and urine (24%) were the most predominant specimens followed by pus (7%) and throat swab (2%).
In the recent years, the department introduced enriched blood culture media with the support from GAVI’s PneumoADIP, and that has lead to progressive increase in blood culture and higher rate of isolation. All the blood culture media, irrespective to the enrolment of the cases in the study, are provided by PneumoADIP of Johns Hopkins University.
Over all Hib is the predominant cause of pyogenic meningitis followed by S. pneumoniae. However, most of the CSF specimens are culture negative due to prior antibiotic use. Etiology of these cases is detected by detection of antigen either by latex agglutination test and / or by Immuno-chromatographic test. Both the tests, for antigen detection, are available in the microbiology laboratory, through PneumoADIP of Johns Hopkins University.
Salmonella typhi is the most common organism among the culture positive cases. Predominance of this organism is more conspicuous in the 2-59 months age group. Other organisms like Klebsiella pneumoniae, Acinetobacter and Serratia are mostly isolated from neonates.
This department is one of the few laboratories in the country and the region that does cultures routinely and isolates and characterizes the fastidious organisms like Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis. This capacity is known to the whole world, through the publications and presentations, and thus the department is functioning as the reference laboratory of seven hospitals of Bangladesh and ICDDR,B for surveillance of invasive Pneumococcal diseases in children.
Serological tests: In addition to bacteriological culture, serological tests, mostly relevant to the paediatric age group, are also done in this department. As with the culture, increase in trend is noted here too. On an average, based on last 5 year-data, the department deals with 7479, 4733, 1652, 400, 320 specimens for CRP, Widal, febrile antigen respectively.
Communication between ward and Laboratory: Microbiology Department maintains a constant communication with the wards for collation and interpretation of the results. This helps the department to provide better service to the patients and to improve the knowledge. Communication helps us to i) inform about the contaminated specimen and request for a fresh one; ii) get additional information about the patient and/or iii) inform about any urgent report like KLB or any growth from CSF, etc.
Capacity to Identify the Organisms: In the last several years, the capacity of the laboratory has substantially increased to precisely identify the most of the bacterial isolates upto the species level. Identification is done based on the standard procedures. Primarily the organisms identified based on growth requirements, biochemical tests, analytical profile index (API) and agglutination with specific antisera. Specific antisera are available to confirm the identification and typing of the organisms, like Salmonella, Haemophilus, Pneumococcus and Meningococcus.
Preparation of Reports: The department uses software, developed by a graduate of Johns Hopkins University, which automatically interprets the antibiotic susceptibility results from the measured zone of inhibition, based on the Clinical Laboratory Standard Institute (CLSI) guidelines. Computer generated reports are then delivered to the wards.
Availability of Data: The test results of the department of microbiology are stored in the computer for any future reference. These data can be analysed to find the prevalence and the trend of the infection causing organisms, and their susceptibility pattern. Data are accessible to our clinical colleagues, if they want to look at the trend of infections among their own patients. These are useful for the treatment policy in the wards and the hospital as a whole.
Delivery of Reports: The Department of Microbiology volunteer to deliver the reports to the respective wards. This facilitates the availability of test results within a short time. The results are also communicated to the doctor of the respective unit over telephone. However, this mostly occurs when the duty doctor or the consultant calls the department and enquires about the test results.
Specimens from other hospitals/clinicians: In addition to in house specimens, microbiology laboratory also receives specimens from other hospitals and private practitioners. These specimens are processed in the same way, and sometime with higher care, to attract more specimens from outside.
Waste disposal: With the continuous improvement in the diagnostic capacity, the staffs are also committed to conserve the environment by following the safe waste disposal strategies. Although complete safe waste disposal depends on national program, the department puts its effort to discard the sharps and infectious materials in a safe way, so that environment does not get affected.
Media preparation and Quality Control: The department has separate sections for media preparation which is well equipped with laminar hood, autoclave, distilled water plant and dispensers. Media are prepared following the standard procedures and labelled with date and batch numbers. All these media are then checked for quality, using reference strains from American Type Collection Centre (ATCC), by a person who is not involved in media preparation. Specimens are processed on these media only if they are approved by the quality control (QC) person. Failure of any batch to pass through QC is reviewed and discussed about to find the cause, and appropriate measures are taken to avoid the future mistakes.
Capacity of the Department of Microbiology: The department has walked forward from the corridor of another laboratory to have its own space through several steps of extension and renovation. Now, the department has eight functional rooms like reception corner for the patients, room for preparation of media and their quality control, data management section, meeting room and so on. The biggest area is devoted for routine bacteriological and serological work, while there are also laboratory areas for molecular biology and immunology related works.
Expansion of the Department: Department of Microbiology of Dhaka Shishu Hospital began its journey in 1983 in a corner of the corridor of the department of Pathology. There was lack of equipment, and constrain of space, both of which are essential to establish a good laboratory. The performance of the department in the collaborative work, achieved high appreciation from all the partners. This appreciation helped the laboratory get the necessary support to expand the department, at different stages, and ultimately bring it to the present form.
Capacity Building: By and large there is always a huge disparity between the availability of laboratory capacity and the burden of infectious diseases. Department of Microbiology has successfully improved its capacity and applied those to explore the work on infectious diseases. The facility of the laboratory now ranges from culturing the routine specimens to molecular finger printing through PCR based identification and serotyping of the organisms. All these are achieved through collaborations with international universities and agencies and active cooperation from the hospital authority. In addition to building the capacity in respect of equipments and appliances, the laboratory has also developed the competence to maintain good laboratory practice.
Capacity and competence helped the department to achieve the recognition as the reference laboratory for S. pneumoniae and H. influenzae for several hospitals in Bangladesh and beyond.
Sheep blood is very important to run the laboratories. Recently, Department of Microbiology closely worked with the hospital authority and arranged to build a dedicated animal house with the help of Prof. T Nagatake of Nagasaki University, Japan and Mr. Biraj Khajanchi of Asia Foundation and Construction Limited, Bangladesh.
Though, Dhaka Shishu Hospital was founded with strong and high ambitions to serve the poor children of the country, and to do research in the field of pediatrics, limited resources have always been a hold back to fulfill these goals. Keeping this in mind, the department of microbiology has constantly tried its best to gather most of its resources by itself. In this process, most of the capital equipments and expensive supplies of the laboratory have been pulled together from external sources.
In the last one decade, the department has collected many capital equipments, these are in use for routine diagnostic tests and researches. The capital equipments are assets of the department and thus of the hospital too.
In addition to equipments, few new and expensive diagnostic kits, like bacterial antigen detection kit, specific antisera for identification, etc. are being available through the departmental research projects. These kits are also in use for the routine diagnostic purposes. If these tests come from paying beds, they are considered as payable tests. This is another way, by which the department is contributing in generation of income of the hospital. It can be mentioned here that, since April 2004, all the blood culture bottles used in this hospital are provided by PneumoADIP of Johns Hopkins University.
It must also be pointed out that the department has reached its present form of robust infrastructure through several expansions and renovations in last several years. All these were done by the help of the research collaborators and friends in the society, without any financial implications to the hospital.
KUMUDINI WOMEN’S MEDICAL COLLEGE AND HOSPITAL