A view from inside the lab
Mr. Collacott, could you please briefly introduce your lab?
We provide microbiology and virology testing to about 600,000 people in Northeastern Scotland. The Department of Laboratory Medicine here at the Aberdeen Royal Infirmary has a staff of about 400, and the combined microbiologyvirology lab has about 70-80 staff members. Overall, it’s a quite comprehensive regional virology and microbiology service. We process about 500,000 samples a year in microbiology, and around 60,000 blood and 12,000 other sample types such as swabs, urine or cerebrospinal fluid in virology.
What are the most frequently performed tests at your lab?
In blood testing, the most common tests would be for viruses such as hepatitis B (HBV), hepatitis C (HCV) or the human immunodeficiency virus (HIV). We also conduct a few thousand norovirus tests a year. In addition, tests are being done to screen patients who have undergone transplants for infections such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV). We also have a large number of respiratory virus samples covering various pathogens, and these are around 5,000 a year.
How are these tests being performed?
We use a mix of immunological and molecular assays. Most of the molecular testing is done in a semi-automated process using various instruments from different vendors. However, we’ve started to transfer several tests to the QIAsymphony RGQ platform which has enabled us to greatly improve automation. We are already routinely using the artus HCV and HIV viral load test kits on this platform and have recently added the artus EBV and CMV kits as well. This is much easier than semi-automated workflows: We simply load the samples, start the extraction run for the nucleic acids of interest, and then tell the QIAsymphony what assay should be prepared. The only manual step is to load the ring holding the tests from the QIAsymphony AS to the Rotor-Gene Q for the real-time PCR process to generate the test results. So there is very low hands-on time. The use of barcode readers and standardized software also means we have far less variability in test results and a far lower risk for mixing up samples.
"It would be absolutely impossible for us to handle our current workload using only manual methods. Automation is absolutely essential, especially as there is an increasing demand to deliver more rapid test results in order to improve patient care."
Ian Collacott, Aberdeen Royal Infirmary, Scotland
When did you start using the QIAsymphony and what factors convinced you to choose this system?
We started evaluating the platform in late 2011 as one of the systems under consideration for a tender. We assigned scores for various factors such as the range of commercially available tests, their sensitivity, the sample processing capacity of the machines, their cost-effectiveness and other features. One of the main points for us was that the system must be “open,” meaning that it could automatically process both our own laboratory-developed tests as well as commercial kits. But the most important factor was convenience – we wanted a system where we just have to load the patient samples at one end and take the tubes off at the other end and load them into a real-time PCR cycler to generate the test results.
What does the split between automated and semi-automated tests look like?
Currently about one-third of the samples are processed on the QIAsymphony and two-thirds on the semi-automated setup. So we still have a significant volume being done in a semi-automated manner. But we’re trying to move more tests over to the QIAsymphony, because it requires less hands-on time from our staff and is also a more secure system. I think that we will keep expanding the test menu on the QIAsymphony during the next one to two years.
So you are trying to automate as much of your work as possible?
Yes, that’s correct. We want to avoid having a staff member sit down and manually pipette all these reagents and samples. The automation does it for you. I think that the way ahead is definitely for more automation, and this will help us to more efficiently produce results and cope with an increasing workload. It would be absolutely impossible for us to handle our current workload using only manual methods. Automation is absolutely essential, especially as there is an increasing demand to deliver more rapid test results in order to improve patient care.
"It wold be desirable to have an even higher grade of flexibility in processing samples for molecular testing. Also, it is very important that we improve the integration of instruments into laboratory information systems, so that reports and test results are automatically loaded to the system."
Ian Collacott, Aberdeen Royal Infirmary, Scotland
When did you initially start using instruments for molecular testing? Is there a certain threshold in terms of volume when automation becomes attractive?
For molecular testing, we started using automated extraction methods about six to seven years ago, and that was actually with a QIAGEN BioRobot. When we started doing real-time PCR tests, we first used a completely manual protocol. As soon as we reached about 20 samples a day, it became worthwhile to invest in an instrument. Processing this amount of tests a day using a completely manual method ties up a skilled person for the good part of the day, and the risk of contamination is far greater. So I would say that if your workload reaches about 100 samples a week, then you should be using automated methods. It is far more efficient, cost-effective and reliable than using manual methods.
How do you measure the efficiency of your workflow?
We have statistics on all of our tests. We know how many tests are being conducted, what test methods are used, and the time from receiving a sample to reporting the results. We also participate in surveys to benchmark our performance against other laboratories. We compare ourselves to other teaching hospitals in the United Kingdom and measure our efficiency in terms of cost per test, number of staff needed to perform a test, workload and other factors. The results show that we have a good system and efficient processes.
What areas do you see for improvement in lab automation?
It would be very desirable to have an even higher grade of flexibility in processing samples for molecular testing. Also, it is very important that we improve the integration of instruments into laboratory information systems, so that reports and test results are automatically loaded to the system. But I think that if we look at the history of automation over the last decade, we can see these needs already starting to be addressed. We started eight years ago with a fairly simple QIAGEN instrument that only did sample extraction, and today we have a very sophisticated instrument with QIAsymphony, which can automate the process from sample to result. So yes, I think manufacturers understand the needs of laboratories and are actively developing products to help improve our processes.
Mr, Ian Collacott is the Chief Biomedical Scientist in Virology at the Aberdeen Royal Infirmary. He has worked in virology since 1974 and joined the institute in 1992. His broad interests include, in particular, molecular diagnostics, blood-borne and respiratory viruses. Since 2002 he has been an examiner in Virology for the Institute of Biomedical Science in the UK.