One crucial yet potentially underused partnership in the battle against healthcare-acquired infections (HAIs) is that between the infection preventionist and the clinical microbiology laboratory (CML) professional.
Pfaller and Herwaldt (1997) point to the symbiotic relationship and describe the roles of each party: “The work required of the clinical microbiology laboratory and of the infection control program has become increasingly demanding, and intertwined as the decade of the 1990s has progressed. To do their jobs effectively and efficiently, these two groups must work as a team, using the expertise from each discipline to improve patient care. As in the past, the microbiology laboratory must be able to detect and identify microorganisms so that the clinicians can diagnose and treat established infections and the infection control team can monitor, prevent, and control infections in the hospital environment. Given the rapid changes in nosocomial pathogens, in medical care, and in healthcare delivery, staff members from the laboratory and from infection control must collaborate continuously and must communicate openly. The relationship between the microbiology laboratory and the infection control program is critical to the success of both groups.”
That relationship has been threatened in recent years when, in a cost-containment effort, managed care attempted to “restructure, centralize or consolidate laboratory services, including clinical microbiology laboratories, into larger working groups that serve multiple hospitals and retain fewer staff with dedicated microbiology expertise,” according to Peterson, et al. (2001). Peterson noted that this restructuring was occurring at a time when infectious diseases rose from the fifth leading cause of death in the U.S. to the third leading cause (a 58 percent increase), and while multidrug-resistant organisms were now seen routinely in community and hospital settings. Peterson, et al. (2001) observe, “In addition to detecting infectious microbes and determining useful therapy, laboratories of the 21st century must now recognize new pathogens and support the national infrastructure needed for surveillance to ensure food safety and counter bioterrorism. Meeting these challenges may not be compatible with the current administrative strategies for laboratory restructuring and/or consolidation.”
Constriction of CMLs parallels the ongoing struggles infection prevention and control departments have with securing increased staff, resources and funding in order to perform basic functions. One such function both parties have in common is surveillance. Recent focus on emerging infectious diseases, pandemic outbreaks and even bioterrorism calls for stepped-up surveillance efforts. Canton (2005) notes, “Clinical microbiology laboratories play a pivotal role in these programs. They have the first opportunity to detect these problems and should participate in the design of reporting strategies and dissemination of this information ... early implementation of response strategies should be designed and performed with the cooperation of microbiology laboratories, and intervention and response protocols should be defined with the participation of clinical microbiologists.”
Thus acknowledging its critical role, what is the average CML’s capacity? Diekema, et al. (2001) state that although CMLs play an important role in supporting infection control efforts, there is a paucity of data to describe the extent to which CMLs provide these supportive functions. The researchers surveyed 109 CML directors in a national study to assess measures recommended to support resistance-control efforts. Among 75 surveys returned 70 CMLs use automated susceptibility testing, but only 36 CMLs reported using confirmatory tests for ESBL detection. The study also revealed that CMLs usually participate (82 percent) on the infection control committee, but only 59 percent are involved in antibiotic formulary decisions. The CML compiles antibiograms for physicians and infection control staff at most hospitals (82 percent). CML representation on the IC committee is associated with CML involvement in formulary decisions, compilation and frequent updating of the antibiogram. Most (87 percent) CMLs immediately notify the infection preventionist when an important pathogen is detected.