The global issue of antimicrobial resistance is of urgent importance and one that can no longer be viewed as not a U . S . issue . From ongoing HAIs to antifungal and other viral and parasitic resistance , the need for real-time communication between the medical laboratory and IP / epi is a necessity for healthcare and public health .”
of COVID testing , and the advent of COVID created many new testing opportunities for hospitals , clinics , businesses and industry .”
Rohde adds that due to the highly contagious nature and severity of the infection , “ Physicians , nurses , and other healthcare professionals had to rethink , re-engineer , and remodel how the patient room and their care would be designed . They had to do this in real time without historical data . This virus was so unknown that we were using influenza as an example and that turned out to be a poor surrogate because of so many asymptomatic carriers . Typically , we know when someone is sick due to signs and symptoms . Not always true with COVID-19 .”
Rohde continues , “ We must also address the overall mental and emotional health of healthcare workers , especially frontline workers . There was a real fear among healthcare personnel , including the clinical laboratory workforce , regarding the lack of PPE and how dangerous this microbe was to their own health .”
He adds , “ This leads me to the impact on clinical lab services . Hospitals and other medical facilities were dealing with massive financial loss due to the cancellation of elective procedures and the disruption of routine care . While we know the clinical / medical laboratory was working non-stop to get COVID-19 testing volume , efficiency and accuracy up , on the other side of the coin , the laboratory was experiencing a dramatic reduction in other testing in some facilities due to all of these cancellations of elective procedures or routine care ( such as annual physical examination , cancer screening , etc .). Ultimately , and in many ways ironic , due to these losses in finances , healthcare organizations often had to cut costs by the release or reduction of their workforce or to pivot to remote work , including clinicians working with telehealth technologies . I had reports from my own medical laboratory alumni and colleagues around the country who told me that people in the medical laboratory were losing hours or jobs . On the other hand , there were also reports of the medical laboratory workforce being worked to exhaustion and burnout once COVID-19 testing was FDA emergency approved . ‘ Doing more with less ’ seemed to become the common workplace policy in the laboratory . This is an ongoing issue today .”
Going forward it is also essential that clinical lab services and infection preventionists and hospital epidemiologists improve their communication and collaboration post-COVID .
“ The global issue of antimicrobial resistance is of urgent importance and one that can no longer be viewed as not a U . S . issue ,” Rohde emphasizes . “ From ongoing HAIs to antifungal and other viral and parasitic resistance , the need for real-time communication between the medical laboratory and IP / epi is a necessity for healthcare and public health . In my experience , one of the best paths to put this communication in motion is to work with not only IP / epi but also pharmacy , nursing , and physicians . There is quite a bit of research and effort being shown to improve this communication via antibiotic / antimicrobial stewardship efforts like nudging . Efforts such as being a ‘ stewie ’ champion , alongside nudging and implementing appropriate antibiotic breakpoints in medical laboratories are practical tools that have shown positive outcomes . Likewise , the development of cross-functional teams and end users input for communication and team building is critical especially in technology / information sharing as well as standard IP / epi regular meetings and communication in-person and virtually .
As Benbachir ( 2018 ) acknowledges , “ The CML is tasked with accurate , consistent and rapid identification of infectious agents at the species level and to identify any potential antibiotic / antimicrobial resistance patterns .”
The Centers for Disease Control and Prevention ( CDC ) has outlined the ways in which microbiology laboratory staff can impact antibiotic stewardship programs . In its Core Elements of Hospital Antibiotic Stewardship Programs ( 2019 ) it indicates several areas where the activities of CML personnel , as part of the antibiotic stewardship program team , have been expanded . As the CDC ( 2019 ) acknowledges , “ It is important for the members of the antibiotic stewardship program to regularly communicate and collaborate . This can be challenging in instances where laboratory services are provided offsite from clinical care settings and there is not daily interaction between clinical infectious diseases , stewardship program , and microbiology personnel .”
The CDC ( 2020 ) recommends that CML personnel should be integrated into the functions of the antibiotic stewardship program , explaining that , “ Their expertise is important in the areas of diagnostic stewardship , development of antibiograms to support optimal antibiotic use , the introduction of new diagnostic tests into the laboratory , the implementation of new antibiotic susceptibility testing interpretative criteria , and education of clinicians on laboratory testing practices .”
It also advises the support and promotion of education and communication between the laboratory and clinicians about test characteristics ( e . g ., test performance , expected turn-around-time , etc .). Specifically , it says that clinicians should be educated about how specific tests should be used in clinical situations , including whether a particular test is better for ‘ ruling in ’ or ‘ ruling out ’ a condition . The CDC adds that whenever possible , test characteristics should be communicated in the electronic health record at the point of ordering . Clinicians should also be educated when new tests or order sets are introduced within the healthcare facility .
For the future , Pearce advocates for an increase in “ routine training , such as seminars , articles and continuing education , that includes forward-think-