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The Key to Preventing C. difficile? Reducing Antibiotics—Part 3

NOV 24, 2017 | KRISTI ROSA
[To help with faster lab results,] there is new technology that has come out that’s available. These are fast ID and susceptibility systems, and IPs have to work with the lab to support them. [Adopting these technologies] should be driven from the clinical side, with IPs supporting the lab to get this technology. What often happens, though, is a disconnect between IPs and the lab, because everything goes into electronic medical records (EMRs). And so, IPs get EMRs in their offices, and they’re able to look at all the cultures from there. In the old days, we would go to the lab in the morning, find out what was going on with gram stains and blood cultures and any unusual organisms, then head up to the ICU and see all the sickest patients, and do our rounds. Now, the IPs are chained to their desks, doing surveillance for the CDC’s National Healthcare Safety Network (NHSN), and not going out doing what they should be doing—which is surveillance out on the floors consulting, providing education, and visiting departments. It’s created a big crisis in infection prevention—the NHSN system—without the support IPs should have had for data analysts to help us navigate the system. 

The laboratory needs support, too, probably through the ASP committee. Through that committee we can all make a case for the lab to get a very rapid system. If we have the PharmD showing the days of therapy and how they could reduce it, the IPs reducing the adverse outcomes, and nursing and critical care and sepsis coordinators all making a business case so that the lab—whose budget is going to go up—can be left alone, then we can say, ‘We’re going to support you clinically.’ But that’s not what happens. Often, it’s left to the lab, and the lab gets shut down.

There’s also a new machine available that will do a blood culture from a half a cc of positive blood, the Accelerate Pheno System. It will automatically identify an organism and its sensitivity within 7 hours, whereas typically, you wait anywhere from 2 to 5 days. When that kind of technology comes out and starts to get adopted in more hospitals, then patients—who are getting more savvy these days—can say, ‘You didn’t use the more rapid, fast technology, and I got an infection because I sat waiting for days; I got C. diff on top of it.’ There are now some legal suits that are going along those lines. Patients are feeling that they’re not having the advantage of some of this more rapid and fast technology for either ID of the organism alone, or the antimicrobial sensitivity. This new system combines the two together.

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