Role of medical technologists in the infection control team

The infection control team (ICT) plays important roles in many different aspects of infection control. They include (1) surveillance for hospital-acquired infection, (2) developing the infection control manual, (3) checking that the manual is followed correctly, (4) giving information about the isolation of microorganisms in the hospital, (5) educating and instructing medical staff, etc. Many data have been accumulated on a database in the microbiology laboratory. Bacterial samples are also examined in the microbiological laboratory therefore medical technologists will be the first to notice hospital-acquired infection. Offering prompt information, obtained by surveillance or routine work, greatly contributes to infection control. Furthermore, a 24hr system for the microbiological laboratory may prevent occupational infection of health care workers. The role of the medical technologist in ICT is thus important. To prevent outbreaks of infection, the regional network is also important for the collection of information about the pathogen and the susceptibility of antimicrobial agents in the region. The medical technologist should participate in and communicate with this network. As mentioned above, the inclusion of medical technologists in infection control practice is essential. To participate in the ICT, medical technologists need to have communication skills, and be recognized by other team members as an essential member.     

Critical role of clinical laboratories in hospital infection control

The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.     

Roles of Department of Clinical Laboratory in infection control

The Department of Clinical Laboratory plays an important role in the hospital and has much information about patients and pathogens. Laboratory data are essential to support clinical physicians who diagnose and treat patients. For nosocomial infections, laboratory-based surveillance is recognized as essential to confirm outbreaks. Therefore, the role of the Department of Clinical Laboratory is very important in infection control. In Tohoku University Hospital, we have an Infection Control Unit located in the Department of Clinical Laboratory. The core role of the Infection Control Unit is diagnosis, treatment and preventative healthcare associated with infections. The Infection Control Team (ICT) performs rounds in the hospital (The ICT members are ICN, ICD, a microbiological technologist and a dietician), consultations about clinical cases, infection control, and organize the regional infection control network, "Miyagi Infection Control Network". The ICT rounds are performed once a week in two wards, and two times a year for one ward. The consultations are an important role of the ICD, and concern clinical infection cases and infection control in our hospital and the other regional hospitals, and produce advice on appropriate clinical information. The regional network is important for the collection of information about the pathogens and the susceptibility of antimicrobial agents in the region. "Miyagi Infection Control Network" has held a forum 5 times a year from 1999, and 300-400 healthcare workers join the forum and discuss infection control.     

The associated law and the authorization for medical technologists that are necessary for clinical microbiological technologists

In a clinical microorganism test domain, high quality laboratory study results are demanded, and quality control administration (QM: Quality Management) of laboratory studies with a guarantee of accuracy (QA: Quality Assurance) and high quality examination methods (GLP: Good Laboratory Practice) is indispensable. Maintenance of an appropriate legal system is necessary, including competent staff, a budget, and facilities for continuous monitoring. The associated law and the authorization for medical technologists that are necessary for medical technologists in charge of clinical microorganism examinations are explained: 1) Medical technologists are mainly concerned about the present conditions of duty restrictions, 2) Certification for clinical microbiological technologists and infection control microbial technologists (ICMT), 3) Nosocomial infection measures well informed person meeting report started to the special functioning hospital head on departmental order October 3, 2003, 4) ISO15189 2003, which is the international standard specifications for clinical laboratory quality and identification requirements (conformity range and management requirements for clinical microorganism tests ISO15190) for conformity ability mentioned security requirements for clinical laboratories.     

In terms of infection control team(ICT)

We think it is important to make up a medical team for the infection control in the hospital since patients admitted often turn to compromised hosts who possessed the high risk to provoke the possible transmission of nosocomial infections. Infection control team(ICT) under the infection control committee(ICC) was established in our Yamagata University Hospital at the 1994 April. Members of the ICT are composed of staffs at various sections: physicians, pharmacists, nurses, clinical laboratory staffs, a neutrionist and administration office staffs, with the aim of preventing the nosocomial infections. Twenty three staffs of ICT who are specialist at each section have practiced the round of wards, leading in hand-washing, checking of the proper use of antibiotics and disinfectants, making and revising of the infection control manual, follow-up of the route of infection, and a countermeasure of prevention for needle pad accidents, etc. Furthermore, ICT has exerted all possible efforts of various investigations for infections when it is necessary. Problems that are faced our ICT are the construction of a network an inter-net among clinical divisions, nursing, pharmacy and clinical laboratory, and a system of the centralized management is actualized thereby.     

Central clinical laboratory and infection control team: an essential partnership controlling health care-associated infections

Infection Control Committee (ICC) of Akita University Hospital was established in 1980's, when methicillin-resistant Staphylococcus aureus (MRSA) spread in teaching hospitals in Japan. After 20 years from the establishment of ICC, we needed to shake up some of the outdated infection control systems. Infection Control Team (ICT) was established in 2002 to reinforce ICC. ICT was consisted of five infection control doctors (ICD), two infection control nurses (ICN), two medical technicians in bacteriological division of clinical laboratory, one pharmacist and three administrative officials in the hospital. Monitoring of multiple drug-resistant pathogens, antibiotic use, surgical site infections and bloodstream infections are mandatory. Personnel training and educational activity are also required. After the establishment of ICT, inappropriate use of antibiotics and prevalence of MRSA were dramatically decreased. The hospital saved more than 30,000,000 yen annually. However, with a great regret, we experienced an outbreak of MRSA in a department of our hospital in 2003. MRSA infection was judged as a cause of death in three patients in the outbreak. MRSA was thought to transmit via medical personnel since pulsed-field gel electrophoresis revealed common genotype in 11 out of 15 patients studied. Prevention of healthcare-associated infections is a crucial in the management of hospitals. In this paper, we verified the efforts to control the outbreak and analyzed factors interfering infection control activities. A crucial role of a clinical laboratory in controlling healthcare associated infections was also discussed.     

Desirable role of the clinical laboratory in hospital infection control

Prevention of hospital-acquired infection is the most important strategy to control infection in terms of the well being of patients and the medical economy. Infection control in hospitals is carried out by the action against hospital-based infection, for which clinical laboratory functions, such as surveillance and outbreak investigation, should be primary responsible. Therefore, it is essential for clinicians to have clinical laboratory rapidly detect pathogenic organisms and provide new and update information on appropriate antibiotics and clinical isolates. It is also desirable for clinical laboratory to collaborate with infection control team (ICT) and link nurse, and provide them with useful information on on-going infection.     

Importance of a network construction with each division and clinical laboratory in the hospital--from a ground of the infection control nurse

To reduce the frequency and extent hospital infection, the infection prevention team is required to work properly. Infection control nurses play various roles in the infection prevention team, including surveillance of the occurrence of infection and checking the actual conditions of infection prevention activities, as well as the communication and coordination with other sections. Thus, they take part in almost all the activities of the infection prevention team, except the diagnosis and the medical treatment of infectious diseases; that is to say, they make reports, communicate, consult and cooperate with the staff members of other sections. As for surveillance, the results of microbiological tests by a laboratory are most important. By feedback regarding the results of surveillance measures against infection, infection prevention activities become more effective. The staff members of the microbiological laboratory and the infection control nurses can obtain information about the outbreak of infection at an early stage, which is critical in infection prevention activities. Therefore, good cooperation between nurses and the laboratory staff facilitates prompt and appropriate actions to prevent further spread of infection. The test section, especially the microbiological laboratory, is the most important section with which the infection control nurses should work in close cooperation.     

Detection of drug resistant bacteria and correspondence of microbiological laboratory to clinical physicians

The world is now being faced with the battle for antimicrobial resistant organisms(ARO), such as MRSA, PRSP, ESBL producing GNR, MDRP and VRSA. These AROs are causing hospital-acquired infections(HAI) by the way of person-to-person transmission. The role of microbiological laboratories in hospitals is quite important in controlling HAI. Firstly, accurate detection of AROs is essential. They have to be proficient in both isolation and detection of AROs. Secondly, they have to return the results rapidly for not only clinicians but infection control team(ICT) to prevent more spread of HAI if an isolated organism is ARO. Thirdly, they have to report the statistical data about isolated organisms for ICT in each hospital. AROs can be isolated by three major methods, detection of responsible resistant genes or proteins and antimicrobial susceptibility tests. Most laboratories isolate AROs, using one or two of these methods. They should be prepared for and follow the most current criteria of AROs by Japanese original standard, or presented from NCCLS. Microbiological laboratories should also play a role in both hospital epidemiology and appropriate antimicrobial use by providing useful information, annual or periodical reports of antimicrobial susceptibility for isolated organisms which are relevant in their hospital. The microbiological laboratory which have good skills in detecting AROs, analyzing epidemiological data and communicating with all hospital workers, is now required from ICT in controlling HAI.     

Role and future aspects of hospital clinical laboratories in medical team approaches

The recent progress in medicine increases the routine works of the physicians or nurses and decreases the chances to obtain the new information on the laboratory medicine. Although the patients desire to know their test results in detail, it is likely to be difficult to obtain them from the physician in charge. Thereby, the quality of the medical services may be deteriorated. In these situations, needs of the medical team approaches in which the medical technologists (MTs) in the hospital laboratories participate are increasing. In Japan, there are a variety of medical team approaches in which MTs are involved. In our university hospital, MTs play important roles in the infection control team (ICT), in the nutrition support team (NST), in the educational class for the patients with diabetes mellitus, in the clinical research center, in the order-made medicine realizing project, in the infertility center and in the laboratory information room. In April 2010, the new payment system for the team approaches such as ICT or NST was established. In the future, the team approaches other than ICT or NST could be chosen for the subjects for the payment if they are recognized as important. The goal of the team approaches is to realize a patient-oriented medicine. MTs can reconfirm that they are working as one of the medical staffs through these team approaches. It is important to always find out a possibility of new team approaches.     

Hospital infection and its countermove

Actual activities of Infection Control Team (ICT) in Suzuka General Hospital is reported. Surveillance of hospital infection, feedback of actual information of infection to each fields and ward round by ICT with certified Infection Control Nurse (ICN) can lead good confidence between ICT and other departments. Participation of ICN for ICT is important due to its trans-department activities.     

Cooperation of the clinical laboratory and infection control department in prevention of hospital infections

Recently, environments that surround hospitals are changing every moment, and hospital infections are no exceptions. As medical technology advances and population of the elderly grow larger steadily, so does the number of immune-compromised hosts. Many patients come to hospitals infected, and in such situations prevention of hospital infections has great amount of importance. Cooperation of microbiological laboratory and ICT is indispensable, accumulation and analysis of the data of resistant bacteria isolated from various medical materials are the biggest task of microbiological lab. Furthermore, nutrition support based on the values of clinical examinations is set as the ultimate goal and NST's cooperation plays a big part in supporting the control of hospital infections.     

Use of a computer-assisted simulation system in undergraduate education of laboratory technologists

In the undergraduate education of laboratory technologists, practical training courses in a hospital are extremely important to gain knowledge, skills and attitudes. In present laboratories, however, senior technologists have less time for teaching their juniors because of increased demands of hospital tasks. To supplement practical training of students, we therefore decided to employ clinical simulation teaching materials using a computer assisted education system. First, a series of e learning coursewares on laboratory tests for blood transfusion were created using pictures taken during our daily work. The pictures were arranged with questions, answers and commentaries, uploaded to the server in our university, and offered to the students. They were received with high rates of student satisfaction. Since e-learning seemed to be an effective and enjoyable strategy to achieve good learning outcomes, it is desirable to establish an organization to collect peer reviewed high quality e learning materials that can be shared with nationwide educators teaching tomorrow's laboratory technologists.     

What laboratories in hospitals should be?--report from a teaching hospital

The author gave personal opinions regarding what the clinical laboratory in a teaching hospital should be. It is very important to raise the level of medical care and maintain it in city hospitals. The success of teaching programs depends on a high level of medical care. The author would like to emphasize several policies for the management of the clinical laboratory: 1) establishment of routine works, considering that the field of the clinical laboratory is "from patient to patient", not "from receipt to report", 2) change of the position on medical care from one of support to one of connection, 3) use of intelligence and arts (technologies) that medical technologists and laboratory physicians have acquired through the practices of the clinical laboratory, for example, quality control, system making, objective analysis of data, high mobility, etc., and 4) teaching the methods of the clinical laboratory to young trainees and professionals. The clinical laboratory in a hospital should contribute to raising the level of medical care, and medical technologists and laboratory physicians should perform tasks with spirit, humility and responsibility as professionals.     

In a disaster, what should medical technologists at a university hospital do? What do they have?

"Disaster medicine" involves "cases that cannot be supported by the normal medical service system of the hospital because many injuries have occurred by an explosion/chemical pollution/radioactive pollution or a pandemic caused deliberately as well as natural disasters". In "disaster medicine", university hospitals should become the base for advanced medical services and wide area transportation. Also, the clinical laboratory/medical technologists of the university hospital should offer high quality laboratory analysis. On the other hand, one of the advantages of a university hospital is an experimental medicine laboratory (integrated universities also have a Department of Science and Department of Engineering). Development of testing equipment to cover all the functions necessary for disaster medicine may be a possibility. A system to conduct simple testing is expected at the actual location of the emergency, and an identification system must be established. "Emergency medicine" and "disaster medicine" have different aspects, but the essence is the same, and medical technologists must have knowledge/techniques to report and interpret results quickly. Because a university hospital is the core of logistical support, daily training is important.     

Surge capacity for response to bioterrorism in hospital clinical microbiology laboratories

Surge capacity is the ability to rapidly mobilize to meet an increased demand. While large amounts of federal funding have been allocated to public health laboratories, little federal funding has been allocated to hospital microbiology laboratories. There are concerns that hospital laboratories may have inadequate surge capacities to deal with a significant bioterrorism incident. A workflow analysis of a clinical microbiology laboratory that serves an urban medical center was performed to identify barriers to surge capacity in the setting of a bioterrorism event and to identify solutions to these problems. Barriers include a national shortage of trained medical technologists, the inability of clinical laboratories to deal with a dramatic increase in the number of blood cultures, a delay while manufacturers increase production of critical products and then transport and deliver these products to clinical laboratories, and a shortage of class II biological safety cabinets. Federal funding could remedy staffing shortages by making the salaries of medical technologists comparable to those of similarly educated health care professionals and by providing financial incentives for students to enroll in clinical laboratory science programs. Blood culture bottles, and possibly continuous-monitoring blood culture instruments, should be added to the national antibiotic stockpile. Federal support must ensure that companies that manufacture essential laboratory supplies are capable of rapidly scaling up production. Hospitals must provide increased numbers of biological safety cabinets and amounts of space dedicated to clinical microbiology laboratories. Laboratories should undertake limited cross-training of technologists, ensure that adequate packaging supplies are available, and be able to move to a 4-day blood culture protocol.     

Desirable medical technologists in a community support hospital

Recently, there have been marked advances in the technological strategies employed in medical examinations. The educational concept to nurture highly capable medical technologists is considered to be a priority issue by not only educators but also employers, even though the medical educational levels have markedly improved in every college and university. It is commonly acknowledged that the results of any examination in the clinical laboratory should be accurate and fed back to medical doctors as soon as possible. The business outline of medical technologists in our hospital is becoming more extensive because we act as a core hospital in the area, and so knowledge regarding many kinds of chemical and transfusion examinations is required in operations performed around the clock. Furthermore, medical doctors, clerical workers, nurses, and volunteers comprise a team of sophisticated workers in our hospital. To accomplish our daily work, character traits such as accuracy, honesty, perseverance, and ability to follow instruction manuals, are the most fundamental and valuable. To nurture a highly career-oriented medical technologist, we propose that the following should be focused on: self-responsibility, reduction of malpractices, economic profitability, brainstorming, education of subsequent generations, and the spirit of cooperativeness and reconciliation. Additionally, it is another basic requirement of competent medical technologists to learn to adapt to laboratory-based changes in their work throughout their career. In conclusion, how to adapt to any social demand and learn strategies in any era should be taught in college or university as well as after graduation because each hospital and institute has a different philosophy and requirements of newcomers. It is important for medical technologists and doctors to develop flexible ways of thinking, although we sometimes might accede to traditional ways.     

Hospital infection control in 21st century, the importance of networking with each division and clinical laboratory in the hospital. 1. From the aspect of clinical laboratory division

Clinical laboratory division plays an important roll for the management of nosocomial infection. Staff from clinical laboratory division including technologist and/or medical doctor can work as a part of infection control team. Since the bacterial surveillance data from clinically isolated strains accumulates in the clinical laboratory division, these staff have a chance to notice outbreak in hospital at first time. While handling information from each strain, we need to feedback these data with additional information for physicians. From June, 2000, a national project started. That was a surveillance program for drag-resistant bacteria. We can compare information from local isolates and nation-wide isolates by this project. Genotypic methods especially pulsed-field gel electrophoresis(PFGE) is suitable for the identification of infection route in the hospital environment. And PFGE analysis for pathogenic strains works effective in our hospital.     

Advantages and disadvantages of outsourcing hospital microbiological testings

In Japan, laws and ordinances were enforced to relax the regulation of the clinical laboratory setting in hospitals by revising the law of medical institutions in 2001. For this reason, outsourcing hospital microbiological testing, particularly by medium- or small-sized hospitals, was encouraged. The advantage of outsourcing microbiological testing is promotion of an efficient hospital management by cost saving. In contrast, the disadvantages are as follows: deterioration of specimen quality by extension of transportation time, delay in reporting by an independent laboratory compared with that by a hospital-based laboratory; this report is generally obtained within 1 or 2 days, difficulty and lack of communication between the laboratory staff and physician, and deterioration of the value of the microbiology report and the quality of the infection control system in a hospital. In addition to performing profit-related maintenance, independent laboratories should strive hard to maintain the same quality as that of a laboratory registered in a hospital. Furthermore, the new role of independent laboratories demands them to have a system allowing instant communication of information regarding the crisis control of infectious diseases to a hospital.