Reading and Reporting Gram-stained Direct Smears (Online CE Course)

Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 1.5 hour(s) Approved through 3/31/2026

Florida Board of Clinical Laboratory Personnel Credit Hours - General (Microbiology/Mycology/Parasitology): 1.5 hour(s) Approved through 3/31/2026

Objectives

• Define direct smear.
• Describe several ways in which Gram-stained direct smears are clinically useful.
• Discuss examination of direct smears with respect to control smears, macroscopic appearance, and characteristics of appropriate microscopic fields.
• Discuss the identification of common nonbacterial elements with respect to purpose, size, shape, differentiating characteristics, and Gram stain reaction.
• Identify the following types of bacteria found in Gram-stained direct smears: gram-positive cocci, gram-negative cocci, gram-positive bacilli, gram-negative bacilli, and gram-negative diplococci.
• Discuss the procedure for reading Gram-stained direct smears with respect to principle, procedure, and sources of error.

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Course Outline

• Purpose of the Gram-stained Direct Smear
• What is a Direct Smear? What is the Value of a Direct Smear?
• Determining the Quality of a Sputum Specimen
• Determining the Quality of a Urine Specimen Submitted for Culture
• Providing the Clinician With Same-day Information Regarding Possible Pathogens
• Cerebrospinal Fluid and Specimens Collected from Other Sterile Sites
• Correlating Direct Smear Results With Culture Results
• True or False: Information from Gram-stained direct smears may help the physician make a preliminary diagnosis when the Gram stain information is comb...
• A large number of which of these types of cells would indicate that a sputum specimen is sub-optimal and should not be used for culture?
• Reading and Reporting Direct Smears
• Gram Stain Principle
• Quality Control Smears
• Macroscopic Evaluation of the Smear
• Thick Smears
• Thin Smears
• Properly Decolorized Smears
• Sources of Error: Under-decolorized or Over-decolorized Smears and Overheating
• Reporting Microscopic Findings
• Sources of Error: Contaminated Gram Stain Solution or Slides
• Procedure: Summary of Gram Stain Reading and Reporting
• What color is the background material in a Gram-stained smear that has been adequately decolorized?
• What is the minimum number of fields that should be scanned under low power before proceeding with the examination of at least 20 fields using the oil...
• True or False: If a smear is over-decolorized, it can be salvaged by repeating the Gram stain procedure.
• What is the purpose of the iodine that is used in the Gram stain procedure?
• Which of the following statements is true regarding the Gram-stained smear that is represented by this image?
• Bacteria in Direct Smears
• Bacteria
• Gram-positive Cocci
• Gram-positive Diplococci
• Gram-negative Cocci
• Intracellular Bacteria
• Gram-negative Diplococci
• Special Considerations for Genital Smears
• Gram-positive Bacilli
• Gram-negative Bacilli
• Significance of Specific Findings
• True or False: The bacteria in this slide are gram-negative cocci.
• What are the structures indicated by the arrows in this field from a Gram-stained smear?
• True or False: The presence of intracellular gram-negative diplococci on a smear made from a purulent urethral discharge from a male is diagnostic for...
• Nonbacterial Cells in Direct Smears
• Size and Appearance of Nonbacterial Cellular Elements on Gram-stained Smears
• Matching question: Match the Gram stain reaction for each of the following nonbacterial elements.
• Which of the following cells are about the same size as red blood cells?
• What nonbacterial structures are present in this microscopic field of a Gram-stained smear?
• This Gram stain was prepared from a sputum specimen and is viewed under oil immersion (total magnification = 1000x). What is the structure that is ind...
• References
• References

Additional Information