Hospital Ecology

DAVID R. WOODARD
MSC, CIC, CPHQ, CLS
 What is it all about

 What is “normal”
 What is unusual
 What is totally weird
 What is OMG
 Usual or Normal

 Organisms that are encountered with some degree of

frequency
 Antimicrobial susceptibilities that are common
 Usual organisms in usual places
 ICU
 Rehab
 MRSA
 MRSA and VRE

 Are all MRSA equal?

 Community acquired

 Hospital acquired

 VRE
 Faecium

 Faecalis

 Cohort
 Screen
 Unusual

 Organisms that you know occur infrequently in your

populations
 Organisms with uncommon susceptibilities but you
recognize
 Common organisms in unusual settings
 Totally weird

 Organisms with names you cannot pronounce

 Organisms that Micro calls you about
 Organisms in places they shouldn’t be –
 Salmonella in spinal fluid

 Chyrsobacterium in sputum
 OMG

 Lots of the same bug in an inappropriate setting

 6 sputum cultures positive for Echinobacteria all in the same
day
 All AFB from the same day all positive for M. gallinarium

 Bugs you have never heard of or were just on “Good

Morning America”
 Antibiotics

 Know your antibiogram

 Is amikacin resistant E. coli “normal in your hospital

 How many carbepenemase producing Klebsiella do you see in

a time interval
 Induceable clindamycin resistance in MRSA
 Pan-resistant organisms
 ANTIBIOGRAM

 A cumulative table comparing bacteria to the

antibiotics that are used for testing
 Expressed a % susceptible
 Compare year over year when possible
 Prepared by microbiology/infection
control/pharmacy
 Antibiotic susceptibility

 Standards are published by CLSI

 Breakpoints
 The point (concentration) where an antibiotic is determined to
be no longer effective
 Change per CLSI

 Effect isolation practices –

 2010 Cephalosporin/enterobacteriaceae major changes
 So what

 Do you have a good communication system with

your lab
 Critical values
 Bugs
 Drugs
 Authority
 Confidence
 Authority

 Implement isolation protocols

 Enforce isolation protocols
 Hand hygiene
 Consequences
 Confidence

 Know and understand your program

 Know and access your resources
 Library

 Internet

 State

 Carry your expertise – just in time education

 Where do bugs come from

 Sources of organisms
 Patients normal flora

 Patient’s transient flora

 Other units/hospitals
 Outside facilities

 Environment
 Equipment
 Supplies
 Patients own flora

 Gut
 Prior hospital exposure
 Medical Tourist (KPC)

 Delhi metallo-enzyme

 Antimicrobial resistant strains from far away places

with strange sounding names
 Imported flora

 Acinetobacter calocaceticus
 Klebsiella pneumoniae (KPC)
 Salmonella sps (food)
 Living in unusual environments
 Peace corps

 Military
 Equipment

 Equipment is mobile
 Rental

 Vendor/total joints

 Specialty procedures
 Rectal probes
 Eye instruments

 Follow-up to outside cases

 Exogenous stuff

 Fried Rice
 Plants
 Fountains
 Animals
 Feral cats

 Turtles

 Stuff
 Endogenous stuff

 Fingernails
 Skin and soft tissues
 Back packs
 OR caps
 Clothing and other attire
 Environmental Biology

 Labs not qualified to do testing

 Water –
 Dialysis

 Drinking

 Equipment and medicines

 Air
 ? What is normal
 Supplies

 Manufacturer’s contamination
 Alcohol pads – Bacillus cereus
 IV solutions
 Heparin flushes – Serratia marcescens
 Pseudomonas aeruginosa & mouthwash

 Equipment
 Sutures
 Dressing
 Recalls

 Hospital recall system

 Products that maybe contaminated
 Internal processing
 Tracking and looking
 Hoarders!

 Hidden cabinets

 Procedure carts (locked)

Questions