Use the Gram Stain
In microbiology we learn to use the Gram stain results of a direct smear to check specimen quality (usually by a count of squamous epithelial cells) and any predominating organisms (e.g. lancet shaped Gram positive cocci on a sputum) that suggest what to work up.
All good micro techs use the Gram stain. Intracellular organisms are an immediate clue of what’s causing an infection. If an organism is seen on the Gram stain and not seen on the plates, it could indicate that the patient is being treated, making the organisms non-viable. Gram staining urine specimens can give hints of certain organisms, such as Aeromonas. It’s one of the first steps in the detective job of the microbiology tech, to tell the doctor what’s causing an infection and how to treat it.
But the Gram stain can also be used to educate and connect with other front line staff. It can be used to elevate our profession and status as a clinical resource, instead of being seen as button pushing phlebotomists.
When a wound culture direct smear shows many squamous epithelial cells and what appears to be mixed skin flora, it’s a chance to talk with the nursing staff about how the specimen was collected. It’s a chance to talk to the pharmacy about how the patient may already be treated. And it’s a chance to check the chart and talk to the physician about why the culture is important e.g. MRSA.
I reviewed a chart of a suspected pneumonia patient, and in the H&P the physician had noted “Gram stain shows many white cells and Gram positive organisms.” This was correct to a point; the reason I reviewed the chart is because the plates were being worked up for Haemophilus. The Gram stain report also reported intracellular organisms and many Gram negative cocci. Why didn’t the H&P accurately reflect the recent report? Why didn’t the admitting doctor see this original report and notice the discrepancy?
All good chances for us to use the Gram stain to improve patient care.
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