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Introduction of molecular diagnostic techniques in the diagnosis of health care associated infections (MRSA and C.diff) - CONCEPTION AND INCEPTION Dr. Venkat Sivaprakasam, Consultant Microbiologist - Hereford Hospitals NHS Trust. BEST PRESENTATION AWARD. CURRENT STATUS

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  1. Introduction of molecular diagnostic techniques in the diagnosis of health care associated infections (MRSA and C.diff) - CONCEPTION AND INCEPTION Dr. Venkat Sivaprakasam, Consultant Microbiologist - Hereford Hospitals NHS Trust BEST PRESENTATION AWARD CURRENT STATUS Consultant Microbiologist with additional responsibilities of Head of The Department and Director of National Leptospirosis Reference Unit at Hereford Hospitals NHS Trust. Tool kits the team embraced in planning strategy: Delegation stakeholder mapping. Empathising Giving and receiving feedback Setting targets meeting deadlines and promises. Sharpening the Saw Regular social meets, The attendance to this year Christmas party is 100% ( First time ever in the History of Hereford Microbiology). Pilot project initiated after creating awareness and inciting interest ‘clostridium difficile associated diarrhea’ uncertainties in testing algorithms and the role of Toxin gene detection ObjectivesTo define an optimum testing algorithm for the laboratory diagnosis of CDAD with the use of clostridium difficile gene detection system (PCR assay) by GeneXpert (Cepheid), with the single objective to achieve zero tolerance to hospital acquired CDAD. Methods – 261 Stool samples from patients with loose stools attending Hereford hospitals NHS trust in UK, were tested for the presence of Clostridium difficile toxin by VIDAS assay (Biomerieux) and cell culture cytotoxin assay (CTA) and the clostridium difficile toxin gene by PCR assay. Results – With reference to CTA as the gold standard the sensitivity and specificity of the VIDAS assay was 83.92% and 75.72 and that of PCR assay was 100 % and 77.66% respectively.. Conclusion – The superiority of the GeneXpert gene detection assay over VIDAS in terms of efficacy is significant. In terms of efficiency (user comfort, turn around time and no equivocal results) we feel the PCR assay is far more superior. The ability to identify the ribotype 027 strain at the same time is beneficial to prevent harmful cohorting. END IN MIND (VISION) A highly motivated and committed team which includes all the staff in the Department of Microbiology to facilitate synergistic work to deliver the highest quality Microbiology services in the most appropriate time scale, that would assist and support the clinicians to deliver a safe, high quality and evidence based health care package to the patients, their relatives and people of Herefordshire that they could be proud of and enable them to enjoy their cushioned journey through the health care system as and when one arises. MOLECULAR GROUP FORMED Mile stones set and achieved: (MISSION) SWINE FLU PCR TESTING – The team has developed respiratory PCR assays including swine flu testing. Routine testing is likely to happen this winter. (The team is very excited and enthusiastic by the product of their synergistic efforts. MRSA TESTING BY PCR: Project has been developed to do MRSA PCR testing for the high risk patientsgroup as POCT using the same platform as for C Diff toxin gene testing. LEPTSPIROSIS TESTING BY PCR: Routine PCR testing is likely to roll out early next year as part of the reference services to the whole of UK.. Molecular work shop: Planned for the entire team and for BMS from neighboring trusts. INNER CHALLENGE New team and new environment. Unpolished and untested leadership qualities. Time management. OUTER CHALLENGE Team more comfortable with historical practices. Resistance to change Lack of awareness to recent advances and developments. Financial constraints. THIS PROJECT WAS PRESENTED AT ECCMID IN VIENNA IN ARPIL 2010 Perceived benefits to the team – Increased awareness and interest leading to confidence. Awards, recognition and the feeling of being valued was motivating and inspiring to the team. No time was lost in spreading the team dynamics and building the team spirit by crediting every member of the team for whatever little contribution made. MARCH CONTINUES WITH INCREASING VIGOUR AND TEAM SPIRIT TOWARDS THE SAME END IN EVERY TEAM MEMBER’S MIND First step: Set exceptional standards for myself by regular training and practising the “SEVEN HABBITS OF LEADERSHIP” Thanks to Merlin and Penny AND all others who have been instrumental in facilitating this seemingly MIRACLE.

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