Medicine is a serious business and when you hear harrowing stories of sepsis, how do you respond? Certainly, many of the accounts you will read, or perhaps you have witnessed through personal exposure to family or friends who have had some form of sepsis, can be very disturbing. Survivor accounts can be as equally distressing to all those allied to the caring professions and for all of us beg the question, what more can we do to improve diagnosis? In Wales, as in other parts of the UK early recognition and detection of sepsis is key to early interventions. The … Read the rest
I had a call this morning from one of our very talented staff nurses who wanted to check out carefully her understanding of when it is appropriate to send a sample for urine in a catheterised patient. She explained that she had an elderly patient and the patients daughter had suggested that the catheter urine should be sent to our laboratory on a weekly basis to check for infection.
The patient did not have any symptoms or signs to suggest urinary infection and had therefore advised that sampling was inappropriate but was facing a series of questions and could I … Read the rest
In a previous article I promised that I would share a measure of the improvement we are seeing in the clinical information on our request forms. As you may know, the Hywel Dda University Health Board is committed to seeing reductions in all aspects of healthcare associated infections and has set themselves the target of reducing E coli bacteraemias by 20% as a global surrogate of all infections across our area.
Why is clinical information important?
Microbiology does not provide explicit answers to the question, “Does this patient have an infection?” Our laboratories will grow bacteria but are bodies are … Read the rest
I have just completed my on-call week. As many will know our working pattern means one consultant is first on service for a seven day period. This ensures a degree of continuity when we receive calls and are dealing with the acute services. In this role, we are the first point of contact for enquiries and I thought therefore I would reflect on a couple of the highlights.
Little Thing #1:
One of my local GP’s rang to ask for a urine sensitivity result. I am always at pains to be as helpful as I possibly can when I … Read the rest
In a previous post I discussed the two simple rules that I ask colleagues to use to test interventions around the management of infections:
- First do no harm
- Second, find and take the positive action
All well and good offering this advice to others, but the challenge was also to me as a clinical microbiologist. In discussions with my colleagues, we agreed that a large number of our E coli bacteramias were probably as a result of urinary associated infection and if we were to make a difference, we needed to take a closer interest in how we managed the … Read the rest
First: do no harm
Second: seek and take the positive action
First do no harm is not easy in dealing with infection because the actions we may need to take will often break this first rule and cause harm. Seriously? Yes, very seriously. Take the apparently simple act of prescribing an antibiotic. Antibiotics are not heat seeking pathogen missiles. While they seek out a specific bacterial target, that target will usually be generic to many bacteria … Read the rest
One of my lab scientists highlighted how a few years ago, when working in a smaller laboratory at a time when they were severely short staffed, they had to take the urgent decision to stop testing any urine sample that came into the laboratory without any clinical details.
There was a two fold effect: the absolute numbers of urine samples arriving in the laboratory, prior to any being rejected for lack of clinical information reduced and secondly, the clinical information on those samples arriving improved dramatically.
Some time later, the staffing situation improved and the lab felt able to stop … Read the rest