Infection Control Today

MAY 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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" Review of CML data remains the most common method for case fnding in HAI surveillance; therefore, the most important role of the CML is to promptly and accurately detect nosocomial pathogens and their antimicrobial resistance patterns. 22 ICT May 2019 www.infectioncontroltoday.com cover story D iekema and Saubolle (2011) remind us that "Preventing infections requires the ability to detect them when they occur, which is why the clinical microbiology laboratory (CML) plays a key role in healthcare-associated infection (HAI) prevention." To review, the CML contributes to infection prevention efforts in several critical ways, including surveillance, outbreak detection and management, antimicrobial stewardship, deliberations of the infection control committee, and education. For example, Diekema and Saubolle (2011) observe that, "Review of CML data remains the most common method for case fnding in HAI surveillance; therefore, the most important role of the CML is to promptly and accurately detect nosocomial pathogens and their antimicrobial resistance patterns. The CML must also work with the infection prevention program and the information technology department to determine how microbiology data are delivered and linked to other surveillance data to streamline this process." The researchers acknowledge the increasing degrees of time pressure applied to the CML for it to produce increasingly rapid test results: "As hospital lengths of stay decrease, the window of clinical relevance becomes smaller and smaller." Technology is revolutionizing the CML, and healthcare epidemiologists and infection preven- tionists (IPs) are scrambling to keep up with the myriad developments. "Rapid diagnostics, particularly using molecular methods, is able to provide information to providers in incredibly effcient timeframes," says Duane W. Newton, PhD, D(ABMM), FIDSA, director of the Clinical Microbiology Laboratory at the University of Michigan as well as associate director of the Division of Clinical Pathology for Michigan Medicine. "It allows healthcare providers — including physicians, pharmacists and IPs — to make management decisions sooner." Clinical Microbiology, Infection Prevention & Epidemiology: Newton points to multiplex panels for positive blood cultures, which provide rapid identifcation and offers limited resistance gene information. "This infor- mation can help IPs with instituting precautions more quickly," Newton says. Other advancements include multiplex panels for respiratory pathogen detection and can help inform bed placement, co-horting and isolation precautions; as well as multiplex panels for GI pathogen detection. Another advancement making a signifcant impact on patient care, according to Newton, is integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). According to Huang and Newton (2013), "MALDI-TOF with antimicrobial stewardship team (AST) intervention has the potential for early organism identifcation, customization of antibiotic therapy, and improvement in patient outcomes." In their study, the researchers assessed the impact of this combined approach on clinical and antimicrobial therapy-related outcomes in patients with bloodstream infections. The AST provided evidence-based antibiotic recommendations after receiving real-time notifcation following blood culture Gram stain, organism identifcation, and antimicrobial susceptibilities. Outcomes were compared to a historic control group. The Trifecta Fighting HAIs By Kelly M. Pyrek

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