Laboratory science education: Back to the future

Epidemiol. Microbiol. Immunol. (Praha) 6:13-23. 17. Souckova, A. and A. Soucek. 1972. Inhibition of the hemolytic action of 2 and 3 lysins of Staphylococcus pyogenes by Corynebacterium haemolyticum, C. ovis and C. ulcerans. Toxicon 10:501-509. 18. Fell, H. W. K. et al. 1977. Corynebacterium haemolyticum infections in Cambridgeshire. J. Hyg. Camb. 79:269-274. 19. Green, S. L. and K. S. LaPeter. 1981. Pseudodiphtheritic membranous pharyngitis caused by Corynebacterium haemolyticum. J. Am. Med. Assoc. 245:2330-2331. 20. Lipsky, B. A. et al. 1982. Infections caused by non-diphtheria corynebacteria. Rev. Infect. Dis. 4:1220-1235. 21. Miller, R. A. et al. 1986, Corynebacterium haemolyticum as a cause of pharyngitis and scarlatiniform rash in young adults. Ann. Intern. Med. 105:778 - 779. 22. Ryan, W. J. 1972. Throat infection and rash associated with an unusual corynebacterium. Lancet ii: 1345-1347. 23. Selander, B. and A. Ljungh. 1986. Corynebacterium haemolyticum as a

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cause of pharyngitis. (letter). J. Infect. Dis. 154:1041. Wickremesinghe, R. S. B. 1981. Corynebacterium haemolyticum infections in Sri Lanka. J. Hyg. Camb. 87:271276. Kovatch, A. L. et al. 1983. Corynebacterium haemolyticum peritonsillar abscess mimicking diphtheria. J. Am. Med. Assoc. 249:1757-1758. Ceilley, R. I. 1977. Foot ulceration and vertebral osteomyelitis with Corynebacterium haemolyticum. Arch. Dermatol. 113:646-647. Kotrajaras, R. and H. Tagami. 1987. Corynebacterium pyogenes: Its pathogenic mechanism in epidemic leg ulcers in Thailand. Int. J. Dermatol. 26:4550. Lammler C. and H. Blobel. 1988. Comparative studies on Actinomyces pyogenes and Arcanobacterium baemolyticum. Med. Microbiol. Immunol. (Berl.) 177:109-114. Washington, J. A., II, W. J. Martin, and R. E. Spiekerman. 1971. Brain abscess with Corynebacterium haemolyticum. Report of a case. Am. J. Clin. Pathol. 56:212-215. Miller, R. A. et al. 1987. Corynebacterium haemolyticum as a cause of

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pharyngitis (letter). Ann. Intern. Med. 106:778-779. Ben Jaacob, D. et al. 1984. Septicemia due to Corynebacterium haemolyticum. Isr. J. Med. Sci. 20:431-433. Chandrasekar, P. H., and J. A. Molinari. 1987. Corynebacterium haemolyticum bacteremia with fatal neurologic complication in an intravenous drug addict. Am. J. Med. 82:638-640. Dethy M. et al. 1986. Septicemia caused by Arcanobacterium haemolyticum (Corynebacterium haemolyticum) and Streptococcus milleri. Acta Clin. Belg. 41:115-118. Goudswaard, J. et al. 1988. Corynebacterium haemolyticum septicemia in a girl with mononucleosis infectiosa. Scand. J. Infect. Dis. 20:339-340. Jobanputra, R. S. and C. P. Swain. 1975. Septicemia due to Corynebacterium haemolyticum. J. Clin. Pathol. 28:798-800. Greenman, J. L. 1987. Corynebacterium haemolyticum and pharyngitis (letter). Ann. Intern. Med. 106:633. Robinson, B. E. and L. L. Murray. 1987. Corynebacterium haemolyticum pharyngitis (letter). Ann. Intern. Med. 106:778-779.

I

Editorial II

Laboratory Science Education: Back to the Future Joanne Bradna, M.S., M.T.(ASCP) Assistant Professor and Admission Coordinator Department of Medical Laboratory Sciences University of Illinois at Chicago Chicago, IL 60612 When talking about the future of the clinical laboratory profession, many people often paint a very grim picture. Educators look back to the 1970s, when educational programs were turning away qualified applicants (1), and sigh, "Where have all the students gone?" Employers look back to the days before prospective payment and sigh, "Where have all the dollars gone?" The 1980s have brought a dramatic change in the number and quality of applicants t o clinical laboratory science training and educational programs, forcing many

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programs to close their doors. This turn of events, along with the exit of many laboratorians from the laboratory, has resulted in the current shortage of qualified laboratory personnel (2). When examining the past 10 to 15 years, people cite a variety of factors that have contributed to this dramatic turn of events. The most common reasons cited include: the greater number and variety of career opportunities that now exist for women, the general decrease in the college-aged population, the effect of the Tax Equity and Fiscal Responsibility Act (TEFRA) on the hospital lab, changing it from a revenue center to a cost center, the poor attitudes of clinical laboratory scientists, resulting from the lack of upward mobility, the moderate salary scale and general job stress, the perceived danger of AIDS, and, as previously mentioned, the exit of many people from the hospital laboratory setting for more profitable opportunities

© 1989 Elsevier Science Publishing Co., Inc.

in the private sector. When one takes these factors at face value, one would find it difficult to disagree that the laboratory professions have a pretty dim future. I, however, am one clinical laboratory science educator who feels that a much brighter future exists than the one painted by so many in our profession. Experience has shown me that many of the previously mentioned trends are cyclic and would probably remedy themselves. The shortage of qualified laboratory scientists has already started to drive up salaries. I have even seen hiring bonuses listed in classified advertisements for medical technologists. Soon not all bright young students will want to flock to business schools. As this market becomes even more saturated, students will look for other career alternatives. However, as we wait for the pendulum to swing, we must take aggressive steps to ensure that we are ready for these future changes.

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Active recruitment and retention programs have been advocated as the best way to prepare for the future and also to provide the most immediate results. The importance of recruitment has recently been stressed by two professional organizations. Both the American Society for Medical Technology and the American Society for Clinical Pathologists have organized task forces on recruitment and have distributed posters and other materials to aid individual institutions in their recruitment efforts. In addition a recent report of the Division of Health Care Services, the Institute of Medicine, and the National Academy of Sciences recommended that both employers and educators collaborate their recruitment efforts to ensure an adequate complement of students and health care workers (3). Active recruitment and retention can have a major impact on the future of the laboratory professions. The education of both clinical laboratory students and current professionals must play an integral role in any recruitment and retention program. The first role that education must play in the successful recruitment of students is the creation of a public awareness in the area of clinical laboratory sciences. This is very important, because it is usually not a teacher or counselor who influences a student's career choice but, rather, a friend or relative. An educated public would help guide students into the clinical laboratory professions. Participation of laboratory professionals in National Laboratory Week, health fairs, and science fairs should be encouraged. Activities such as these enlighten the public on the important role that the clinical laboratory plays in the health care arena. When students are recruited to educational programs, less traditional applicant pools must be pursued, including minorities, older students, and career changers. However, if recruitment efforts are directed toward these applicants, one must be prepared to address their unique problems. Older students and career changers often have families to support and hold jobs that can not be given up in order to return to school full time. Educa-

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tional programs must be designed that accommodate such lifestyles yet do not compromise the quality of education provided. Part-time programs are one alternative that can be structured for these people. Likewise, minority students often require additional academic support services for retention in educational programs. Programs to address such situations must be in place in order to attract and retain these less traditional students. Once students have enrolled in laboratory science programs, educators must provide them with a course of study that prepares them for the changing health care environment. Many educators feel that future clinical laboratory scientists will need multiple skills to be competitive in the job market (4). A recent survey of 106 members of the Clinical Laboratory Management Association (CLMA) supported this point of view and cited five areas that should be emphasized in laboratory science education programs (5). These include computer technology, management skills, instrumentation and trouble shooting, clinical experience in both large and small laboratories, and quality assurance. In regard to microbiology, similar suggestions were made by the American Society for Microbiology ad hoc Commission on Clinical Microbiology (6). I agree with the CLMA suggestions, emphasizing that all of these experiences must be presented in a way that ensures their relevancy to clinical laboratory practice. Introduction of these newer areas of expertise must not compromise the traditional theoretical and technical course of study that is required to prepare competent general laboratory practitioners. As the laboratory scientist's scope of practice expands, we must guard against the trap of overeducating and overpreparing students. Taking precautions against this practice would ensure that graduates are not frustrated by unrealistic expectations about what their work and profession would entail. This should help retain students and practitioners in the laboratory science professions. Employers can greatly affect the entrance and exit rates of people into a profession. Increased compensation

© 1989 Elsevier Science Publishing Co., Inc.

has already been mentioned as a factor in successful recruitment and retention. This, however, is not the total solution. Employers must not ignore the needs for viable career paths and professional stimulation. Alternative pathways for entry into various levels of the profession must be explored. Current laboratory professionals must be encouraged to take advantage of career mobility or career-ladder programs that now exist. These programs allow mobility between associate and baccalaureate degree programs. Professional stimulation can be accomplished by encouraging people to take part in continuing education programs or by offering enrichment opportunities. Attendance at continuing education programs can be costly, and often it is the continuing education line of the budget that disappears first when cutbacks must be made. There are, however, alternatives available that can provide low-cost continuing education for a large number of people. One such alternative is audioteleconferencing. Teleconferencing programs available through EDUNET (Willowbrook, Ill.) present timely topics in the area of clinical microbiology. Continuing education credits are awarded for participation in the teleconferencing series, and the minimal registration fee of $35.00 per person or $350.00 per institution includes all course materials and participation in all sessions of a series. Enrichment experiences can also include evaluation of commercial products, development of new procedures, or participation in quality assurance programs. Participation in such activities gives a person a break from the day-to-day routine, a sense of satisfaction and accomplishment, and provides exposure to the areas of clinical research and laboratory management. A number of ideas and suggestions have been presented in this editorial. None of these can be successful unless educators, together with employers and professional organizations, foster an interest in the laboratory sciences among qualified prospective students. This can be accomplished only if employers, educators, and laboratory professionals try to understand each others' concerns,

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constraints, and the pressures that have been brought on by the changing health care environment. Failure to do so would continue to weaken the work force and dilute the contributions made on a daily basis by laboratory professionals currently in practice.

References 1. French, R. M. and C. M. Elkins.

1982. Trends in enrollments and application pools. Lab. Med. 13:479-481.

3. Allied Health Services. June 1988. Avoiding crises: report of a study. Division of Health Care Services, Institute of Medicine, National Academy of Sciences. National Academy Press, Washington, D.C.

4. Baumberg, R. 1981. Educating clinical laboratory scientists in the 1980's: some suggestions. Am. J. Med. Technol. 47:259-261. 5. Matuscak, R. and A. J. Ducanis. 1988. Preparing clinical laboratory scientists to meet the demands of a changing health care market: projections for the future. Lab. Med. 19:661-666. 6. Check, W. 1987. ASM commission sees positive future for clinical microbiology. ASM News 53:315-318.

Immunodiagnostic, Bellevue, Wash.), MRC-5 (Bartels; Whittaker M. A. Bioproducts, Walkersville, Md.), and primary rabbit kidney (Bartels, Whittaker). Typically, after 4 h of incubation at 35°C in 5% CO 2, cells began rounding up, granulating, vacuolating, and eventually detaching from the coverslip. The pH of the culture medium did not change. The opening of the shell vial is fitted tightly with a plastic stopper that is snapped to open and close. The shell vial caps can be removed two ways during inoculation and feeding: i) by holding the upper portion of the cap with the lower edge of the palm, as is traditionally done when handling bacterial culture tubes; or ii) by holding the upper portion of the cap with two fingers. Either method can lead to contamination, because the inner extension of the stopper is frequently moistened with culture medium. On the other hand, our laboratory conforms to the universal precautions policy (3), which requires that gloves be worn when handling all specimens. A recent change in the glove manufacturer was noted to coincide with the occurrence of the shell vial problem. We conducted the following experiment and established the link between the phenomenon of monolayer detachment and latex-glove contamination. A quarter-sized area on the palm surface of each of 5 latex gloves of the same brand was moistened with a cotton swab and transferred to 2 mL of Eagle's minimal essential medium with L-glutamine and 2% fetal bovine serum (EMEM). Two fractions, powder (cornstarch) and superuatant, were separated by centrifugation at 1,000 × g

for 10 min. The supematant fraction was filtered through a 0.45-wm Millipore filter, the powder fraction was washed twice with phosphate buffered saline, pH 7.4, and resuspended to a no. 0.5 MacFarland turbidity standard in EMEM. A simulated inoculation was performed by adding a mixture of 0.2 mL EMEM and 0.1 mL of either fraction into 1 vial of MRC-5 (Whittaker). The vial was centrifuged at 2,000 × g for 30 min at 30°C, and 1 mL of EMEM was added at the end of centrifugation. The coverslips in the bottom of the shell vials were examined at 4 h and 24 h of incubation at 35°C. The experiments were conducted without wearing gloves. Nine brands of latex gloves were investigated. None of the powder fractions showed damage to the integrity of cell monolayer after 24 h of incubation. The concentration of powder particles was estimated to be at least 100-fold higher than a normal contamination during processing of clinical specimens. Supernatant fractions from four brands of latex gloves, including the brand currently used in our laboratory, produced the typical detachment phenomenon after 4 h of incubation. This phenomenon was prevented when the same experiment was conducted with gloves previously washed with running tap water. According to the manufacturer, glove production involves molding in liquid latex, drying with heat, and powdering with cornstarch. The length and temperature of the drying step vary among brands. The latex consists mainly of a hydrocarbon polymer with a low percentage of protein, sugar, and inorganic salts. Conceivably, break-

2. Del Polito, G. A. 1984. Prospective payment: a sign of the changing times. J. Med. Technol. 1:62-67.

Letter to the Editors Detachment of Cell Monolayers in Shell Vial Cultures due to Latex-Glove Contamination To the Editors: The shell vial cell culture method has been used successfully for rapidly detecting cytomegalovirus and herpes simplex virus (HSV) in clinical specimens (1, 2). A low-speed centrifugation and staining of acetone-fixed coverslips with fluorescent or immunoperoxidase reagents have enhanced the speed and sensitivity of this procedure. The availability of both shell vial cell cultures and staining reagents from commercial sources has made the system amenable for routine use in clinical laboratories without tissue culture equipment and experience. We have used such a procedure for detecting HSV for several years. In the preceding 3-year period, cell monolayers detached from the coverslips after fixation at an incidence rate of 1%. This phenomenon usually could be attributed to either microorganism contamination or a high concentration of virus in the clinical specimen. In a recent 2-month period, however, we experienced a 50% increase of complete cell monolayer detachment among specimens collected from the same patient population. Neither microorganism contamination nor overwhelming HSV infection could be documented. Therefore, an investigation was initiated. The phenomenon of monolayer detachment was not associated with the type of specimen and was manifested in several different cell lines. We tested various shell vials, including human newborn foreskin fibroblast (Barrels

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