Partners in Prevention: Raising the Profile of the Clinical Microbiology Laboratory in Ongoing HAI Control and Outbreaks
By Kelly M. Pyrek
The clinical microbiology laboratory (CML) plays a critical role in the surveillance, treatment, prevention and control of healthcare-acquired infections (HAI), working alongside infection preventionists and healthcare epidemiologists. The major importance of medical microbiology is that it helps in the identification, isolation, diagnosis, and treatment of pathogenic microorganisms.
For example, the diagnosis of bloodstream infections (BSIs) is one of the most critical functions of CMLs. But they also help establish an etiologic diagnosis of infections within the central nervous system, such as meningitis and encephalitis; soft tissue infections; upper and lower respiratory tract bacterial and fungal infections, including hospital-acquired and ventilator-associated pneumonias; gastrointestinal infections; bone and joint infections; urinary tract infections, including catheter-associated urinary tract infections (CAUTIs); genital infections; viral syndromes, and others.
As the American Clinical Laboratory Association (ACLA) observes, “America’s clinical laboratories serve as the foundation for early diagnosis, prevention, and personalized care for millions of patients. From routine blood tests to ground-breaking genetic and molecular diagnostics, clinical laboratories play a vital role in improving patient outcomes and quality of life while delivering better value for the health system. Clinical laboratories serve as a driving force in medical innovation. The growing demand for laboratory developed tests – clinical diagnostics that are often designed in response to unmet clinical needs – has revolutionized our approach to patient care and provides an essential foundation for future medical breakthroughs.”
The complexity of the healthcare landscape is reflected in the escalation of the importance of CML services and the need for flawless analysis, observe Miller, et al. (2018) who explain, “Unlike other areas of the diagnostic laboratory, clinical microbiology is a science of interpretive judgment that is becoming more complex, not less. Even with the advent of laboratory automation and the integration of genomics and proteomics in microbiology, interpretation of results still depends on the quality of the specimens received for analysis … Microbes tend to be uniquely suited to adapt to environments where antibiotics and host responses apply pressures that encourage their survival. A laboratory instrument may or may not detect those mutations, which can present a challenge to clinical interpretation. Clearly, microbes grow, multiply, and die very quickly. If any of those events occur during the preanalytical specimen management processes, the results of analysis will be compromised, and interpretation could be misleading.”
The journey begins when the infectious disease physician or healthcare epidemiologist needs some basic data from the CML, including answers to three critical questions, “Is my patient’s illness caused by a microbe? If so, what is it? What is the susceptibility profile of the organism so therapy can be targeted?” according to Miller, et al. (2018) who add, “To meet those needs, the laboratory requires a specimen that has been appropriately selected, collected, and transported to the laboratory for analysis. Caught in the middle, between the physician and laboratory requirements, are the medical personnel who select and collect the specimen and who may not know or understand what the physician or the laboratory needs to do their work. Enhancing the quality of the specimen is everyone’s job, so communication between the physicians, nurses, and laboratory staff should be encouraged and open with no punitive motive or consequences. The diagnosis of infectious disease is best achieved by applying in-depth knowledge of both medical and laboratory science along with principles of epidemiology and pharmacokinetics of antibiotics and by integrating a strategic view of host–parasite interactions. Clearly, the best outcomes for patients are the result of strong partnerships between the clinician and the microbiology specialist.”
Read further from the July 2022 issue HERE