Laboratory Best Practices

Chapter Summary

Technological advances and increased interconnectivity among laboratory partners are helping generate data to detect and respond to outbreaks more quickly and more effectively. 

In Chapter 6, Laboratory Best Practices, we expand on the basic concepts presented in previous chapters to highlight the roles and contributions of laboratory partners. This chapter further develops concepts, explanations, and processes, while adding examples and emphasizing best practices.

This chapter begins with an overview of the various types of laboratories and their roles. Public health laboratories are well positioned for the early recognition of sentinel cases (those involving unusual pathogens or resistance patterns) or clusters of related illness. Many aspects of healthcare outbreak response benefit from active collaboration and coordination between public health laboratories and other types of laboratories, public health agencies, and healthcare partners. 

The chapter continues with descriptions of laboratory functions that support outbreak response and the importance of reliable and clearly communicated data. Specific to laboratorians, we also address safety practices to be followed when working with AR pathogens and the validation of AR and HAI test methods.

As advances occur in outbreak protocols, this guidance document will be updated. Previous changes can be tracked below:

• 2nd Edition – Published June 2024
• 1st Edition – Published June 2023
• URLs in this document are valid as of May 31, 2024. 

1. Centers for Disease Control and Prevention (U.S.). About the AR Lab Network. Centers for
   Disease Control and Prevention. 2023 Feb. Available from:
   https://www.cdc.gov/drugresistance/ar-lab-networks/domestic.html. 
2. Centers for Disease Control and Prevention (U.S.). National Healthcare Safety Network. Centers
   for Disease Control and Prevention. 2023 March. Available from:
   https://www.cdc.gov/nhsn/index.html.
3. Tindall BJ, Sutton G, Garrity GM. Enterobacter aerogenes Hormaeche and Edwards 1960
   (Approved Lists 1980) and Klebsiella mobilis Bascomb et al. 1971 (Approved Lists 1980) share
   the same nomenclatural type (ATCC 13048) on the Approved Lists and are homotypic synonyms,
   with consequences for the name Klebsiella mobilis Bascomb et al. 1971 (Approved Lists 1980).
   Int J Syst Evol Microbiol. 2017;67(2):502–4.
4. American Society for Microbiology. Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. 2009
   December. Available from: https://asm.org/getattachment/2594ce26-bd44-47f6-8287-
   0657aa9185ad/Kirby-Bauer-Disk-Diffusion-Susceptibility-Test-Protocol-pdf.pdf.
5. Clinical & Laboratory Standards Institute. AST News Update June 2022: Updating Breakpoints–
   New Developments from CAP. Available from: https://clsi.org/about/blog/ast-news-updatejune-2022-updating-breakpoints-new-developments-from-cap/.
6. Prussing C, Canulla T, Singh N, McAuley P, Gosciminski M, King E, et al. Characterization of the
   First Carbapenem-Resistant Pseudomonas aeruginosa Clinical Isolate Harboring blaSIM-1 from
   the United States. Antimicrob Agents Chemother. 2021 Sep 17;65(10):e0106621. 
7. Reller LB, Weinstein M, Jorgensen JH, Ferraro MJ. Antimicrobial Susceptibility Testing: A Review of General Principles and Contemporary Practices. Clin Infect Dis. 2009 Dec 1;49(11):1749–55. 
8. Centers for Disease Control and Prevention (U.S.). Antibiotic resistance threats in the United States, 2019. 2019 November. Available from: https://stacks.cdc.gov/view/cdc/82532. 
9. Clinical & Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 32nd ed. CLSI supplement M100. 2022. 
10. Association of Public Health Laboratories. Best Practice Guidance: Specimen and SpecimenProduct Storage and Retention. 2016 February. Accessed at: https://www.aphl.org/aboutAPHL/publications/Documents/ID_Specimen_Storage_0216.pdf. 
11. Sehulster L, Rose L, Noble-Wang J. Chapter 72: Microbiologic Sampling of the Environment in Healthcare Facilities. Hospital Epidemiology and Infection Control. Edited by C. Mayhall, 4th Edition, Wolters Kluwer Health, 2012, pp. 1059-75.