The application of near patient testing to microbiology

Near patient testing (NPT) was the norm in days when urine was examined by smell and taste. More recently, general practitioners and physicians in genitourinary medicine began to use light microscopes in their consulting rooms to examine urine for pus cells and urethral and other swabs for pathogens. Increasing knowledge has led to specialisation, however, with clinicians obtaining specimens for examination by others. Improved technology has speeded up the practice of medicine, raising expectations of patients and doctors alike, and reductions in the size and expense of testing instruments have made a renaissance of NPT possible. Such a rebirth has already been seen in high dependency units and neonatal intensive care units, where arterial blood gases and serum bilirubin have to be tested in less time than it would take a sprinter to reach the laboratory. People with diabetes, rushing about in the community, stop and test their own blood glucose to determine the ideal dose of insulin, and patients with asthma measure peak expiratory flow rates to titrate doses of inhaled and oral corticosteroids. To what extent has NPT developed in microbiology? General practitioners have nitrite dipsticks and dipslides with which to identify urinary tract infections and elsewhere in this issue the prospect for testing for Helicobacter pylori infection is discussed. Do-it-yourself HIV testing kits can be bought in some countries. Are these desirable developments for communicable diseases, the results of whose investigation are used not only to benefit the individuals tested but also to monitor trends in populations and determine policies for the prevention and control of infection? If NPT is desirable, or inevitable, in microbiology, how can it be developed so as to ensure a high quality service both for patients and the population? This review considers the implications of NPT in the field of communicable diseases for microbiology laboratories, quality assurance, accreditation, and the legal framework in which medical devices are used.