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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" Updates in the available technology will impact the capabilities of the infection prevention program in many ways. Working together, these advances can be leveraged to provide safer care for patients. — Hilary M. Babcock, MD, MPH, FSHEA, FIDSA 26 ICT May 2019 www.infectioncontroltoday.com in the natural and the healthcare environment, how they are transmitted to and among people, and how the microbiology lab identifes them. Epidemiology is summarized as the who, what, where, when and how of disease. Understanding these principles allows IPs to investigate clusters of infections and to promote practices that interrupt disease transmission." For the intermediate to advanced IP, staying abreast of the aforementioned advances in molecular diagnostics, can signifcantly affect their performance. "Advances in microbiology lab practices can have a profound impact on infection prevention programs," Babcock says. "More rapid identifcation of organisms from clinical cultures can allow earlier isolation of contagious patients, as well as earlier recognition of clusters of infections. In addition, advanced molecular techniques can provide rapid identifcation of respiratory and gastrointestinal viral infections, facilitating earlier adoption of appropriate isolation and environmental cleaning interventions. Also, detailed molecular characterization of organisms can determine whether clusters of infections are due to a single source or not, which has signifcant implications for control." Babcock continues, "Updates in the available technology will impact the capabilities of the infection prevention program in many ways. Working together, these advances can be leveraged to provide safer care for patients. Microbiology lab representation should be included in infection prevention committee meetings and new staff in each department should be introduced to each other to keep close and collegial ties between the groups." She adds, "Infection preventionists and healthcare epidemiologists are critical partners in leading healthcare facilities to provide safe care to all their patients. Healthcare epidemiologists bring a deep knowledge of infectious disease epidemiology, transmission, clinical impact and treatment. They are experienced in outbreak investigation and response and can engage physicians in discussions about safe practices. A strong collaboration between Infection Prevention Specialists and healthcare epidemiologists leads to a better program and better outcomes. SHEA and APIC have an annual leadership course specifcally designed for the preventionist/epidemiologist team that is an excellent opportunity to strengthen that relationship." Newton acknowledges that the communication fow between infection prevention, hospital epidemiology and clinical microbiology must include managing expectations of and for each department. "Just because a test is available, doesn't mean it should be used in every situation," says Newton, providing an example of assumptions that can serve as barriers to collaboration. "Lab can and should be consulted with to understand appropriate utilization. In addition, molecular tests can't differentiate infection from colonization, live from dead, so interpretation is imperative to be taken in the right clinical context. Work with the lab to understand benefts and limitations of tests, both in-house and send-outs." Newton adds, "From a very practical perspective, culturing of environmental samples (water, surfaces, tubing, etc.) is fraught with problems. There are specifc reference labs that use validated procedures for processing and testing these types of specimens, and most hospital-based labs are not skilled in these processes. As a result, the interpretation of results (positive or negative) is challenging and often does not justify the resources expended. I feel like a signifcant amount of conversation should occur between the IP and the lab if this type of testing is being considered, so that a clinically appropriate and resource effcient approach can be identifed jointly." Newton says the relationship between the IP and the CML can be enhanced by improved understanding, "Largely because we view each other as partners on the clinical team, working together to improve patient care. I think both sides know what the others' respective roles are, but it is critical to view each other as working together, not one 'serving' the other." He adds, "I think it can be enhanced by continuing to engage in communication, understanding each other's needs and capabilities, through regular meetings and updates. We have gained a lot from the lab visits from our IPs when they share their stories about how the information the lab provided has been used, such as specifc surveillance initiatives, outbreak investigations where we did special cultures or collected isolates or data, so the technologists could understand how their extra effort was advancing our mutual clinical mission. Also, not every hospital lab has a doctoral level microbiologist that can be identifed/used as a clinical point person for the IP, so extra work may need to happen to identify the lab-based resources to function as clinical/medical liaisons with the IP." Newton says it is critical for IPs to have a good grounding in clinical microbiology. "I teach clinical micro- biology to MPH students in our School of Public Health, many of whom end up doing infection prevention-related work. I think it is so important for users of lab data to understand how that information is generated, what it means, and importantly, what it is not telling you." Regarding clinical microbiology-related knowledge gaps among IPs, Newton says, "I think there are more opportunities to engage with each other in educational activities at a professional level (local, regional and national meetings). Maybe propose joint meetings or cross-pollenate more at national meetings. I fnd those opportunities to be very valuable, personally. Continue to maintain the dialogue, as technologies change, organism names change, priorities change — regular communication ensures that everyone is on the same page." References: Croxatto A, Prodhom G, Faverjon F, RochaisY and Greub G. Review: Laboratory automation in clinical bacteriology: what system to choose? Clinical Microbiology and Infection. Vol. 22, No. 3. Pages 217-235. March 2016. Diekema DJ and Saubolle MA. Clinical Microbiology and Infection Prevention. Proceedings of Camp Clin Micro 2011. Huang AM, Newton D, Kunapuli A, Gandhi TN, Washer LL, Isip J, Collins CD, Nagel JL. Impact of rapid organism identifcation via matrix-assisted laser desorption/ionization time-of-fight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis. 2013 Nov;57(9):1237-45. Newton DW and Novak-Weekley S. Enhancing the Function of Clinical Microbiology Laboratories: Can We Navigate the Road Less Traveled? Proceedings of Camp Clin Micro. 2011. Continued from page 23

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