Role of Microbiology Labs in Infection Control

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Lab results form an integral part of the complex decision making process and may influence upto 70% of medical diagnosis.

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Role of Microbiology Labs in Infection Control

  1. 1. THIS PRESENTATION WASPRESENTED AT APOLLO INTERNATIONALFORUM ON INFECTION CONTROL(AIFIC’ 2013), CHENNAIThe presentation is solely meant for Academic purpose
  2. 2. ROLE OF MICROBIOLOGY LABORATORY IN INFECTION CONTROL
  3. 3. ROLE OF MICROBIOLOGIST IN ORGANIZINGTHE LAB Lab results form an integral part of the complex decision making process and may influence upto 70% of medical diagnosis To ensure the same, the lab has to issue quality reports Quality of report relies on quality of clinical specimen submitted To avoid pre-analytical errors, lab has to putforth Specimen acceptance & Rejection criteria Specimen to be submitted with relevant clinical details Open and free communication between Clinicians & Microbiologist / Micro Lab essential Facility to access patient records preferred (healthcube)
  4. 4. CRITERIA FOR REJECTION OF SPECIMEN Problem ActionImproper or no label Telephone the nurse or physician , process the specimen but do not issue the reportProlonged transport Alert the concerned staff & request a repeat specimenImproper container Do not process & request a repeat specimenLeaking container Do not process & request a repeat specimen. Protect the laboratory staffOropharyngeally Do not report or process. Indicate thecontaminated discrepancy & request another specimenObvious foreign Alert the concerned staff & request a repeatcontamination specimen
  5. 5. Problem ActionDuplicate specimens Refrigerate the specimen, contact thesubmitted on same day concerned staff. Culture on request onlyfor same requestSpecimen unsuitable for Contact the concerned staff, indicate theculture request e.g., discrepancy, request a proper specimenanaerobe request withaerobic transportQuantity not sufficient For blood: if < 5ml for an adult, inform the concerned staff, request another specimen. Process but add note on report For other specimens: if quantity not sufficient for multiple requests, call the physician and determine the priority of request
  6. 6. Specimen Collection, Transport and Processing: General Instructions for collection of culture specimens Select the correct anatomic site Collect the specimen using proper technique & supplies Package the specimen in appropriate container Transport promptly to the lab within 2 hrs of collectionConditions of transport & storage of samples Profound influence on their usefulness
  7. 7.  Follow standard techniques to process samples Fulfill quality control requirements Quality Control check for media and stains Potency testing for antibiotic disk Sterility check for collection containers
  8. 8.  Identify causative organism to species level Use of automation helps speedy isolation & identification - Automated blood culture systems Automated ID & sensitivity systems Interpret results judiciously Differentiate commensals / colonizers from pathogens Perform quantitative cultures wherever required
  9. 9. ANTIBIOTIC SENSITIVITY TESTINGKirby-Bauer Disk Diffusion Method – Points to remember : McFarlands Standard for inoculum preparation Depth of the media and pH Proper storage of antibiotic disk Proper placing of the disk- use template 16 – 18 hrs of incubation 24hrs for Staph and Entero - Oxacillin & Vancomycin
  10. 10. Selection of Anti microbial disk : Based on type of organism & source of isolate Formulate Inhouse Antibiotic Policy with reference tointernational guidelines Use 1st line of antibiotics for out patient isolates 2nd line to be used if resistance noted to 1st line & forisolates from critically ill patients Use of E-strips for fastidious organisms / CSF isolates / Ciprofloxacin to SalmonellaInterpret according to International GuidelinesSMF Antibiotic Policy – Restrictive Policy
  11. 11. 1ST & 2ND LINE ANTIBIOTICS FOLLOWED AT SMF1st line of Antibiotics 2nd line of Antibiotics (Restricted)Penicillin-G AmikacinAmpicillin CeftazidimeCephalexin CefotaximeCiprofloxacinOfloxacin CefepimeNitrofurantoin Piperacillin/tazoNalidixic acid Cefaperazone/sulGentamycin ImipenemTobramycin MeropenemAzithromycin ErtapenemNorfloxacinCotrimoxazole AztreonamOfloxacin VancomycinAmoxy/clav LinezolidCefuroxime TeicoplaninCefixime Polymixin-BCeftriaxone (Salmonella) ColistinClindamycin
  12. 12. Looking for Resistance patterns: (to guide antibacterial therapy)Lab to detect common resistant mechanisms β-lactamase detection with Cefinase disk Screening for ESBL & Amp C β-lactamase with Cefpodoxime & Cefoxitin disk Performing DDPT for phenotypic confirmation of ESBL Can be performed while testing 2nd line of antibiotics Oxacillin & Cefoxitin disk for Staph. isolates
  13. 13.  Look for Inducible Clindamycin resistance in Staph isolates - D Test Quinolone resistance in Salmonella - Nalidixic Acid disk as marker - E-strip to Ciprofloxacin Detection of Carbapenamase - Modified Hodge test - EDTA disk synergy testOther methods for resistance detection - Automated ID & Sensitivity System (Vitek 2) - Molecular methods
  14. 14. Infection Control Critical Values (Early Warning Systems) Micro lab to inform ICN on a daily basis: - MDR GNB, MRSA, VRE - Sputum AFB + cases Microbiologist to note suspected HAI in HAI chart Convey to ICN for data collection in surveillance form Inform notifiable diseases to MRD Chennai Corporation - Dengue - Typhoid - Chikungunya - Malaria - Swine flu
  15. 15. Role of Microbiology lab in Hospital Infection Control Identifying outbreaks early- Pseudo or true outbreak Conveying information to ICT & concerned ward/unit Charting down action plan, control measures Implementation through ICT Monitoring effectiveness of control measures Stock isolates from patients & suspected source Source identification using phenotypic & molecular methods
  16. 16.  Designing the HIC Plan in accordance with infrastructure & consensus of user departments Monitoring key infection control measures along with ICN - Hand hygiene practices - Standard & Isolation precautions
  17. 17. Compiling Culture & Sensitivity Data of hospital isolates Periodical review of culture & sensitivity patterns Analyze sensitivity pattern of isolates from : - Out patients & inpatients separately - Pediatric age group and adults separately - Resistant isolates from that of sensitive isolates Prepare a chart at the end of the year To help Clinicians - to know the common pathogens & their sensitivity pattern - to formulate Empirical Antibiotic of Choice
  18. 18. OCCUPATIONAL EXPOSURES – REPORTING& POST EXPOSURE PROPHYLAXISNeedle Stick Injuries – Reporting Protocol Reported immediately to ER Medical Officer Assess injury & takes action Enter details in Occupational Exposure Form Inform ICN & Microbiologist Source (if known) & Staff evaluation for viral markers Micro lab to process samples as Stat Reports conveyed to Microbiologist & ICN Counseling done
  19. 19. Post Exposure Prophylaxis: If source negative for viral markers - only counseling If source positive consult ID & initiate PEP If employee vaccinated for HbsAg assess AntiHBs titres If titre low booster dose If negative Re vaccination If source unknown Anti HBs tires for Staff &follow up
  20. 20. Employee Health: Pre employment health check up Staff in direct patient care tested for : - HBsAg - HIV at entry time - HCV Vaccination details collected Vaccination for Hepatitis B (3 doses) if not vaccinated
  21. 21.  Canteen & Dietary staff – Typhoid, Hepatitis A & B Maintenance staff - Typhoid, Hepatitis B Bio Medical staff - Hepatitis B Lab staff – Hepatitis B, Microbiology – Typhoid Influenza vaccine if there is outbreak Food handlers health check up once in a year Anti HBs titres checked after vaccination
  22. 22. Bio Medical Waste management: ICT to educate hospital staff on waste segregation Included in the induction training for House Keeping, Nursing & other para medical staff Re-education as & when required ICN monitors segregation on a daily basis HK Supervisor ensures safe transportation Handing over to Central facility Records maintained by HK Supervisor
  23. 23. ThankYou

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