IP Lab Webinar 8/23/2012

Transcription

1 2 What Infection Preventionists need to know about the Laboratory Anne Maher, MS, M(ASCP), CIC Richard VanEnk PhD, CIC 1

2 Objectives Describe what the laboratory can do for you; common laboratory tests and techniques relevant to infection prevention practice Identify current channels of communication between the IP and the laboratory; and list ways of collaboration between the two departments Summarize important laboratory topics to disseminate to other departments 4 Introduction/Overview Types of healthcare settings Types of laboratories Types of laboratory tests and what they mean How Infection Preventionists use this information to do their job Infection Prevention--laboratory communication what each needs from the other Dissemination of information across the organization to the people that need it 5 What settings does your healthcare organization include? Hospital Community University Rural Nursing Home Rehabilitation Center Home Care 6 2

3 What services does your facility provide? Intensive Care Units: PICU, NICU Transplant Service Dialysis Research Location near international airport Elder Care 7 What kind of laboratory support do you have? Hospital Community University Commercial Reference laboratory State laboratory CDC 8 Questions to ask the laboratory: What are the hours of operation? What tests are performed on site? What tests are sent to reference or state laboratories? What are turnaround times for the tests that I most often need? What is the best test to tell me what I need to know? Who are my contacts in the laboratory? 9 3

4 Review of tests for infectious diseases 10 Laboratory Structure Clinical laboratories are organized into departments or disciplines of related areas, some are sub-divided Microbiology Chemistry Hematology Blood Bank Histology Cytology You may need information from several of these departments 11 Indicates quality of specimen Guides further laboratory testing Guides treatment Can suggest a viral versus bacterial infection Can help guide initial antibiotic therapy Gram Stain 12 4

5 Other direct specimen stains Acid fast stain Very important for Infection Prevention The criterion for airborne precautions for tuberculosis Direct fluorescent stains Can identify some pathogens like Legionella, viruses May include a new technology called PNA- FISH 13 Rapid direct specimen antigen tests Examples Group A Streptococcus Influenza RSV Value Interpretation Performance; good and bad 14 Bacterial Cultures Recovers and identifies bacterial organisms Includes antibiotic susceptibility testing Can do further testing like strain typing Can be quantitative to help differentiate pathogens from normal flora Can distinguish different strains of the same species 15 5

6 Blood Cultures Collection Timing Amount Processing Time Preliminary Results 16 Stools Collection and Handling: Enteric pathogens Ova and parasites C. difficile Rotavirus 17 Tuberculosis Appropriate specimens Acid fast stain Culture and organism identification Conventional culture and molecular testing Timeframe Antibiotic susceptibility testing The new blood tests for tuberculosis; IGRAs 18 6

7 PCR Assays Viral Influenza RSV Bacterial Chlamydia trachomatis and Neisseria gonorrhoeae MRSA VRE C. difficile 19 Infectious disease serology tests IgM tests; for acute infections IgG tests; for chronic infections and tests of immunity Definitive for some reportable infectious diseases Hepatitis A, B, C, D, E HIV 20 Immune Assays IP- Assists with Isolation precautions Exposure control /Post-exposure Prophylaxis Communicable Diseases Bloodborne Pathogens Immunization Hepatitis B Measles Chickenpox 21 7

8 Antibiotic susceptibility testing Designed to detect resistance Based on evaluation of specimen: Qualitative (Gram stain, organism identification) Quantitative (amount of growth) Antibiotic susceptibility profile can also be used by infection preventionists to distinguish different strains of the same species 22 Viral load testing Viral load is the number of copies of the virus found in the patient s blood Goes up as the infection gets worse, goes down if treatment is successful HIV Hepatitis B 23 Tests for fungal infections Wet mount for vaginal infections Antigen tests for cryptococcal meningitis Culture for fungi and antifungal susceptibility testing 24 8

9 Communication: a Two-Way Street Laboratory Infection Prevention 25 Communication Surveillance Outbreak detection and management Antimicrobial Stewardship Infection Prevention Committee Infection Prevention Risk Assessment and Plan 26 Surveillance What is reported to IP? All results? Positives? Active surveillance screens? And how? Printed report Phone call Electronic interface 27 9

10 Surveillance: Electronic Systems Select system that meets needs of multiple departments Interface: Lab IP Pharmacy EMR 28 Surveillance: Critical Values Select critical values: Positive BC, CSF Communicable diseases MDRO s How are critical values communicated? Electronic Alert Phone Fax 29 Reporting Requirements: Communicable Diseases Who reports what and how? Check state regulations Laboratory findings alone or chart review required? Sexually Transmitted Infections HIV Meningitis Hepatitis Tuberculosis 30 10

11 Reporting Requirements: Healthcare Associated Infections Active Surveillance Cultures Why are we screening? What are we screening How often? 31 Reporting Requirements: Healthcare Associated Infections NHSN Surveillance definitions include some laboratory test criteria Bloodstream infection Urinary tract infection Ventilator-associated pneumonia Surgical site infection Outbreaks Trends Notification Real vs. Pseudo-outbreak Molecular typing 33 11

12 Antimicrobial Stewardship Susceptibility result reporting Guide antibiotic treatment What s on the panel? Suppress reserve antibiotic or cascade based on resistance Can include cost of antibiotics 34 Antimicrobial Stewardship Cumulative Antibiograms Indicates resistant trends Published at set time intervals Can be unit specific Guides prioritized interventions 35 Committee Participation Microbiology contribution to infection prevention issues Available resources for planned activities Contribute to Risk Assessment and Plan 36 12

13 Collaborative Planning Discuss with lab: Routine Environmental Cultures When and how often Active Surveillance: Cultures vs. PCR How many? Cost? Outbreak Need it NOW! 37 Collaborative Planning: Special Projects Reduce blood culture contamination More efficient use of lab time Better treatment of patients Product or process evaluation Central line catheters or needleless systems 38 Dissemination of Information 39 13

14 Educate Clinical Staff Appropriate tests New tests Collection of specimens Turnaround times Critical Value alerts Test Interpretation Use of Antibiograms 40 Share your Knowledge Clinical and other staff: hand culture demo Environmental Services: pathogens on surfaces Hemodialysis: acceptable colony counts Rehabilitation Therapists: coliform bacteria in pool

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