In an earlier blog, I explored the laboratories role in infection control. In this follow up, I will offer 8 tips for how the microbiology lab can support infection control and surveillance.

The effectiveness of infection control efforts hinges to a large extent on the active involvement of the microbiology laboratory in all aspects of the infection control/surveillance program.  Laboratory personnel should understand why infection control is necessary, the approaches being taken by the infection control program to meet its objective to reduce nosocomial infections, and how the laboratory can support and cooperate with the program.

Liaison to Clinical Services: Designate at least one person from the microbiology laboratory to be the consultant to the infection control program and to serve as a member of the infection control committee.

Any activity of the infection control program that involves the laboratory should be coordinated through a designated person.   This representative should keep the infection control program informed about changes in the laboratory that may affect surveillance and other aspects of the program. This person should be selected for his or her knowledge of and interest in infection control.

Make laboratory test results available in an organized, easily accessible, and timely manner.

The infection control program depends on the cooperation of the laboratory in making laboratory data accessible. The design of the laboratory’s record-keeping system should accommodate the needs of the infection control program and should be developed in collaboration.

Provide training on basic microbiology for the infection control program staff.

Most beginning members of Infection Control Programs do not have a working knowledge of microbiology and will require training before they are able to effectively use the laboratory services for the infection control program.

Monitor laboratory results for unusual findings.

The laboratory should watch for clusters of pathogens that may indicate an outbreak, the emergence of multidrug-resistant organisms, and the isolation of highly infectious, unusual, or virulent pathogens. The laboratory staff is usually the first to recognize these unusual events or trends, and reporting them early to the infection control program may avert a more serious problem.

Use environmental cultures judiciously.

Microbiology laboratories are often asked to perform environmental cultures to assess microbial contamination of inanimate objects or the level of contamination in certain areas of the hospital.  Such culturing must be coordinated with the infection control program to ensure that it is performed only when indicated and that the specimens are processed appropriately. Environmental cultures, including personnel cultures, should not be done unless epidemiologic evidence clearly indicates an environmental source of the pathogen. Under these circumstances, information about the etiologic agent can often lead to a clearer understanding about the source of the infection and mode of transmission.

Take proper action when contamination of a commercial product is suspected.

Contamination of commercially produced products or devices during manufacture or transportation is rare. If intrinsic contamination is suspected, the hospital laboratory should not attempt to culture the product or device, since special techniques and equipment are required… If substantial patient disease or mortality is occurring, notify your state health department. The Hospital Infections Program at CDC can assist in an investigation if invited to do so by the state health department.

Epidemiologic uses of laboratory findings.

Laboratory findings are used to support epidemiologic evidence of the spread of a common organism between patients, employees, and the environment. Strain identification permits the infection control program to confirm the association between patients (hosts) and reservoirs for the microorganisms of interest and to determine possible modes of transmission. The mode of transmission, reservoir, and nature of the susceptible hosts are easier to determine if a single strain is involved, because the mode of transmission or reservoir may not be the same for multiple strains.  The degree to which organism identification is routinely carried out can be important.  In general, identifying an isolate as Pseudomonas cepacia provides more useful epidemiologic information than identifying the organism only as “Pseudomonas species,” since a variety of related bacilli could be included in the latter group but have different reservoirs or modes of transmission. The laboratory should assist the infection control program by making clear the strengths and weaknesses of different assays when they use them for epidemiologic purposes.

Store isolates that may require further identification for epidemiologic purposes.

In collaboration with the infection control program, the laboratory should develop a system for storing epidemiologically important strains of pathogens from nosocomial infections by sub-culturing them and maintaining them in a viable state. The collection should be reviewed frequently, and isolates should be discarded when they are no longer needed.