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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" Total lab automation in microbiology has the potential to shorten time to detection of positive cultures. — Duane W. Newton, PhD, D(ABMM), FIDSA 23 May 2019 ICT Huang and Newton (2013) included in their fnal analysis a total of 501 patients with bacteremia or candidemia: 245 patients in the intervention group and 256 patients in the preintervention group. They found that MALDI-TOF with AST intervention decreased time to organism identifcation (84.0 vs. 55.9 hours), and improved time to effective antibiotic therapy (30.1 vs 20.4 hours, P = .021) and optimal antibiotic therapy (90.3 vs. 47.3 hours). Mortality (20.3 percent vs. 14.5 percent), length of intensive care unit stay (14.9 vs. 8.3 days) and recurrent bacteremia (5.9 percent vs. 2.0 percent) were lower in the intervention group on univariate analysis, and acceptance of an AST intervention was associated with a trend toward reduced mortality on multivariable analysis. It has been more than a decade since automation systems were introduced to the laboratory environment; since then, "it has rapidly proved its value by increasing productivity, allowing a continuous increase in sample volumes despite limited budgets and personnel shortages," according to Croxatto, et al. (2016), who add, "The laboratory automation systems are rapidly evolving to provide improved hardware and software solutions to optimize laboratory effciency." "Total lab automation in microbiology has the potential to shorten time to detection of positive cultures," Newton affrms. "Laboratories can then shift staffng to read cultures when ready, so there is increased 24/7 availability of culture results." Finally, advancements key to the CML include molecular coming to the point-of-care (POC) environment for respiratory viruses and Group A strep. "This could impact IPs in different ways," Newton says, "such as fewer patients coming to the emergency department for testing, or more positive patients identifed in an ambulatory setting." Newton emphasizes that "technology is improving interpretation and reporting of results in the healthcare setting by making more information available sooner, thus offering clinicians a greater basis to make decisions. It's also improving the detection of pathogens that were not able to be easily detected before, and more specifc diagnoses can be made." Swift, dependable results are beneficial for the healthcare institution's antimicrobial stewardship program. As Diekema and Saubolle (2011) observe, "Antimicrobial stewardship efforts are directly dependent on reports from the CML, so good communication between the laboratory, pharmacy, infection prevention program, and a stewardship team is essential." To that end, Diekema and Saubolle (2011) add, "It is paramount that the clinical microbiologist participates on the infection prevention/control committee and acts as a consultant to infection preventionists. He or she is the best person to provide expertise in the interpretation of culture results, advice about the utility of microbiological approaches to an infection control problem, and input regarding the CML resources needed to accomplish the goals of the committee. He or she should describe how changes in the methods used for detection, identifcation, and susceptibility testing of nosocomial pathogens will impact the infection prevention program. The benefts of close collaboration and interaction between the CML and the IPP are diffcult to measure but are real. One large survey of CML directors found that those hospitals with CML directors on the infection prevention/control committee were more likely to have CML involvement in formulary decisions, to produce an annual antibiogram, and to provide molecular typing support." It is essential, then, that IPs strive toward optimal communication and collaboration with their institution's CML. "Infection prevention is built on an understanding of infectious disease transmission," says Hilary M. Babcock, MD, MPH, FSHEA, FIDSA, medical director of the BJC Infection Prevention and Epidemiology Consortium, emphasizing the importance of the novice IP grasping the principles of epidemiology and microbiology and applying them to their work in HAI prevention. "Understanding transmission requires an understanding of microbiology as well as principles of epidemiology," adds Babcock, who is also medical director of occupational health at Barnes- Jewish and St. Louis Children's Hospitals; and professor of medicine in the Infectious Disease Division at Washington University School of Medicine. "Basic microbiology concepts of importance for Infection Prevention include what kinds of organisms are found where (reservoirs), what kinds of clinical syndromes they cause in patients (e.g., pneumonia vs skin infections), how well they survive Continued on page 26

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