Reading and Reporting Gram Stained Direct Smears (by LabCE)

1.5 P.A.C.E. contact hour(s)

(based on 1,453 customer ratings)

Authors: Betty Smith, MT (ASCP), Jaimy Hill, MT (ASCP)
Reviewer: Julie Ann West PhD, MLS (ASCP), SM(ASCP)

Course provided by LabCE.

Has your laboratory ever had difficulty correctly reporting out cerebrospinal and joint fluid gram stains during off hours? This course helps provide training for technologists who must read gram stain but do not work primarily in the microbiology laboratory. Great for cross-training and for clinical laboratory science students as well.

See more courses in: Microbiology

Included In These Course Packages

Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 1.5 hour(s)
Course number 578-018-22, approved through 3/31/2024
Florida Board of Clinical Laboratory Personnel Credit Hours - General (Microbiology/Mycology/Parasitology): 1.5 hour(s)
Course number 20-905089, approved through 9/1/2022


  • Define a direct smear.
  • Describe several ways that 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, gram negative diplococci.
  • Discuss the procedure for reading Gram stained direct smears with respect to: principle, procedure, and sources of error.

Customer Ratings

(based on 1,453 customer ratings)

Course Outline

  • Purpose of the Gram Stained Direct Smear
      • What is the Value of a Direct Smear?
      • Determine the Quality of a Sputum Specimen
      • Determine the Quality of a Urine Specimen Submitted for Culture
      • Provide the Clinician With Same-Day Information Regarding Possible Pathogens
      • Cerebrospinal Fluid and Specimens Collected from Other Sterile Sites
      • Correlate Direct Smear Results With Culture Results
  • Reading and Reporting Direct Smears
      • Gram Stain Principle
      • Quality Control Smears
      • Macroscopic Evaluation of the Smear
      • Thick Smears
      • Thin Smears
      • Properly Decolorized Smears
      • Under-decolorized or Over-decolorized Smears
      • Reporting Microscopic Findings
      • Contaminated Gram Stain Solution
      • Summary of Gram Stain Reading and Reporting Procedure
  • Bacteria in Direct Smears
      • 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
  • Nonbacterial Cells in Direct Smears
      • Size and Appearance of Nonbacterial Cellular Elements on Gram Stained Smears
  • References
      • References

Additional Information

Level of Instruction: Basic
Intended Audience: This course is suitable for basic clinical microbiology courses at the post-secondary level. It can also be used as review material for clinical laboratory practitioners, medical students, and pathology residents. It requires skill in the use of the microscope, aseptic techniques, experience preparing and Gram staining smears, and experience reading smears from cultures.
Author Credentials: This course was developed by Betty Smith MT (ASCP) and Jaimy Hill MT (ASCP), and was updated by Education Materials for Health Professionals, Inc., under the supervision of Marjorie Spahn MT(ASCP). It was reviewed and adapted for online use by Paul Fekete, M.D. fellow C.A.P.
Reviewer Credentials: Dr. Julie Ann West is certified by the American Society for Clinical Pathology (ASCP) as a Medical Laboratory Scientist (MLS) and as a Specialist in Microbiology (SM). In addition, Dr. West has earned a PhD in Public Health - Infectious Disease Epidemiology and is Certified in Public Health (CPH) by the National Board of Public Health Examiners. Dr. West is experienced as a Technical Specialist, Safety Officer, Educator, and Lead in the Veterans Administration Healthcare System, and has prior experience as an Administrative Laboratory Director.
Copyright: Copyright EMHP Inc., Dayton OH. Licensed to MediaLab Inc., Lawrenceville, GA. Web-based version produced solely by MediaLab Inc.
Course Description: This course describes the morphology and Gram stain reactions of bacteria and nonbacterial elements found in Gram stained smears of clinical material.

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Course provided by LabCE.


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