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A high-tech strategy to become a reference laboratory

The Konstanz-based Labor Dr. Brunner is the first medical laboratory in Germany to use a worldwide revolutionary instrument for liquid sample processing in bacteriological laboratories. The Walk-Away Specimen Processor (WASP) is a faster and more reliable processor that automatically identifies resistant pathogens such as MRSA or ESBL-type bacteria that have become part of the growing number of antibiotic-resistant pathogens that cause hospital-acquired infections. The time between the receipt of samples in the laboratory and the communication of results to the treating physician can be reduced by up to 24 h.

Fully automated and precise sample processing. Heike Haag checks the work of the Walk-Away Specimen Processor on the screen. © Michael Statnik

The instrument recently purchased by Labor Dr. Brunner is two metres deep, slightly over one metre wide and around two metres in height. The innovative Walk-Away Specimen Processor (WASP) replaces rather time-consuming manual procedures by enabling the automated planting and streaking of microbiology samples on agar plates. Since the establishment of medical microbiology by Robert Koch in the 1880s, human samples have been applied to solid agar plates using platinum inoculation loops. This is a very time-consuming procedure, and the quality and consistency of specimen inoculation can often vary considerably. "It is often necessary to repeat the procedure especially in cases when a sample unexpectedly contains high numbers of pathogens, and this can often cause delays of up to 48 h," said Dr. Oliver Nolte, head of micro- and molecular biology at Labor Dr. Brunner. The WASP instrument, developed by Copan, will now speed up the laboratory's investigations as well as simplifying identification of the bacteria. WASP uses a single platform with innovative, made-to-measure planting and streaking tools that allows the automated and highly accurate planting and streaking of bacteriology specimens on solid culture media. It also improves the resolution of bacterial growth. "The system enables the easier, more sensitive and hence more accurate identification of problematic pathogens such as MRSA," said the microbiologist.

Precise and safe sample processing using parallel and interconnected steps

Until recently, Labor Dr. Brunner used to manually inoculate microbiology samples onto agar plates. © Michael Statnik

WASP weighs around 650 kilograms. When WASP starts planting and streaking samples it immediately becomes obvious that the platform is based on very sophisticated technology. "Several processes run in parallel and are interconnected," the microbiologist explains. A robot arm opens the lid once the sample vials have been inserted into the device. "The automated removal of the specimens in an isolated space creates a safer environment for both samples and laboratory staff. In terms of risks, heat could lead to the build-up of pressure in faeces vials, which might have unpleasant consequences for our staff when they open the vials manually," said Dr. Oliver Nolte summarising the advantages of the revolutionary instrument. After the specimen container has been decapped, a second robot arm inserts a filigree inoculation loop of around 3 mm in diameter into the vial to remove liquid and spread it on an agar plate that has previously been removed from its storage place, labelled with a barcode and accurately positioned by another WASP component. "When the samples are being removed from the vials, the inoculation loop is checked with an infrared camera to see whether it contains too much or too little sample material, and, if required, the loop is inserted deeper into the vial to adjust the sample quantity," said Nolte highlighting the advantages of automation. On average, the WASP can process around 180 agar plates per hour. "No human being can do this," said Nolte. The WASP is far superior to the manual handling of the samples, because the instrument is far more accurate and also enables the clearer fractionation of the bacteria. Manual procedures often require between five and ten per cent of the samples to be re-inoculated before a pathogen can be reliably identified.

Another advantage of using WASP is that, in total contrast to the manual handling of the samples, it precludes the risk of mixing up samples and causing cross-contamination. This is because the patient's barcode and specimen descriptors are permanently inkjet-labelled on the glass slide in a process that was specifically adapted to the requirements of Labor Dr. Brunner. Oliver Nolte is convinced that WASP will help the laboratory to optimise the workflow between sample processing and analysis. In order to efficiently integrate the new instrument into the laboratory's workflow, two staff members were trained in the company's Italian production facility. "We also believe that the expansion of our equipment with WASP will help us recruit new, highly-qualified people.  I am sure that working with innovative technologies such as WASP will encourage and motivate people to come and work for us," said Dr. Oliver Nolte.

Investment of pan-regional importance

Dr. med. Simone Brunner-Zillikens, physician specialising in microbiology, infection epidemiology and laboratory medicine; Dr. Oliver Nolte, head of Molecular Genetics, and Mechthild Kommerell, physician specialising in microbiology, infection epidemiology, laboratory medicine and transfusion medicine, are using state-of-the-art equipment at Labor Dr. Brunner. © Labor Dr. Brunner

The installation of WASP at Labor Dr. Brunner represents a considerable improvement in the quality of service and in the reduction of the time it takes between the analysis being carried out and the results being sent to hospitals and GPs. "We are working on positioning ourselves as the reference laboratory for Germany and for the Lake Constance area bordered by Switzerland, Germany and Austria," said Dr. Oliver Nolte. "The wasp, as the Labor Dr. Brunner staff call the instrument, is the first step on the company's road towards the implementation of a sustainable high-tech strategy within the next 12 months. The company believes that it will be possible to reduce the time it takes between receiving test specimens to sending the results to doctors by up to 24 h or more. The laboratory is aiming to use WASP to process between 90 and 95 per cent of all samples it analyses. The purchase of the new instrument also frees up staff for other functions that increase productivity. The laboratory has considerably expanded its molecular diagnostics service offers and urgently requires the freed up staff for other activities. "We have no plans to reduce staff. Our main intention when we purchased WASP was to integrate it into a concept for long-term sustainable growth and create new professional jobs," said the microbiologist. Oliver Nolte is sure that human beings will remain indispensable and will always have the last word. "We see WASP as an effective complement to our efforts to identify human pathogens, which will lead to effective ways of treating infections," said Nolte adding that the analysis of samples takes a lot of experience as well as an inspection of the visual aspects and the smell of bacterial cultures. And this is precisely what makes people indispensable in the analysis of bacterial pathogens.

Hardware expansion to strengthen medical diagnostics

Labor Dr. Brunner has already planned further hardware investments in order to further improve the quality and speed of diagnoses, which includes linking the new hardware with WASP. "One of our next purchases will help us in the biochemical analysis of the samples processed by WASP," said Dr. Oliver Nolte explaining that the new device will help laboratory staff to assess antibiotics that are best suited for the treatment of specific infections. In addition, working with Oliver Nolte and the entire company team, the physicians Dr. Simone Brunner-Zillikens and Mechthild Kommerell plan to link up the existing laboratory equipment and combine the acquired data to further optimise laboratory workflow. "We also want to set new standards and become a leader in this field," confirmed the microbiologist.

Labor Dr. Brunner is already a reference laboratory in the field of molecular biology: "We have been dealing with the technically and methodologically highly complex identification of pathogen DNA in materials removed during surgery (e.g., aortic valves) or joint aspirates for a year now," said Dr. Oliver Nolte referring to the company's expertise in a method that is used by very few, mainly university-based, laboratories.

Further information:
Priv. Doz. Dr. Oliver Nolte
Molecular Biology | Microbiology
Labor Dr. Brunner
Mainaustr. 48 a/b;
D-78464 Konstanz (Germany);
Tel.: +49-(0)7531-8173-0
Fax: +49-(0)7531-8173-99
E-mail: o.nolte(at)labor-brunner.de

Website address: https://www.gesundheitsindustrie-bw.de/en/article/news/a-high-tech-strategy-to-become-a-reference-laboratory