Monthly Archives: February 2013

“Microbiology Committees, What works and what doesn’t”

Confessions of a Microbiologist,

These thoughts are based on several years experience sitting on microbiology, infection control and antimicrobial stewardship committees.

Committees per se get bad press. Just click here for some negative quotes on committees! However I don’t think they are always as bad as made out, and are probably a necessary evil in order to avoid autocracies and dictatorships.

Here is what I think works and doesn’t work on committees, microbiology committees if you like…

What works:

  • Having Internet access and electronic access to policies within the meeting room. No excuse for not having this facility in the digital age.
  • Small number of people on the committee. Any more than six and it’s an uphill struggle for any kind of consensus. Plus it takes an age for everyone to have their say….
  • Making a decision on every agenda point. Make deferring a decision a last resort as opposed to the norm. If the decision is “wrong” it’s usually not the end of the world anyway.
  • Strong chairpersonship. Striking a balance between giving everyone their say, and moving through the agenda. Also important for getting decisions made, as above.
  • “Guest appearances”. Attendance at meetings from people in specialised areas when required can be very useful. Make them feel welcome , and important.

What doesn’t work:

  • Reporting to another committee. A committee reporting to another committee can be too much bureaucracy to bear sometimes. Happens all too often in large institutions.
  • Disengaged committee members. Committee members that don’t want to be there of little use. Best to replace with willing participants where possible.
  • Sub-committees. Theoretically sounds like it might be a good idea. In my experience though, virtually useless.
  • Silence. A non-contributor in a committee meeting may as well not be there.
  • Long meetings. Two hours is my concentration limit. This seems to be getting shorter as I get older!
  • The name “committee” as already mentioned does not always carry good vibes. Could consider replacing it with something more original.

What sometimes works:

  • Skype, teleconferencing. Obviously gets round the distance issue, but sometimes there is nothing quite replaces face to face interaction….

Michael

p.s. I have added a few MCQs on Staphylococcus aureus

 

“Falling at the Last Hurdle.”

The Art of Microbiology, ,

You may have a fantastic paperless processing system in your laboratory. You may have modern up to date technology and automated methods. You may even have low turnaround times and great QC results….

However if that urgent or important result is mistakenly phoned to the cleaner on the ward, then you have a problem.

"A laboratory telephone?"
“A laboratory telephone?”

 

In the digital age, audit trails within the laboratory are generally becoming very good. We can tell exactly who did what, when and why. However where there is still the potential to fall down is outwith the laboratory.

If a result is being phoned, it is critically important to find out who is on the other end of the phone, what their designation is (and whether they are suitable to receive the result), and then document this information.

Only with this information at hand, can the vertical audit trail be completed.

The cleaner may be good at getting rid of Clostridium difficile spores after the patient has moved on, but not so good at treating the infection……

Michael

p.s. Busy schedule this week, not much chance so far to add resource content to the website.

“MRSA, MSSA and resistance v virulence”

Antimicrobial Resistance, The Science of Microbiology, ,

There are three sound reasons why mortality in sepsisStaph aureus culture due to Methicillin Resistant Staphylococcus aureus (MRSA) is higher than that of Methicillin Susceptible Staphylococcus aureus (MSSA).

 

  • If the patient is put on initial treatment that just covers MSSA and not MRSA, then effective therapy may be delayed.
  • The antibiotic most commonly used for treating sepsis due to MSSA (flucloxacillin, cloxacillin) is a more effective antibiotic than that usually used for MRSA sepsis (vancomycin)
  • The cohort of patients with MRSA sepsis tends to be a “sicker” cohort (ie more co-morbidities, more prior antibiotics, more hospital admissions etc) than that of patients with sepsis due to MSSA. (This is particularly true for “hospital type” MRSA strains.)

Some people/experts suggest a fourth reason, that MRSA may be a more virulent bacterium per se than MSSA. Some research trials have actually claimed this. However such trials are fraught with difficulty. It is hard enough to attribute mortality to a particular micro-organism. Throw in the confounding variables as described above and you are on a hiding to nothing.

However there are theoretical reasons why MRSA should not be more virulent than MSSA. Generally a bacterium utilises energy in order to become resistant. Sometimes, but not always, this energy is the energy used for making virulence factors within the bacterium.

It doesn’t make any logical or evolutionary sense that MRSA should be both more resistant and more virulent per se than MSSA.

On the contrary it may well be that the converse is true, that MRSA is a slightly less virulent bacterium than MSSA.

Trying to convince the “experts” of this is another matter…..

Michael

The link between bacterial resistance and virulence is very interesting. Unfortunately the more you read about it, the more complex it gets. More on this topic in later articles….