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

(based on 421 customer ratings)

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

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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.

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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


  • 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.

Customer Ratings

(based on 421 customer ratings)

Course Outline

Click on the links below to preview selected pages from this course.
  • 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 mag. =1000x). What is the structure that is indicated by ...
  • References
      • References

Additional Information

Level of Instruction: Basic
Intended Audience: This course meets the requirements of 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.

How to Subscribe
MLS & MLT Comprehensive CE Package
Includes 180 CE courses, most popular
$109Add to cart
Pick Your Courses
Up to 8 CE hours
$55Add to cart
Individual course$25Add to cart
Need multiple seats for your university or lab? Get a quote


Gram positive

S. pneumoniae_smaller

<i>N. gonorrhoeae</i>

appropriate reading field for gram stain

Gram positive bacilli