2.2 Gram stain

The Gram stain test allows you to see basic bacterial morphology and group bacteria into two main types; Gram-positive and Gram-negative.

Watch Video 1 to see how the test is performed. If you are unable to watch this video, you can view a transcript of the content by clicking on ‘Show transcript’ below.

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Video 1 How to perform a Gram stain
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Note that laboratories without a gas supply can still perform Gram stain tests by using single use sterile plastic loops which are disposed of into disinfectant.

Activity 7: Troubleshooting

The Gram stain may seem like a simple test, but things can still go wrong. Think about your own laboratory practice – why might Gram-positive organisms appear Gram-negative? What measures can you take to prevent this happening?

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Discussion

Factors that can lead to incorrect results for the Gram stain include:

  • excessive heat fixation damaging the cell wall
  • over-decolourisation, so that the stain is washed out
  • old or badly stored iodine
  • using an old culture to do the smear – organisms are damaged.

Measures that can be taken to prevent errors include:

  • following laboratory SOPs exactly
  • making sure reagents are dated and renewed regularly – if reagents are stored long enough bacteria can grow in them and appear on the slides!
  • only using fresh cultures.

2.1.1 Processing blood cultures

3 Commercially available and more advanced tests