How the IAQ professionals could help improve laboratory reports

• Discuss with the laboratory the objectives of the investigation
  If the laboratory understands the objectives of the investigation, they may help in deciding the most suitable types of samples to collect for the intended investigation. The laboratory would also know what to report and how to report it. (click here for information on how to collect and send samples).



• Provide adequate amount, size and/or number of samples for analysis
  The size or amount of sample should be adequate to allow the microbiologist to perform the test and retain some of the material for reference or for retesting in case something goes wrong during the first test or if detailed tests were required after the initial basic test. Where resources allow, the minimum number of samples that can allow statistical analysis of the resulting data should be provided.



• Provide clear instructions on the tests required
  If the IAQ consultant has not discussed the objectives of the investigations with the laboratory, they should clearly indicate the tests they require the laboratory to perform and how they desire the results reported or presented. This is particularly important with some types of samples that can be analysed in more than one way (see sample analysis flow chart below). For example a swab or a dust sample can be analysed by direct microscopic examination (DME), culturing by direct plating or culturing for quantification (serial dilution). The results for quantification could also be expressed as colony forming units (CFU) per unit area (or per unit weight in case of dust). Each of these analytical methods has its own limitations and gives different data. Similarly a bulk sample such as a drywall could also be analysed by culturing or DME. If the laboratory is not directed on what analysis to perform, they may use methods which may not give the results that were expected by the consultant or that may not adequately answer the question being investigated. For instance if the consultant was interested in species present on a bulk sample, DME analysis may not provide this information. The flow chart below shows how various samples could be analysed.

How laboratories could improve the quality of their reports.

• Give adequate information in the reports.
  Inadequate information may lead to inappropriate decisions being taken. So, reports generated by the laboratory should include adequate, useful, organized, informative and easy-to-understand information.



• Provide helpful comments in the reports.
  Reporting without comments may also lead to inappropriate action. Consider this case: a consultant takes pre-remediation (background) air samples to a laboratory. The samples are highly overloaded with dust particulates and therefore become difficult to analyse. The resulting counts are therefore very low. After remediation, samples are taken again to assess the effectiveness of remediation. This time the samples are not overloaded with dust and counts are significantly higher than the pre-mediation results. If the lab had commented on the first report that the samples were overloaded with dust and that this may result to low counts, the consultant would have decided on whether to take another set of samples or not.



• Provide information on medical significance of reported moulds
  Most laboratories avoid commenting on the medical significance of the moulds or bacteria they identify claiming that they were not qualified to make such comments. While this is true, one of the most important functions that a laboratory should perform is to decide what organisms are of health concern and what constitutes normal flora since this information is already documented in reputable journals or textbooks. By providing this information the laboratory is not in anyway taking the role of medical professionals. If such information is not available the laboratory should indicate so in the reports.



• Provide a list of references
  The laboratories should provide a list of references where the consultant can obtain more information concerning the identified moulds and bacteria and their health significance.

Conclusion

Communication between the IAQ professionals and the laboratories is the key to quality reports.

To read Part (I) of this Issue click Part (I)

References

Lee A, McLean S. The laboratory report: a problem in communication between clinician and microbiologist? Med J Aust 1977;2:858-860.

ABOUT THE AUTHOR:

Dr. Jackson Kung’u is a Microbiologist who has specialised in the field of mycology (the study of moulds and yeasts). He is a member of the Mycological Society of America. He graduated from the University of Kent at Canterbury, UK, with a Masters degree in Fungal Technology and a PhD in Microbiology. He has published several research papers in international scientific journals. Dr. Kung’u has analysed thousands of mould samples from across Canada. Dr. Kung’u is the Principal Microbiologist for Mold & Bacteria Consulting Laboratories (MBL) Inc., a company that provides laboratory identification services for indoor mould and bacteria to homeowners, environmental consultants, institutions and indoor air quality professionals across Canada. Get more information about indoor mould and bacteria at http://www.moldbacteria.com.