한 대학병원에서의 혈액배양검사에 대한 질지표 관리 활동

방해인,임현미,장의영,박은수,이은정,김태형,박노진,신정원,최태윤 대한임상미생물학회 2015 Annals of clinical microbiology Vol.18 No.3

Background: Blood culture is a critical test for diagnosing bloodstream infections. Frequent microbial contamination during sampling and testing leads to abuse of antimicrobial agents. We evaluated methods for reducing contamination and obtaining more reliable results. Methods: We analyzed blood cultures obtained between 2009 and 2015. We established 6 quality indicators: true positive rate, contamination rate, blood sampling volume, number of sets of blood cultures, delayed transportation rate, and percentage of samples collected from the femoral region, with reference to the CLSI guideline M47-A, 2007. Education was provided for interns and nurses responsible for blood sampling and transportation of specimens, and data were analyzed monthly. Results: At baseline, the true positive rate was 12.8%, and the contamination rate was 4.0%. During the intervention period, these were decreased to 10.9% and 1.9%, respectively. The percentage of samples smaller than 5 mL decreased from 29.7% to 2.7- 11.3%. The rate of one set of blood cultures being ordered was always <5%. The delayed transportation rate decreased from 35.6% to 5.5-7.7%. Finally, the percentage of samples collected from the femoral region decreased from 41.5% to 22.0-31.0%, because of which we did not attain our goal, 20.8%. Conclusion: The results showed improvements in contamination rate, specimen volume, specimen transportation time, and the percentage of samples collected from the femoral region. The quality management of blood cultures in 2011 was comparatively poor, which led to increased contamination rate, large number of samples containing <5 mL of blood, and increased percentage of samples collected from the femoral region. Thus, quality improvement methods can produce more reliable results of blood cultures. (Ann Clin Microbiol 2015;18:-93)

Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs

방해인,장미애,이용화 대한진단검사의학회 2017 Annals of Laboratory Medicine Vol.37 No.6

The demand for rapid and broad clinical toxicology screens is on the rise. Recently, a new rapid toxicology screening test, the Triage TOX Drug Screen (Alere Inc., USA), which can simultaneously detect 11 drugs of abuse and therapeutic drugs with an instrument-read cartridge, was developed. In the present study, we evaluated the efficacy of this new on-site immunoassay using 105 urine specimens; the results were compared with those obtained by using ultra-performance liquid chromatography with tandem mass spectrometry (UPLC-TMS). Precision was evaluated according to the CLSI EP12-A2 for analyte concentrations near the cutoff, including C50 and±30% of C50, for each drug using standard materials. The C50 specimens yielded 35-65% positive results and the±30% concentration range of all evaluated drugs encompassed the C5-C95 interval. The overall percent agreement of the Triage TOX Drug Screen was 92.4-100% compared with UPLC-TMS; however, the Triage TOX Drug Screen results showed some discordant cases including acetaminophen, amphetamine, benzodiazepine, opiates, and tricyclic antidepressants. The overall performance of the Triage TOX Drug Screen assay was comparable to that of UPLC-TMS for screening of drug intoxication in hospitals. This assay could constitute a useful screening method for drugs of abuse and therapeutic drugs in urine.

Utility of Plasma Cell Screening Tube Kit to Differentiate Neoplastic Plasma Cells from Reactive Plasma Cells

방해인,최태윤 대한진단검사의학회 2020 Laboratory Medicine Online Vol.10 No.4

Flow cytometry is a powerful tool for analysis of hematologic malignancies, that provides rapid, quantitative, and multiparametric analysis of heterogeneous cell populations, but requires standardization because of complexities in panel design and interpretation. Here, we compared the Plasma Cell Screening Tube (PCST) kit (Cytognos, Spain) in conjunction with EuroFlow antibody panels for standardization of flow cytometry to a conventional method for diagnosis of plasma cell dyscrasias. Thirty-nine bone marrow samples and one peripheral blood sample from 40 patients were tested. Thirty-three patients were diagnosed with multiple myeloma (MM), and seven were in a reactive state. In PCST implementation, eight antibodies were used for staining, including anti-CD45-Pacific Blue, anti-CD19-PECy7, anti-CD138-OC515, anti-CD38-FITC, anti-CD56-PE, anti-β2-microglobulin-PerCPCy5.5, anti-kappa-APC, and anti-lambda-APC-C750. Plasma cells were initially identified using CD38 and CD138; thereafter, CD38+, CD138+ gated cells were analyzed for CD56, CD19, CD45, cytoplasmic kappa, cytoplasmic lambda, and β2-microglobulin. Conventional flow cytometry was performed with six monoclonal antibodies, including anti-CD56-FITC, anti-kappa-FITC, anti-CD19-PE, anti-lambda-PE, anti-CD138-PECy5, and anti-CD45-PECy7 (Beckman Coulter, USA). Monoclonal plasma cells with cytoplasmic light-chain restriction were detected in 30 of 33 (90.9%) MM cases by conventional methods, and 32 of 33 (97.0%) MM cases with the PCST method. No differences were noted between PCST and the conventional method in immunophenotyping and plasma cell percentages (P=0.323). Among plasma cells, levels (%) were significantly higher by the PCST approach than those in the conventional method (97.6% vs 95.8%, P=0.010). PCST exhibited better performance for plasma cell dyscrasias diagnosis, and could improve laboratory efficiency and quality. Flow cytometry is a powerful tool for analysis of hematologic malignancies, that provides rapid, quantitative, and multiparametric analysis of heterogeneous cell populations, but requires standardization because of complexities in panel design and interpretation. Here, we compared the Plasma Cell Screening Tube (PCST) kit (Cytognos, Spain) in conjunction with EuroFlow antibody panels for standardization of flow cytometry to a conventional method for diagnosis of plasma cell dyscrasias. Thirty-nine bone marrow samples and one peripheral blood sample from 40 patients were tested. Thirty-three patients were diagnosed with multiple myeloma (MM), and seven were in a reactive state. In PCST implementation, eight antibodies were used for staining, including anti-CD45-Pacific Blue, anti-CD19-PECy7, anti-CD138-OC515, anti-CD38-FITC, anti-CD56-PE, anti-β2-microglobulin-PerCPCy5.5, anti-kappa-APC, and anti-lambda-APC-C750. Plasma cells were initially identified using CD38 and CD138; thereafter, CD38+, CD138+ gated cells were analyzed for CD56, CD19, CD45, cytoplasmic kappa, cytoplasmic lambda, and β2-microglobulin. Conventional flow cytometry was performed with six monoclonal antibodies, including anti-CD56-FITC, anti-kappa-FITC, anti-CD19-PE, anti-lambda-PE, anti-CD138-PECy5, and anti-CD45-PECy7 (Beckman Coulter, USA). Monoclonal plasma cells with cytoplasmic light-chain restriction were detected in 30 of 33 (90.9%) MM cases by conventional methods, and 32 of 33 (97.0%) MM cases with the PCST method. No differences were noted between PCST and the conventional method in immunophenotyping and plasma cell percentages (P=0.323). Among plasma cells, levels (%) were significantly higher by the PCST approach than those in the conventional method (97.6% vs 95.8%, P=0.010). PCST exhibited better performance for plasma cell dyscrasias diagnosis, and could improve laboratory efficiency and quality.

체액세포분석 수기검사: 국내 실태조사 및 임상검사실 지침(2021)

방해인,김현영,신새암,이자영,김인숙,조영욱,김지명,신명근,이정녀,황상미,공선영 대한진단검사의학회 2022 Laboratory Medicine Online Vol.12 No.4

To investigate the current status of body fluid analysis for cellular composition in Korea, an online survey was performed. Responses were received from 76 laboratories of general hospitals in Korea. The questionnaire included questions on pre-analytical, analytical, and post-analytical processes of body fluid cellular analysis (cell count using hemocytometers and cytospin) performed in each laboratory. The survey showed that the body fluid cellular analysis in Korea is not harmonized. Based on this, the “Committee for Standardization in Korean Society for Laboratory Hematology” suggests clinical laboratory guidelines for the pre-analytical (sample collection and handling), analytical (cell count, slide preparation), post-analytical (reporting, turnaround time), and quality control steps. We hope that the results of this survey and guideline will serve as a basis for setting future standards of body fluid cellular analysis in Korea, and ultimately have a positive impact on patient care 국내 체액세포분석 수기검사의 실태조사를 위한 온라인 설문조사에서 종합병원 이상 규모의 76개 기관의 회신을 받았다. 설문 문항은 체액세포분석에 대한 검사 전 단계, 검사 단계, 검사 후 단계 (혈구계수기를 이용한 세포수산정, 세포침전)에 대한 질문을 포함하고 있다. 설문조사 결과 국내 기관마다 체액세포검사의 검사법이 일치하지 않음을 확인하였다. 이를 바탕으로 진단혈액학회 표 준화위원회에서는 검사 전 단계(검체 채취 및 이송), 검사 단계(세 포계수법, 슬라이드 제작법), 검사 후 단계(보고, 검사소요시간), 정도관리에 대한 임상검사실 지침을 제안하였다. 이 설문조사 결 과와 지침이 향후 표준안을 설정하는 바탕이 되어 궁극적으로 환자 진료에 긍정적 영향을 미치게 되길 기대한다.

병원성 미생물에 대한 약산성 차아염소산수 네오록스의 살균소독력 평가

방해인,최태윤 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.2

Objective: Disinfection/sterilization of hospital devices prevents the occurrence of several infections; therefore, disinfectants are essential for public health. The purpose of this study was to evaluate the biocidal effect of a hypochlorous acid solution. Methods: Hypochlorous acid solution, Neolox (Neo Chemical, Paju, Korea) obtained from Purester (Morinaga Engineering, Tokyo, Japan) was used. Antimicrobial activity of the solution against bacteria, yeasts, and mycobacteria at different exposure times (0.5, 1, 2, 5, 10, 15, and 30 minutes) was evaluated. Results: All strains of bacteria and yeasts showed a 5-log10 reduction within 30 seconds of exposure to the solution, and mycobacteria showed the same reduction within 2 minutes. Conclusion: Hypochlorous acid solution has been widely used as a disinfectant in recent years. Neolox can be used as an effective intermediate- to high-level disinfectant for hospital infection control.

De novo Leukemic Variant of Mast Cell Leukemia With KIT D816V

방해인,박노진,원종호,박은수,최인호,김경하,신정원,최태윤,한경자 대한진단검사의학회 2015 Annals of Laboratory Medicine Vol.35 No.2

A Case of Central Nervous System Myelomatosis with Complex Chromosome Aberrations

방해인,유진영,김경하,박노진,신정원,최태윤,이상철,박희숙,원종호 대한진단검사의학회 2010 Annals of Laboratory Medicine Vol.30 No.4

Involvement of the central nervous system is very uncommon in multiple myeloma, observed in approximately 1% of the multiple myeloma patients. We report a case of central nervous system myelomatosis with complex chromosome aberrations in a 62-yr-old female patient, who had previously been diagnosed as multiple myeloma. Fluorescent in situ hybridization revealed 13q deletion, p53 gene deletion and IGH/FGFR3 rearrangement and chromosomal study showed complex chromosome aberrations. After four cycles of chemotherapy, the patient was admitted to the hematology department with severe headache. Plasma cells were found in the cerebrospinal fluid (CSF), and CSF immunoelectrophoresis revealed abnormal precipitin arcs against anti-IgG and anti-lambda antisera. She was given systemic chemotherapy and eight courses of intrathecal chemotherapy,which cleared plasma cells in the CSF. Two months later, she was given autologous stem cell transplantation. Three months after stem cell transplantation, central nervous system myelomatosis progressed to plasma cell leukemia and two months later,the patient expired. (Korean J Lab Med 2010;30:334-8)

급성백혈병 진단검사 결과보고서의 표준 및 지침: 골수검사, 유세포검사, 세포/분자유전검사

방해인,김인숙,박상혁,이승태,황상미,허정원,허희진,송재우,박노진,이영진,김용구,공선영,대한진단혈액학회 표준화위원회 대한진단검사의학회 2021 Laboratory Medicine Online Vol.11 No.1

Reports on hematological neoplasms are produced in various formats in different laboratories. For best patient care, standardization of reports adopting a format that provides concise and clear information is necessary. To this end, the Diagnostic Hematology Standardization Committee, or ganized by the Korean Society for Laboratory Hematology, has proposed a standardized format for reporting diagnostic test results for acute leu kemia patients. It is hoped that this standardization will broadly improve communication with clinicians and improve patient care.

의료기기의 멸균/소독 전, 세정을 목적으로 개발된 메디자임-플러스의 소독력 평가

방해인,최태윤 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.2

Objective: Disinfectants are essential for public health and environmental hygiene. The aim of this study was to investigate the in vitro antimicrobial activity of Medizyme-Plus (Soosan Co. Ltd., Seongnam, Korea) developed for cleansing prior to disinfection/sterilization, against bacteria and yeasts. Methods: Clinical isolates were exposed to Medizyme-Plus (a product containing quaternary ammonium and a protease, amylase, and lipase) for various periods (0.5, 1, 2, 5, 10, 15, and 30 minutes). After exposure, the mixtures of isolates and Medizyme-Plus were inoculated into tryptic soy broths. To enumerate the surviving bacteria or yeasts, treated isolates were inoculated onto solid agar media (blood agar, MacConkey agar, and Sabouraud dextrose agar) and cultured at 35°C . Results: All strains of bacteria and yeasts showed a 5-log10 reduction within 0.5 minutes of exposure to Medizyme-Plus. Conclusion: Medizyme-Plus can be used as a low-level disinfectant, in addition to cleanser, for hospital infection control. It will be necessary to perform disinfection/sterilization after cleansing with Medizyme-Plus.

수 종 잠상산물의 Nicotinamide 및 GABA 함량

방해선,손해룡,이완주 한국잠사학회 1997 한국잠사곤충학회지 Vol.39 No.2

Nicotinamide and GABA(r-aminobutyric acid) contents in sericultural products, Mori Folium, Mori Fructus, Mori Cortex Radicis, silkworm podwer, Bombycis Excrementum and Bombycis Corpus were analyzed by HPLC. Nicotinamide content was higher in silkworm derived-products han in mulberry derived-products. Nicotinamide contained Bombycis Excrementum was the highest by 0.31 mg/g DW among the sericultural products. GABA content showed the highest by 1.68 mg/g DW in Mori Cortex Radicis among the sericultural products.