Covid-19General Health

How does Clinical Microbiology help improve patient care?

Before the 1960s, many scientists and specialists considered pathology and medical microbiology to be the same, and many institutions did not offer medical microbiology as a subject. In modern medical science, clinical microbiology is an emerging specialty that plays a significant role in patient care and clinical decision making. Clinical microbiology also influences personalised medicine as it involves coming up with a treatment plan that is appropriate for the patient. 

MedPiper Technologies and JournoMed had conducted a webinar on 21st January, 2022, titled “Role of Clinical Microbiology in Improving Patient Care” where the speaker, Dr. Suranjan Pal gave a detailed account on the pivotal role of Clinical Microbiology in healthcare. Dr. Suranjan Pal (MD, DNB Microbiology) is the Assistant Professor at the Department of Microbiology, RG Kar Medical College and Hospital. 

The key roles of Clinical Microbiology in healthcare include: 

  1. Identifying the causative pathogenic organism of the patient’s infection
  2. Detecting global outbreaks such as in the case of the COVID-19 pandemic
  3. At the institutional level, proposing and maintaining infection control practices

Clinical Microbiology has undergone several transformations due to the emerging rapid molecular biology techniques and bioinformatics. Clinical Microbiology and Molecular Biology techniques generate a large amount of data, which can be sorted into databases with the help of bioinformatic tools. Microbiologists, clinicians and researchers can access this database to obtain information about disease patterns and possible antimicrobial therapies. 

Flow of information between a clinician and a clinical microbiologist 

The clinician indicates the diagnosis in the patient. The samples to determine infection or disease are selected based on what the clinician deems correct (pre-analytical stage). The samples are then collected from the patient and sent to the laboratory. The microbiologist will perform the culture identification studies to find out the disease causing organism (analytical-stage). The generated report with comments and interpretations are then sent to the patient, physician or customer (post-analytical stage). 

Based on the report, the clinician will formulate the treatment strategy for the patient. This flow of information between a clinician and a clinical microbiologist is crucial to ensure the timely diagnosis and management of infectious diseases. 

Domains of Clinical Microbiology in patient care

  1. Positive Blood Culture Management

Blood culture is done for patients in the Intensive Care Patients and to check for sepsis in the blood. From a positive blood culture broth, a gram stain or a direct susceptibility test to obtain the preliminary identification of the pathogen. 

2. Policy making: 

Clinical microbiologists can help formulate infection prevention and control protocols in the hospitals since they will be aware about how to curtail the spread and the common therapies used to manage the disease-causing pathogens. While Hospital Infection Control is the responsibility of every staff at the hospital, a clinical microbiologist will be able to contribute through educating about nosocomial infections, implementing infection control protocols, managing outbreaks and helping in biomedical waste management. This would also help with the accreditation of the hospital. 

3. Leadership in laboratory diagnostic strategy 

It falls upon the clinical microbiologists to come up with the therapeutic indices and determine the Minimum Inhibitory Concentration of an antimicrobial drug. They may also help to clear technical and clinical issues during emergency hours. 

4. Education and Research

Clinical Microbiologists are constantly educating the hospital staff and clinicians about the various pathogens and the antimicrobial therapies needed to control them. They are also educating the students regarding infectious diseases. 

5. Business planning: 

With the help of next generation sequencing (NGS) and bioinformatics, the microbiologists can determine the type of tests and technologies needed using other sectors and thus maybe help improve the efficacy of a lab. 

Clinical Microbiology in the ICU

More samples per patient are collected when they are in the ICU. Patients in the ICU also receive more antibiotics and thus, there is a high chance of antimicrobial resistance. The clinical microbiologists have to do ward rounds frequently in order to assess the mentioned situations and set up guidelines to control the spread of nosocomial infections Antimicrobial stewardship, a policy to arrive at an appropriate antimicrobial therapy to obtain the best patient outcomes, are also set up by the clinical microbiologists which is extremely useful in treating ICU patients. 

Clinical Microbiology in the COVID-19 pandemic and Public Health

During the COVID-19 pandemic, the Indian Council of Medical Research (ICMR) has helped to set up over 126 laboratories with VDRL (Venereal Diseases Research Laboratory) in order to offer services and sample collection. Techniques such as RT-PCR, Rapid Antigen tests, CB-NAAT, True NAAT etc. help in the molecular detection of the SARS-CoV-2 virus. The Integrated Disease Surveillance Project (IDSP) collects and collates data on vector borne and food borne outbreaks. National Health Programs like the National Viral Hepatitis Control Program (NVHCP) have set up labs to help the affected patients. 

The higher incidence of global outbreaks and infectious diseases have fortified the need for clinical microbiology as a specialty. Dr. Pal states that while it is currently an important subject in the medical curriculum, clinical microbiology research and analysis is still limited. With technological advances, clinical microbiology has major scope to improve and become more efficient as a discipline.

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