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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Infectious disease departments usually have case conferences where staff present cases involving a specific patient. The microbiologist and the infection prevention are often invited to attend and share their knowledge of the case or the particular organism or the infection. It provides a forum for learning, sharing critical information and team building. Changing nomenclature is also a challenge for both professions - what was once called by one name are being renamed based on better genetic identifi cation through whole genome sequencing. For example, Pseudomonas capacia is now Burkholderia cepacia or Moraxella (Branhamella) catarrhalis was formerly Neisseria or Micrococcus catarrhalis. Branhamella was created in honor of the work done by Sara E. Branham. Q : D o y o u h a v e o t h e r o b s e r - vations related to the imperatives between infection prevention and clinical microbiology? A : To day 's m o d er n mi cro b i o l o g y laborator y communicates their results through an electronic information system. Labs in limited resource areas may not have a sophisticated reporting system. Nevertheless, the communication of micro- biological results is paramount to patient care, infection prevention and antimicrobial stewardship programs. The importance of Informatics continues to grow contributing to improvement in workflow, timeliness and cost. The IP should be included in the discussion related to the informatics and what is needed to facilitate infection prevention. There must be agreement on what is to be reported for clinically important specimens such as cerebral spinal fl uid and epidemi- ologically signifi cant organisms, the timing of these report and who should be notifi ed. These reports should be done through verbal notifi cation and followed up with the usual reporting mechanism. Infection prevention and microbiologists need very similar epidemiological data to provide the best information and interpre- tation of the microbiological data. The W's of epidemiology refl ect the critical information needed: where the patient is, when was the specimen taken, what type of specimen was submitted to the laboratory; who is the patient and was the specimen collected at the right time, was the specimen the best to diagnose the suspected infection and was it collected appropriately and transported to the laboratory. The microbiology laboratory, infection prevention and the infectious disease physicians must collaborate to be assure that these key pieces of information are available and that the best procedural processes for collecting a specimen are used. Inappropriate collection and transport practices including delays in getting the specimen to the lab can adversely impact the effi cacy of the laboratory results. With the advent of direct laboratory electronic data reporting, the epidemi- ological/public health role of the clinical microbiology laboratory and the infection preventionist are further aligned in response to mandatory reporting. Sentinel organism surveillance data for Clostridium diffi cle and multidrug-resistant organisms (MDROs) such as carbapenem-resistant Enterobacteriaceae (CRE) are reported to government agencies via the lab electronic medical database. Analysis of the trends in microorganisms can often identify outbreaks and assist in outbreak investigations, not only at the local level but at state and regional levels as well. The CDC has funded regional public health reference laboratories to expand surveillance data and improve identifi cation of microorganisms and antimicrobial susceptibility testing that can identify common microorganisms and determine when additional testing such as molecular typing would be useful. It is very helpful to talk to the regional laboratory to understand how they function and how they should be contacted when needed. It will be helpful to have the procedure defi ned prior to an outbreak or the occurrence of an emerging pathogen. Finally, the review and analysis of microbiology data can provide and interpret accurate antimicrobial susceptibility patterns for use in treatment and antimicrobial stewardship activities. Unfortunately, many labs are not funded to cover the cost of working up clusters and outbreaks especially in resource limited settings. Both the laboratory and infection prevention would benefi t with improved funding for these functions. Typing of isolates can determine the relatedness of organisms to identify/confi rm clusters or outbreaks. Not all facilities have the capacity to preform typing, if a facility does not have the capability, they should have a procedure developed for using a reference lab or the state or regional T e microbiology laboratory, infection prevention and the infectious disease physicians must collaborate to be assure that these key pieces of information are available and that the best procedural processes for collecting a specimen are used. — Loretta Litz Fauerbach, MS, FSHEA, FAPIC, CIC Ò public health lab as appropriate. Typing can identify common reservoirs and potential carriers. Typing can also identify that even though the same genus and species has been isolated from a common area that the isolates are genetically different. Knowing if isolates are related or not allows the micro IP teams focus on prevention and control activities. It can determine prevalence and mode of transmission which will assist in controlling and containing the outbreak causative microbe. In conclusion, infec tion prevention and microbiology are partners in infection prevention and control as well as antimi- crobial stewardship programs. They should collaborate in developing policies and procedures, setting up communication work fl ow, assuring quality practices, and educating other healthcare professionals on infection prevention and the agents of causing healthcare associated infections and other infectious diseases. References: Benbachir M. and Bearman G. Chapter editor. Role of microbiology laboratory in control of nosocomial infections. Guide to Infection Control in the Hospital. Chapter 3: Role of the Microbiology Laboratory in Infection Control. International Society for Infectious Diseases. Updated January 2018. https://www.isid.org/wp-content/ uploads/2018/02/ISID_InfectionGuide_Chapter3.pdf Accessed March 18, 2019. Daly J. Tips For How the Microbiology Lab Can Support Infection Control and Surveillance. Oct. 29, 2015. http://www.labtestingmatters.org/8-tips-for- how-the-microbiology-lab-can-support-infection- control-and-surveillance/. Accessed March 18, 2019. Emori TG and Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clinical Microbiology Reviews, 1993;6/4:428-442. DOI: 10.1128/ CMR.6.4.428. https://cmr.asm.org/content/6/4/428 Accessed March 18, 2019. Mahony J, Chong S, Merante F, Yaghoubian S, Sinha T, Lisle C and Janeczko R. Development of a Respiratory Virus Panel Test for Detection of Twenty Human Respiratory Viruses by Use of Multiplex PCR and a Fluid Microbead-Based Assay. J Clin Micro. 2007; 45/9: 2965–2970. doi:10.1128/JCM.02436- 06. https://jcm.asm.org/content/45/9/2965.short Accessed March 28, 2019. 25 May 2019 ICT

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