under the microscope
By Rodney E . Rohde , PhD , MS , SM ( ASCP ) CMSV CM , MBCM , FACSc
Teamwork Makes the Dream Work – Fighting HAIs and AMR
The Centers for Disease Control and Prevention ( CDC ) have often stated that approximately 1 in 25 patients hospitalized in a U . S . acute care hospital has at least one healthcare – associated infection ( HAI ), adding up to over 700,000 infections annually . Urinary tract infections , ventilator associated pneumonia and surgical-site infection are some of the most common infection types , with as the most common pathogen . Methicillin-resistant Staphylococcus aureus ( MRSA ), Clostridioides difficile , and Vancomycin-resistant Enterococci ( VRE ) are just some of the antimicrobial resistant ( AMR ) microbes that are globally becoming more common every year . The COVID-19 pandemic has also exacerbated the problem due to the need to focus on stopping the SARS-CoV-2 virus , sometimes with empirical antibiotic treatment .
The World Health Organization has stated that by 2050 , antibiotic resistance and HAIs will have a global economic impact of up to $ 100 trillion and 10 million deaths . If this prediction comes true , that will be one new antibiotic resistant infection every three seconds and it will exceed cancer mortality . Infection control and prevention , diagnostics , and antimicrobial stewardship are identified as key measures that can address this global problem . This article will discuss how a healthcare team approach – especially between pharmacy , infection prevention , and the medical laboratory professional – may be considered the Super Stewards of antibiotic stewardship .
Most people likely assume that a physician in the critical agent in the war on AMR and HAIs . While physicians certainly play a large role , there are many other healthcare , public health and medical professionals involved in this war . The primary soldiers in this battle include pharmacists , medical laboratory professionals , infection preventionists , environmental services , and nurses . Certainly , there are others , but I would argue that these professionals along with physicians create the most important team in the fight .
Infectious diseases pharmacists are frequently the lead person within health care systems in the management of antimicrobial stewardship programs and these pharmacists have emerged in the last decade as major leaders in this regard . In optimizing systems , it is apparent that interaction with medical laboratory personnel is required to enhance existing services and provide timely , accurate and easily understandable information to medical providers . While pharmacists get little ( if any ) education on the happenings of the medical laboratory during school , it turns out many of us need medical laboratory help to do the best job possible .
According to the Association for Professionals in Infection Control and Epidemiology ( APIC ), infection preventionists ( IPs ) are professionals who make sure healthcare workers and patients are doing all the things they should to prevent infections . Most IPs are nurses , epidemiologists , public health professionals , microbiologists , doctors , or other health professionals who work to prevent germs from spreading within healthcare facilities . They look for patterns of infection within the facility ; observe practices ; educate healthcare teams ; advise hospital leaders and other professionals ; compile
infection data ; develop policies and procedures ; and coordinate with local and national public health agencies . An APIC-credentialed IP will become “ Certified in Infection Control ( CIC ) along with their other degrees and credentials .”
The term environmental services ( EVS for short ) refers to a group of professionally trained cleaning staff who help to prevent the spread of infectious disease within a hospital . EVS technicians work alongside clinical staff to create a clean environment for patients while they are being treated . In other words , they are truly the front-line defender at preventing pathogens from inhabiting or colonizing your health care or community environment . These certified professionals are truly a secret weapon in the war on pathogen transmission and surface control .
Medical laboratory testing is the most critical component to a patient ’ s medical outcome , including the diagnosis of an antibiotic resistant infection . In fact , I preach to my students , colleagues , and anyone in healthcare or the public that there are two things I want them to remember if they believe they have an infection . First , ask ( or demand ) that your physician order a diagnostic confirmatory laboratory test to identify your infection before they prescribe you an antibiotic , whenever possible . In most cases , no one ( not even your physician ) can tell you with certainty that you have a bacterial infection without a confirmatory laboratory test . You may have a viral illness , an allergy , or some other type of immune reaction that is NOT being caused by a bacterium . If you do not have a bacterial infection , an antibiotic is wrong for you . Second , if you do have a bacterial infection , then be sure the provider orders an antibiotic susceptibility test when possible . This complex laboratory test will determine the susceptibility profile for the bacteria . It is just as important as finding out you have a bacterial infection because it will let the physician and pharmacist know exactly which antibiotic ( s ) to use . Without this information , we are all just driving the issue of antibiotic resistance and superbug creation via “ survival of the fittest .” These are two medical laboratory tests you must demand .
These credentialed medical laboratory professionals form the backbone of healthcare and the public health system . They conduct some 13 billion laboratory medicine tests annually in the U . S . Currently , these individuals have also performed more than 1 million COVID-19 tests and counting during the pandemic . Why should anyone care ? Laboratory testing is the single highest-volume medical activity affecting Americans , and it drives about two-thirds of all medical decisions made by doctors and other healthcare professionals from cradle to grave . Simply put , every time you enter a hospital or healthcare facility for care , your life is in the hands of a medical laboratory professional .
Each of these professionals are now integral parts of an effective antibiotic and antimicrobial stewardship team effort to reduce HAIs and AMR pathogens . Physicians and nurses will always be in the public view regarding patient care , but it is truly a team effort when it comes to prevention , diagnosis , treatment , and therapeutic measures .
Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM SVCM , MBCM , FACSc , serves as chair and professor of the Clinical Laboratory Science Program at Texas State University . Follow him on Twitter @ RodneyRohde / @ TXST _ CLS , or on his website : http :// rodneyerohde . wp . txstate . edu /