The Role of Clinical

Microbiologist in Hospitals

Anis Karuniawati, Prof. Henri A. Verbrugh

Department of Microbiology, FMUI
Goals of Health Care Industry

• Patient centered
• Effective
• Efficient
• Equitable
• Safe
• Timely
 Infectious Diseases
• Top three of causes of mortality worldwide

• WHO 2004: responsible for 4 millions

deaths, 27% South Asian region

• Since 1945: over 350 emerging infectious

diseases have been reported
emerging infectious diseases
role for medical centers

• cure and care for individual patients

• provide isolation facilities

• control use of antimicrobial agents

• educate and train professionals
• communicate with ‘outsiders’*
• foster (clinical) research

* public health sector, NGO’s, body politic,..

 emerging infectious diseases
role for public health

• surveillance of communicable diseases

• reference laboratory services

• managing outbreaks in the community

• educate the public in health promotion and
infection prevention
• communicate with health care
• foster (public health) research
 the clinical microbiologist today

• professional leader in the microbiology laboratory

• qualified consultant in infectious diseases

• managing head of the microbiology laboratory

• professional leader in the control of hospital-acquired

infections

Eur. Union Med. Spec. 1999

 the clinical microbiologist today

• initiator/consultant in hospital-wide antibiotic policy

• collaborator of public health authorities in the control of

microbial threats to the health of the public

• contributor to the advancement of science in infectious

diseases

• contributor to the training of professionals in the field of

infectious diseases

Eur. Union Med. Spec. 1999

 clinical microbiologist infectious disease clinician
professional laboratory diagnostics * (?)
training laboratory technicians *
laboratory management responsibilities *
training medical microbiology fellows *
public health concern & involvement *
infection control & prevention
basic (molecular) research *

training infection control practicioners *

antibiotic policy & control

consultant infectious diseases
translational research *
involvement curriculum medical schools *
training infectious diseases fellows *
clinical research *
individual patientcare responsibilities
Professional Laboratory Diagnostics

GARBAGE IN, QUALITY IN,

GARBAGE OUT QUALITY OUT

Test ordering
Result transcription
Order transcription
Result delivery
Patient preparation Sample testing
Result review
Specimen collection
Action taken on basis
Specimen identification of result
Specimen transport

Pre analytical Analytical Post analytical

 Important requirements
• Adequate collection, transport, and
processing of clinical specimens

• Cooperation among medical team members :

– Clinical practitioners
– Nurses
– Laboratory practitioners

• Ongoing communication and education among

all members of the team
“report it all and let the
doctor decide……..”
?
Laboratory

Clinician
“If the microbiologist names it,
the physician feels obliged to
treat it”
 Susceptibility Test Results
Usual report:
‘susceptible to this drug’
‘resistant to this drug’

Interpretative Reading:
• Recognizing unusual results
• Recognizing drugs best avoided owing to
their risk of selecting resistance in the
particular pathogen
• Using ‘indicator’ drugs
 Infection Control Responsibility
(Prevention of HAI, A Practical Guide, 2nd Ed, WHO)

Role of:
• Hospital management • The food services
• The physician • The laundry service
• Microbiologist • The housekeeping service
• Hospital Pharmacist • Maintenance
• Nursing staff • The infection control
• The central team (hospital hygiene
sterilization service service)
 Role of Microbiologist in Infection Control

• Handling patient and staff specimens to maximize

the likelihood of a microbial diagnosis

• Developing guidelines for appropriate collection,

transport, and handling specimens

• Ensuring laboratory practices meet appropriate

standards

• Ensuring safe laboratory practice to prevent

infections in staff
 Role of Microbiologist in Infection Control

• Performing antimicrobial susceptibility testing following

internationally recognized methods, and providing
summary reports of prevalence of resistance

• Monitoring sterilization, disinfection and the

environment where necessary

• Timely communication of results to the infection

control committee or hygiene officer

• Epidemiological typing of hospital microorganisms where

necessary
 critical success factors
clinical microbiology department

• have a vision, mission, strategy, 5 year action plan

• select and train (>2) staff members for clinical tasks
• visit wards and communicate with clinicians daily
• evaluate logistics and quality of sampling and transport
• upgrade laboratory repertoire (media-range) and
identification system for routine isolates
 …cont’

• re-design administrative organisation to support

clinical work and to document lab work, and
produce surveillance reports
• collaborate closely with infectious disease
clinicians
• ‘incorporate’ infection control team in department
• collaborate closely with public health authorities
Koningin Wilhemina Institute
Department Microbiology, FMUI