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Hospital Ecology: Understanding Organisms and Antibiotics

Discover the usual, unusual, totally weird in hospital ecology - from common organisms to OMG moments, learn about antimicrobial susceptibilities, unusual organisms, and antibiotic susceptibility testing. Gain insights on isolation practices, antibiotic stewardship, and sources of organisms in the hospital setting.

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Hospital Ecology: Understanding Organisms and Antibiotics

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  1. Hospital Ecology David r. woodard Msc, cic, cphq, cls

  2. What is it all about What is “normal” What is unusual What is totally weird What is OMG

  3. 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

  4. MRSA and VRE • Are all MRSA equal? • Community acquired • Hospital acquired • VRE • Faecium • Faecalis • Cohort • Screen

  5. Unusual Organisms that you know occur infrequently in your populations Organisms with uncommon susceptibilities but you recognize Common organisms in unusual settings

  6. 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

  7. 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”

  8. 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 • Induceableclindamycin resistance in MRSA • Pan-resistant organisms

  9. 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

  10. 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

  11. So what • Do you have a good communication system with your lab • Critical values • Bugs • Drugs • Authority • Confidence

  12. Authority Implement isolation protocols Enforce isolation protocols Hand hygiene Consequences

  13. Confidence • Know and understand your program • Know and access your resources • Library • Internet • State • Carry your expertise – just in time education

  14. Where do bugs come from • Sources of organisms • Patients normal flora • Patient’s transient flora • Other units/hospitals • Outside facilities • Environment • Equipment • Supplies

  15. Patients own flora • Gut • Prior hospital exposure • Medical Tourist (KPC) • Delhi metallo-enzyme • Antimicrobial resistant strains from far away places with strange sounding names

  16. Imported flora • Acinetobactercalocaceticus • Klebsiellapneumoniae (KPC) • Salmonella sps (food) • Living in unusual environments • Peace corps • Military

  17. Equipment • Equipment is mobile • Rental • Vendor/total joints • Specialty procedures • Rectal probes • Eye instruments • Follow-up to outside cases

  18. Exogenous stuff • Fried Rice • Plants • Fountains • Animals • Feral cats • Turtles • Stuff

  19. Endogenous stuff Fingernails Skin and soft tissues Back packs OR caps Clothing and other attire

  20. Environmental Biology • Labs not qualified to do testing • Water – • Dialysis • Drinking • Equipment and medicines • Air • ? What is normal

  21. Supplies • Manufacturer’s contamination • Alcohol pads – Bacillus cereus • IV solutions • Heparin flushes – Serratiamarcescens • Pseudomonas aeruginosa & mouthwash • Equipment • Sutures • Dressing

  22. Recalls • Hospital recall system • Products that maybe contaminated • Internal processing • Tracking and looking • Hoarders! • Hidden cabinets • Procedure carts (locked)

  23. Questions

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