임상병리검사 질 가산율 산출 및 적용기준의 검토

양병선,박상묵,배형준,김원식,박훈희,임용,김윤식,최세묵,배도희,박지애,Yang, Byoung Seon,Park, Sang Muk,Bae, Hyung Joon,Kim, Won Shik,Park, Hun Hee,Lim, Yong,Kim, Yoon Sik,Choi, Se Mook,Bae, Do Hee,Park, Ji Ae 대한임상검사과학회 2020 대한임상검사과학회지(KJCLS) Vol.52 No.3

본 연구는 질 가산율 산출 및 적용기준을 검토하여 우수검사실 신임인증 및 전문인력영역에 있어 임상병리사를 추가 가능성을 알아보았다. 연구에 참여한 6개 기관은 1,000병상 이상의 대형병원 규모이며, 상근 진단검사의학과 전문의 평균 5명, 임상병리사는 평균 53명으로 전문의 1명당 10.6명으로 나타났다. 임상병리사의 행위분류별 소요시간에 대한 분석결과, 분석 중 행위는 낮아지고 있는 반면 검사실 운영, 정도관리 등의 강화로 포괄적 분석 전 행위의 비율이 높게 나타났다. 분석 중 행위는 생화학 검사수행 등의 비중이 높았고, 분석 후 행위는 결과분석 등이 대부분을 차지하였다. 이와 같이 검체검사 질 향상을 위해 많은 시간이 소요되며, 그에 맞는 인력이 요구된다. 결론적으로 검체검사 질 향상을 위해 임상병리사의 채용 역시 중요하며, 그에 따른 인원 규정이 필요하다 할 수 있다. This study reviewed the quality addition rate, calculation, and application criteria needed to identify the possibility of additional medical technologists in the field for new certification and professional manpower to provide a superior laboratory. The six institutions that participated in the study were the size of large hospitals with more than 1,000 beds, with an average of five full-time laboratory physicians (also called clinical pathologists) and an average of 53 medical technologists, with 10.6 per laboratory physician. An analysis of the time required for each activity category of medical technologists revealed decreasing behavior during the analysis. In contrast, the ratio of the comprehensive pre-analysis activities was high due to the strengthening of laboratory operations and quality control. During the analysis, the proportion of biochemistry tests was high, and post-analysis of most of the results was performed. Hence, improving the quality of sample testing requires significant time, and appropriate personnel are required. In conclusion, the recruitment of medical technologists is also a key component to improving the sample quality, and corresponding personnel regulations are necessary.

PCR을 이용한 Listeria monocytogenes종의 특이적 검출

양병선(Byoung-Seon Yang),박진숙(Jin-Sook Park) 大韓微生物學會 1997 大韓微生物學會誌 Vol.32 No.2

Listeria monocytogenes의 분리 및 특성

양병선 ( Byoung Seon Yang ),박진숙 ( Jin Sook Park ) 대한임상검사과학회 1998 대한임상검사과학회지(KJCLS) Vol.30 No.3

Three listeria sp. were isolated from cerebrospinal fluid samples and their biochemical charaters were compared with the type strains; L m:na:ytogenes ATCCl5``313T, L monocytogenes ATCC19119T, L inncua ATCC33IDT, L grayi ATCC191WT L seeligeri ATCC35967T and L welshimeri ATCC35897T. The cellular fatty acid correosition and quinone profile of the isolates were investigated Also, the DNA G+C<mol%) contents were analyzed All the isolates were polar flagella regular rod-shaped bacteria The result of VI1EK GPI indicated that the isolates were listeria sp: In the result of antibiotic susceptibility test, all strains showed resistance to CIP, SM, and l\1OX The G+C content of DNA was ranged from 38.4% to 39.5% and MK-7 was found to be the major quinone in all the isolates. The major amino acid in the peptidoglycan layer of the isolated strains was meso- A2pm On the basis of the G+C contents, quinone profiles, amino acid analysis and biochemical characteristics, were identified as L monocytogenes

경남지역 종합병원에서 분리된 그람음성막대균으로부터 bla_KPC 및 bla_NDM 유전자 검출

양병선 ( Byoung Seon Yang ),박지애 ( Ji Ae Park ) 대한임상검사과학회 2021 대한임상검사과학회지(KJCLS) Vol.53 No.1

본 연구는 국내에서 가장 빈번히 검출되는 CPE의 유전자형 중 bla_KPC 및 bla_NDM 유전자의 진단으로 기존의 표현형 검사 및 일반 PCR 검사보다 시간 단축 및 사후 분석의 단점이 보완된 real-time PCR의 융해 곡선을 이용한 분석법에 대해 알아보았다. 표현형적 검사결과 MHT는 35균주 중 25균주에서 양성을 확인하고, CIT는 meropenem+PBA 및 meropenem+EDTA에서 각각 14균주의 양성을 확인하였다. PCR 검사결과 KPC 25균주에서 증폭 산물을 확인하였고, K. pneumoniae 10균주, E. coli 5균주, A. baumannii 5균주, P. aeruginosa 4균주, P. putida 1균주로 나타났다. NDM은 8균주에서 증폭 산물을 확인하였고, K. pneumoniae 2균주, E. coli 3균주, P. aeruginosa 1균주, E. cloacae 1균주, P. rettgeri 1균주로 나타났다. 실시간 중합효소연쇄반응(Real-time PCR)을 이용한 융해 곡선 분석결과 KPC 25균주, NDM은 8균주에서 증폭을 확인하였고, PCR 결과와 100% 일치함을 확인하였다. 결론적으로 real-time PCR을 이용한 신속하고 특이성이 높은 CRE의 조기진단은 공중보건 및 감염 중에 항균 관리접근법을 통한 병원내 감염확산 방지 및 통제가 가능할 것으로 사료된다. This study investigated the use of real-time PCR melting curves for the diagnosis of bla_KPC and bla_NDM genes among the most frequently detected carbapenemase-producing Enterobacteriaceae in Korea. As a means of addressing the shortcomings of phenotype tests and conventional PCR. The modified Hodge test confirmed positivity in 25 of 35 strains, and carbapenemase inhibition testing confirmed positivity in 14 strains by meropenem+PBA or meropenem+EDTA. PCR analysis showed amplification products in 25 strains of Klebsiella pneumoniae carbapenemases (KPC), 10 of K. pneumoniae, 5 of E. coli, 5 of A. baumannii, 4 of P. aeruginosa, and 1 of P. putida. New Delhi metallo β-lactamase (NDM) identified amplification products in 8 strains, that is, 2 K. pneumoniae, 3 E. coli, 1 P. aeruginosa, 1 E. cloacae, and 1 P. retgeri strains. Real-time PCR melting curve analysis confirmed amplification in 25 strains of KPC and 8 strains of NDM, and these results were 100% consistent with PCR results. In conclusion, our findings suggest early diagnosis of carbapenem resistant Enterobacteriaceae by real-time PCR offers a potential means of antibacterial management that can prevent and control nosocomial infection spread. Copyright Ⓒ 2021 The Korean Society for Clinical Laboratory Science. All rights reserved.

COVID-19 시대 임상병리사의 역할 및 영역

양병선 ( Byoung Seon Yang ),최세묵 ( Se Mook Choi ),배형준 ( Hyung Joon Bae ),김윤식 ( Yoon Sik Kim ),임용 ( Yong Lim ),강희정 ( Hee Jung Kang ),배도희 ( Do Hee Bae ),최병호 ( Byoung Ho Choi ),이재숙 ( Jae Suk Lee ),박지애 ( Ji A 대한임상검사과학회 2022 대한임상검사과학회지(KJCLS) Vol.54 No.1

본 연구는 COVID-19 시대에서 빠르고 정확한 진단검사를 위해 임상병리사의 역할을 파악하고, 효율적으로 대응할 수 있는 체계적인 시스템 마련을 위한 기초자료를 제공하고자 하였다. 연구 방법은 15개 의료기관을 대상으로 설문조사 및 초점 집단 면담을 통한 분석을 하였다. 검체 채취 기관(11개)을 분석한 결과, 선별검사소 운영 기관은 7개, 임상병리사 10.4명, 채취 소요시간 2.1분, 검사소요시간 5.4시간, 검사건수 9,670건, 검사인력 6.2명으로 조사되었다. 초점 집단 면담 분석결과, COVID-19검사와 관련하여 검체 채취자 및 검사자를 보호하기 위한 근무시간, 근무장소, 근무환경이 포함된 표준화된 지침은 없었다. 그리고 감염사고 발생 시 법적인 보호 조치가 미흡하며, COVID-19와 관련한 인력에 관한 규정이 마련되어 있지 않았다. 또한, 신뢰도 있는 COVID-19 검사를 위해 검체 채취자 및 분자진단 검사자의 전문적인 교육이 요구되었다. 결론적으로 COVID-19와 같은 긴급상황 감염병 발생 시 대처할 수 있는 특수검사 단기수련기관 등을 통한 전문교육의 시행과 안정적인 인력공급 할 수 있는 법적인 체계마련이 필요할 것으로 사료된다. This study attempted to provide the basic data for developing a system to identify the role of medical technologists and ensure an efficient response for quick and accurate diagnostic tests in the COVID-19 era. The research method involved using focus group interviews for a survey and analysis of 15 medical institutions. Eleven sample collection institutions, 10.4 medical technologists, 2.1 minutes of collection time, 5.4 hours of test time, 9,670 tests, 6.2 member test workforce size, and 7 screening center operating institutions were surveyed. The results of the focus group interview analysis revealed that there were no standardized guidelines covering working hours, area, and environment to protect sample collectors and testers in relation to the COVID-19 tests. Also, legal protection measures were insufficient in the event of accidental infections and there were no personnel regulations related to COVID-19. In addition, the professional training of sample collectors and molecular diagnostic testers was required for reliable COVID-19 testing. In conclusion, it is necessary to provide professional education through special test short-term training institutions to cope with emergency infectious diseases such as COVID-19. Legal systems should be put in place to protect the workforce and ensure stability.

임상병리사 교육과정 및 임상실습에 대한 연구

양병선 ( Byoung-seon Yang ),최세묵 ( Se-mook Choi ),심문정 ( Moon-jung Shim ),김충환 ( Chung-hwan Kim ),배형준 ( Hyung-joon Bae ),육근돌 ( Keun-dol Yook ),김윤식 ( Yoon-sik Kim ),임용 ( Yong Lim ),강지혁 ( Ji-hyuk Kang ),김홍성 ( 대한임상검사과학회 2018 대한임상검사과학회지(KJCLS) Vol.50 No.3

본 연구는 임상병리사의 3년제 교육과정, 4년제 교육과정, 임상실습현황, 해외 교육과정 및 실습을 조사 분석하여 급변하는 우리나라의 임상병리분야에 대처할 수 있는 정책의 기초 자료를 제공하고자 하였다. 교육커리큘럼의 분석은 3년제 25개 대학 및 4년제 25개 대학의 2017학년도 기준 교육과정을 요청하여 전수 조사하였다. 임상실습은 설문조사를 실시하여 대학 76건, 산업체 1142건을 분석하였다. 교육과정의 분석결과 3년제 대학의 교육과정은 임상병리사 국가시험위주의 교육과정의 편성을 파악할 수 있었으며, 4년제 교육과정은 미래변화를 반영한 과목이 다양하게 개설되어 있었지만 일부 대학에 불과했다. 또한, 자율적인 수강신청으로 전공과목 중 학생들이 어렵게 여기는 과목에 대해서는 수강하지 않고서도 국가시험을 볼 수 있는 문제점이 발견되었다. 임상실습의 경우 다양한 실습기관과 실습시기, 실습학점으로 현실적으로 표준화가 어려운 것이 실정이었다. 실무중심의 교육을 위하여 교내실습교육도 강화되어야 하겠지만, 현장에서의 실무교육 또한 중요하므로 임상실습의 기간과 교육시간에 따른 학점의 편성이 표준화되고, 적절하게 산출되어야 할 필요가 있을 것이다. 임상병리사 직무분석 및 임상현장을 고려하여 현장실무형 교육과정 개정이 필요하며, 이는 임상병리사평가원을 통해 교육과정과 임상실습모델의 표준화 작업이 필요할 것으로 생각된다. This study analyzed the curriculum and clinical practicum of the department of clinical laboratory science in Korea. The 2017 educational curricula of all 3-year and 4-year universities were analyzed. Clinical practice was conducted by a questionnaire. As a result of curriculum analysis, the 3-year curriculum was able to grasp the curriculum that focused on the national examinations of medical technologists, and the 4-year curriculum was open to a variety of subjects reflecting the changes in the future, but only at a few universities. In addition, the autonomous enrollment application made it possible to take a national examination without enrolling in courses that students find difficult in major courses. In the case of clinical practice, it was difficult to standardize in various practical institutes, practice periods, and practice credits. Therefore, it will be necessary to standardize the composition of the credits according to the duration of clinical practice and the duration of education. Moreover, is necessary to revise the curriculum in consideration of medical technologist job analysis and clinical field, and it will be necessary to standardize the curriculum and clinical practice model through the Medical Technologist Evaluation Center.

지방산 분석을 이용한 Vibrio속 세균의 동정

양병선 ( Byoung Seon Yang ) 대한임상검사과학회 2000 대한임상검사과학회지(KJCLS) Vol.32 No.3

Isolated from Nam Hae coastal waters, three gram-negative Vibrio were compared with T the type species Vibrio parahaemolyticus ATCC 17802T, Vibrio alginolyticus KCIC 2472 T (ATCCI7749T), Vibrio vulnificus ATCC 27562T with regard to physio-biochemical characters. πle celluar fatty-acid compositions of the three Vibrios spp. were also compared by examing their taxonomic markers and the isolates were gram-negative curved rods. and showed positive characters on the nitrate reduction, oxidese and glucose fermentation tests. Also the isolates grew on TCBS agar plates, in alkaline peptone water at 35 oC, and on nutriant agar plates at 40 0C. Two of the three isolates were identified as V. parahaemolyticus and one was V. algonolyticus by using the API ID 32 GN kit and physio-biochemical characters. The isolates contained of 16:1w7c(21-38%), 16:0(16-32%), 18:1w7c(8-26), major cellular fatty-acid compositions the same as the Vibrio type strains. As a resu1t of thls study, we can clearly see that physio-biochemical characters and cellular fatty-acid composition provide useful tools for identification of bacteria, especially in the study of genus Vibrio.

Multiplex PCR을 이용한 Extended-Spectrum β-Lactamase 생성 Escherichia coli와 Klebsiella pneumoniae의 Quinolone 내성 qnr유전자 검출

양병선 ( Byoung Seon Yang ) 대한임상검사과학회 2007 대한임상검사과학회지(KJCLS) Vol.39 No.3

To develop a rapid and reliable single-tube-based PCR technique for detection simultaneously the quinolone resistance qnrA, qnrB and qnrS genes. After multiple alignment, primers were designed to detect known qnr variants. I was used for A total of 43 extented-spectrum β-lactamases (ESBLs) producing Escherichia coli and Klebsiella pneumoniae isolated from university hospital were tested for screening, as with qnr genes. In optimized conditions, all positive controls confirmed the specificity of the PCR primers. Out of 43 isolates, qnrA genes were detected 19 (44.2%), qnrB genes 5 (11.7%), qnrS genes 15 (34.9%) and 8 (18.6%) isolates were not detected. I report here a fast and reliable technique for rapid screening of qnr positive strains to be used for epidemiological surveys.

Multiplex Polymerase Chain Reaction을 이용한 Extended-Spectrum β-Lactamase 생성 Klebsiella pneumoniae 균주의 검출

양병선 ( Byoung Seon Yang ) 대한임상검사과학회 2006 대한임상검사과학회지(KJCLS) Vol.38 No.3

The production of extended-spectrum β-lactamases (ESBLS) is the main mechanism of bacterial resistance to third-generation cephalosporins and monobactams, whose prevalence varies depending on the different geographical areas. In the last years it has increased notably to the point of being considered a health problem of great importance. The characterization of the ESBLs producing Klebsiella penumoniae strains present in clinical isolates is time-consuming. I describe here the development of a new system, which consists of a multiplex PCR. I found 51 K. pneumoniae strains to be presumptive strains ESBLs producers by clinical and laboratory standards institute (CLSI) guidelines. The double disc synergy test showed 47 positive K. pneumoniae, which were K. pneumoniae isolates. All ESBLs producing K. pneumoniae strains were resistant to antibiotic amikacin, gentamicin and ciprofloxacin. By multiplex PCR analysis, blaTEM gene in 17 strains 44 blaSHV genes and blaCTX genes in 33 strains were identified. In this study, the multiplex polymerase chain reaction (PCR) assay was a good method to detect and differentiate ESBLs producing K. penumoniae strains in clinical isolates.

충청지역병원에서 분리된 Extended-Spectrum β-Lactamase 생성 대장균과 폐렴간균의 bla 유전형 및 분자역학적 분석

육근돌,양병선,박진숙,Yook, Keun Dol,Yang, Byoung Seon,Park, Jin Sook 한국미생물학회 2014 미생물학회지 Vol.50 No.2

충청지역병원에서 ESBL생성 장내세균 122균주를 분리하여 Clinical and Laboratory Standards Institute (CLSI) 방법에 따라 cefotaxime과 cefotaxime/clavulanate를 이용한 combination disk test (CDT)에 의하여 항균제 감수성을 조사하고, 특이 유전자를 대상으로 multiplex PCR을 실시하여 유전형을 검출하였으며 enterobacterial repetitive intergenic consensus (ERIC)-PCR에 의해 분자 역학조사를 실시하였다. ESBL 생성 Escherichia coli 76균주와 Klebsiella pneumoniae 46균주를 CDT로 확인한 결과, ESBL 생성 E. coli의 경우 96.1%가 양성을 나타내었으며 K. pneumoniae의 경우 93.4%가 양성을 나타냈다. Multiplex PCR 결과, E. coli의 경우 CTX-M-2형이 60.5% 양성으로 나타났으며 K. pneumoniae의 경우 VEB-1형이 56.5%가 양성으로 나타났다. ERIC-PCR을 실시한 결과 E coli는 분리지역에 따라 5개의 cluster을 형성하였고 K. pneumoniae는 4개의 cluster을 형성하였다. ESBL생성 장내세균의 유전형은 임상에서 분리한 균주의 감별과 검출에 유용하였으며 ERIC-PCR의 결과는 분리지역에 따라 cluster을 형성하여 지역 간 감염 감시체계 확립에 도움이 될 것으로 사료된다. A total of 122 ESBL-producing intestinal bacteria were collected from regional hospitals in the Chungcheong area. Combination disk test (CDT) was performed for antimaicrobial susceptability using cefotaxime and cefotaxime/clavulanate according to Clinical Laboratory Standard Institute (CLSI). Mutiplex PCR using specific primers was performed for a detection of ESBL-genotypes and enterobacterial repetitive intergenic consensus (ERIC)-PCR was carried out for the tracking of molecular epidemiology. In the confirmation test using CDT, 73 out of 76 (96.1%) ESBL-producing Escherichia coli and 43 out of 46 (93.4%) ESBL-producing Klebsiella pnemoniae were positive. In the multiplex PCR, 60.5% of E. coil were positive for CTX-M-2 type gene and 56.5% of K. pneumoniae were positive for VEB -1 type gene. In the ERIC-PCR, E. coil isolates formed 5 clusters and K. pneumoniae isolates were grouped into 4 clusters depending on region. Genotypes of clinical isolates are useful for detection and differentiation of ESBL producing intestinal bacteria. The ERIC-PCR method is thought to be helpful for establishing a regional surveillance system for infection due to its formation of different clusters depending on region.