NEW YORK (360Dx) – ARUP Bacteriology Laboratory has installed massive new robotic specimen processing equipment that is expected to reduce the manual labor required to process bacteriology specimen and cut processing times.
The equipment, WASPLab from Copan Diagnostics, was installed in November, and went live about a month ago following an extensive validation period. The installation is expected to help address a growing problem faced by ARUP and other labs, a shortage of personnel.
"It is getting harder and harder now to replace medical technologists with the shortage of medical technologists in the field, and experienced microbiologists are even rarer. Looking to the future, this is going to help us handle staffing shortages when there aren't that many med techs entering the field," said Rhonda Hensley, assistant vice president and group manager, technical operations infectious diseases, ARUP.
In 2016 the Bureau of Labor Statistics estimated 12,000 new medical laboratory professionals were needed per year to meet growing demand, but academic programs currently produce just 5,000 graduates per year, according to the American Society for Clinical Laboratory Science. In addition, the average age of certified medical technologists is 43.7, slightly older than the average nurse age of 43.3, but the medical technologist field is aging at a rate 78 percent faster that the rate for the overall US labor market, according to ASCLS.
WASPLab is a barcode-driven conveyor belt system that works with the Walk Away Specimen Processor, or WASP DT, so that the combined solution automates the processing of bacteriology specimen from receiving the specimen through tracking growth of cultures during incubation, according to Gabriela Franco, marketing director with Copan Diagnostics.
WASP DT reads the barcode on patient samples and mixes the samples, labels agar plates with patient information, opens the samples, and streaks the plates with specimen automatically. WASP DT then automatically transfers the plates to the WASPLab conveyor belt system, which takes the plates through the process of having photos taken at time zero, sending the plates to a smart incubator, and pulling them out again at a preset time to take a second image. The system then returns specimens to the incubator until lab personnel view them. The systems are modular and some labs start with the WASP DT alone, but ARUP has the entire system, according to Franco.
Lab personnel can view agar plates on a screen to evaluate growth without taking them out of the incubator, Franco noted.
For ARUP, the automation has cut the time required for several manual processes.
"Not having to go to the incubators and pull the plates out saves time, and not having to streak the plates by hand saves time, so we save a lot of time on the upfront processing part," Hensley said.
In addition, plates that have no growth can be automatically discarded by the system, saving the time and effort required to pull and discard no-growth plates manually, she said. The lab has also completed an interface that enables WASPLab to automatically enter no-growth determinations into patient records, eliminating the need for those records to be manually entered, she said.
Over time, artificial intelligence in the system will begin to recognize which plates are typically characterized by the lab as no-growth, and will group images of no-growth plates together and query lab personnel to confirm the no-growth classification. This should further improve efficiency, Hensley said.
WASPLab employs artificial intelligence to determine no-growth classification because different labs have different thresholds for what level of growth is deemed insignificant, Franco noted.
While the lab has not been able to quantify its labor savings yet because the system is so new, other labs have indicated that the system has reduced labor requirements by about 20 percent, Hensley said.
"We are not there yet because we are still on the learning curve, but we are hoping that will happen. What a lot of other places have done is as they have seen an increase in growth, they just haven't increased the number of bodies," she said.
ARUP Bacteriology lab also anticipates that the equipment might speed test turnaround time, because the cultures are not disturbed during incubation as much as they are when manually monitored, according to Hensley.
"When we brought plates out of the incubator ourselves, we would put them on the counter. There might be 30 or 40 of them on the counter, and we would take two at a time to look at them. Those cultures on the counter are not incubating and that slows their growth," Hensley said. "We have heard other labs [that use WASPLab] are able to get their cultures out more quickly because they are incubating longer without being disturbed in the smart incubators."
By reducing manual labor requirements, the system is also expected to add to the ARUP Bacteriology Lab's surge capacity, according to Hensley. From time to time, when events such as weather disasters shut down labs in certain parts of the country, ARUP Bacteriology is called to take over lab workflow until the local lab working conditions return to normal, Hensley said. She would not specify the total number of specimen the WASPLab system could process but said that as a result of adding the system, the lab would not be constrained as to how much surge capacity it could add.
While it was not difficult to train lab personnel to use the system, it was an adjustment for some staff to learn to examine cultures on agar plates digitally, rather than manually.
"The plus is you can blow it up even larger on a high-definition screen, but the downside is you are used to smells and certain small contours," she said.
The system does allow plates to be pulled from the system and viewed manually in cases where lab personnel would like a different view of the samples, she noted.
WASPLab installations are customized for different clients depending on the needs of the lab, and ARUP's system is a large installation, according to Franco. Hensley would not provide specifications on the size of the of the equipment but noted that the ARUP Bacteriology Lab moved to a larger room across the hall to accommodate an installation with the capacity that the lab wanted. In addition, since the bacteriology lab is on the second floor, ARUP added extra support, such as floor joists, to support the equipment's weight.
Currently, ARUP Bacteriology lab is using the system for urine cultures but hopes to add stool cultures next followed by wound cultures and screening cultures to detect a specific organism. Hensley estimates it will probably take a year for the lab to put every type of specimen on the system that the lab plans to add because ARUP will undergo an extensive validation process for each new specimen type.
The lab plans to add a majority of the culture types it processes to the system, with the exception of certain cultures that must incubate exceptionally long, out of concern that long-held cultures might dry out in the same system with other types of specimen, Hensley said. The lab plans to incubate long-held cultures, such as Legionella cultures which are held for 10 days, in a separate environment with higher humidity.
Looking to the future, Hensley anticipates once ARUP Bacteriology Lab has completed adding more sample types to the system, it will explore adding other modules that further automate the back-end processing of specimens.
"Once we have growth, we have to identify what the organism is and test it against drugs. That is still a manual process for us right now, but [Copan Diagnostics] is creating a module called Colibri that will go on the back end," Hensley said.
Colibri will seed colonies onto plates for further testing and conduct antibiotic susceptibility testing. There is currently one installation of the module at a Kaiser Permanente laboratory for research purposes only, pending FDA clearance of the module, according to Franco.
ARUP Bacteriology lab is also interested in eventually adopting chromogenic detection software from Copan Diagnostics' PhenoMatrix suite of software products, Hensley said. This software compares the shape, color, and appearance of colonies against a library of images and suggests the type of pathogen. Tests using the system to study MRSA and VRE found the technique to have sensitivity rates of 100 percent, and specificity rates of 90.7 percent and 89.5 percent respectively.