MCCCD Official Course Competencies:

HCE246  2006 Spring – 2011 Summer II

Clinical Microbiology

1.

Differentiate the types of microbial infectious agents and the associated diseases. (I)

2.

Apply safety precautions, use of safety equipment, and appropriate procedures for specimen collection, handling, storage, and disposal of biological material. (II)

3.

Evaluate specimen acceptability criteria using protocols and documentation. (III)

4.

Distinguish the classification, colony morphology, and phenotypic characterization of microorganisms. (IV)

5.

Differentiate the staining characteristics of microorganisms, and prepare and stain direct microscopic smears of specimens. (V)

6.

Differentiate the macroscopic and microscopic morphologies of microorganisms, and evaluate and interpret direct microscopic smears of specimens. (VI)

7.

Determine appropriate pretreatment, decontamination, and concentration techniques for select microorganisms. (VII)

8.

Describe the use of biotechnology and molecular technology in clinical microbiology. (VIII)

9.

Properly identify specimen type and source, and specify the common microbial flora found in each specimen type. (IX)

10.

Select appropriate media to isolate and identify microorganisms. (X)

11.

Perform inoculation and incubation of culture media at appropriate atmosphere and temperatures using standard inoculation techniques. (XI)

12.

Evaluate growth on primary isolation media by distinguishing colony morphologies and perform standard isolation techniques to isolate individual bacterial colonies. (XII)

13.

Interpret the biochemical and differential tests used in the isolation and identification of microorganisms. (XIII)

14.

Differentiate rapid and commercial methods for identifying microorganisms. (XIV)

15.

Interpret cell culture and direct method detection tests for viral particles or antigens. (XIV, XV)

16.

Differentiate the microbial agents of bioterrorism and describe the role of the clinical laboratory in their detection and reporting. (XV)

17.

Differentiate among the principles and procedures of antimicrobial susceptibility testing, drug resistance, and troubleshooting test results. (XVI)

18.

Perform and interpret calibration and quality control on instruments used in microbiology testing. (XVII)

19.

Differentiate among principles of quality assurance and quality control procedures in interpreting, evaluating, and reporting microbiology test results. (XVIII)

20.

Report results considering correlation of culture and direct examination, epidemiological significance, and regulatory requirements. (XVIII)

MCCCD Official Course Outline:

HCE246  2006 Spring – 2011 Summer II

Clinical Microbiology

I. Microorganisms and Associated Diseases

A. Bacteria

B. Yeasts and molds

C. Parasites

D. Viruses

II. Safety Equipment and Specimen Handling

A. Personal protective equipment

B. Safety hoods

C. Aseptic techniques

D. Specimen storage

E. Decontamination

F. Biohazard handling and disposal

G. Specimen acceptance and rejection criteria

III. Specimen Acceptability

A. Acceptance criteria

B. Rejection criteria

C. Protocols

D. Documentation

E. Other

IV. Classification, Phenotyping, and Morphology

A. Taxonomy nomenclature

B. Differentiation of microorganisms

C. Phenotyping

1. Cell growth and reproduction

a. Cell division

b. DNA (Deoxyribonucleic Acid) replication

c. Gene expression

2. Metabolism and nutrition

D. Morphology

1. Structures and functions

2. Bacterial toxins

3. Pigment

4. Texture

5. Colonization

6. Growth rate

V. Smear Preparation and Staining

A. Smear

1. Stains and reagents preparation

2. Specimen preparation

3. Smear preparation

4. Fixation

5. Tape preparation

6. Capsule technique

7. Thick and thin blood films

B. Stains

1. Gram

2. Acid fast

3. Fluorescent

4. Dark field

5. India ink

6. KOH (Potassium Hydroxide)

7. Calcofluor

8. Wright

9. Periodic Acid Schiff (PAS)

VI. Macroscopic and Microscopic Evaluation

A. Macroscopic

1. Pigmentation

2. Appearance

3. Presence of structures

4. Colony size and shape

5. Tape

B. Microscopic

1. Light microscopy

2. Fluorescent microscopy

3. Quantitation of growth

4. Evaluating specimen quality

5. Morphologies

6. Spores

7. Capsules

8. Spirochetes

9. Intracellular and extracellular elements

10. Artifact

VII. Pretreatment and Concentration Techniques

A. Digestion

B. Decontamination

C. Centrifugation

D. Sedimentation

E. Flotation

VIII. Biotechnology and Molecular Technology

A. Nucleic acid

1. Hybridization

2. Amplification

3. Sequencing and enzymatic digestion

B. Chromatography

C. Immunochemical tests

IX. Specimen Type and Source and Common Flora

A. Cerebral spinal fluid (CSF)

B. Blood

C. Genital

D. Upper respiratory

E. Lower respiratory

F. Tissue

G. Urine

H. Wound

I. Gastrointestinal (GI)

J. Autopsy

K. Zoonotic infections

L. Other body fluids

X. Media

A. Enriched

B. Selective

C. Fastidious or unusual growth

D. Differential

E. Nutritive

F. Egg based

G. Transport

H. Environmental requirements

XI. Inoculation and Incubation

A. Inoculation

1. Quantitative

2. Semi-quantitative

3. Standard streaking techniques

a. Swab

b. Loop flaming

c. Disposable loops

d. Streaking for isolation

e. Stab

B. Incubation

1. Atmosphere

a. Aerobic

b. Carbon dioxide (CO2)

c. Anaerobic and microaerophilic

2. Temperature

3. Humidity

XII. Evaluate Growth and Individual Isolation

A. Sheep blood agar

B. Chocolate agar

C. Differentiate fermentation and hydrogen sulfide producers

1. MacConkey (MAC) agar

2. Eosin methylene blue (EMB)

3. Hektoen-enteric (HE) agar

4. Others

D. Thayer-Martin agar

E. Campy-blood agar (BA)

F. Anaerobic agar

G. Trypticase soy broth (TSB)

H. Cell culture

I. Evaluation criteria

1. Correlate clinical diagnosis and specimen source

2. Correlate direct Gram stain results and culture results

3. Colony characteristics

a. Gram stain

b. Size and shape

c. Surface appearance

d. Pigmentation

e. Odor

f. Changes in media

4. Correlate growth on various media

5. Quantitation of growth

6. Normal flora versus potentially significant isolates

XIII. Biochemical and Differential Tests to Identify Organisms

A. Biochemicals

B. Differential antibiotics and chemicals

C. Immunologic

D. Slide cultures

E. Hair perforation

F. Cyptococcal antigen

G. Exo-antigen

H. Tease preparations

I. Algorithms and databases

J. Other

XIV. Rapid and Commercial Identification Methods

A. Direct antigen

B. Direct antibody

C. Enzyme immunoassay (EIA)

D. Radioimmunoassay (RIA)

E. Immunoperoxidase

F. Molecular biology

1. Nucleic acid detection

2. Nucleic acid amplification

G. Non-automated

H. Automated

I. Other

XV. Microbial Agents of Bioterrorism and Reporting

A. Microbial agents

1. Bacillus anthracis

2. Brucella species

3. Francisella tularensis

4. Yersinia pestis

5. Salmonella typhi

6. Others

B. Reporting

1. Sentinel laboratories

2. Relationship with state laboratories

3. Centers for Disease Control (CDC)

4. Specimen handling and transport

XVI. Antimicrobial Susceptibility Testing

A. Testing principles

B. Clinical Laboratory Standards Institute (CLSI) guidelines

C. Antimicrobial agents classification

1. Beta lactams

2. Aminoglycosides

3. Carbapenems

4. Fluoroquinolones

5. Glycopeptides

6. Macrolide-lincosamides

7. Others

D. Mechanisms of antimicrobial resistance

E. Troubleshooting

XVII. Instrumentation

A. Principles of method analyses

B. Calibration

C. Quality control

D. Proficiency testing

E. Preventive maintenance

F. Troubleshooting

G. Assaying patient samples

1. Evaluate results

2. Correlate and interpret results

3. Report results

H. Documentation

XVIII. Quality Assurance

A. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards

B. CAP (College of American Pathologists) standards

C. Performance improvement programs

D. Equipment and instrumentation documentation

E. Staff competency and education

F. Epidemiological standards

G. Other regulatory standards