Infectious Diseases

Objectives/Activities

1.    The resident will spend 1-2 day in Medical Microbiology to introduce them to the functions and processes of the medical microbiology laboratory. At the end of the week they will compose a ½-1-page reflection document summarizing what they saw and what they learned during the day and review it with the preceptor.

2.    The resident will spend ½-1 day with an infection control nurse to introduce them to the functions and processes of the Infection Control Department. At the end of the day they will compose a ½-1 page reflection document summarizing what they saw and what they learned during the day and review it with the preceptor with a focus on:
a.    How they can effectively incorporate infection prevention techniques into daily practice.
b.    Describe appropriate infection prevention and control measures when an antibiotic-resistant organism is identified.
c.    Describe appropriate infection prevention and control measures in an outbreak scenario.

3.    The resident will systematically assess and present to the preceptor a minimum of 6 infected patients by focusing on the following:
a.     Determine the focus of the infection
b.    Anticipate and interpret the microbiologic testing that is most appropriate for an infected patient and the usual timeline for the results.
c.    Determine the typical pathogens and appropriate empiric antimicrobial options for the identified infection.
d.    Incorporate pharmacokinetic/pharmacodynamic theory into the decision making process around selection of an optimal antimicrobial regimen.
e.    Apply a head-to-toe approach to monitoring an infected patient for both efficacy and safety of their antimicrobial regimen.

Infectious Diseases – Three Days Down!

January 6, 2010: I’ve just completed three days of my ID rotation.  I got to sit in on ICU rounds on day 1. It’s like a whole other language! I ended up adjusting a vancomycin dose on a patient growing S.epidermis in his blood who is also on CRRT which I have never done before. Patients on CRRT have an eGFR ~ 30 mL/min so I adjusted it to 15 mg/kg q24h.

I spent two mornings in the microbiology lab shadowing the technicians – one on the urine bench and another on the sputum bench. It was really interesting to see what goes on “behind the scenes” and how stuff actually gets reported on Powerchart.  I amazed to see how they could identify microorganisms simply by the colour or size that grew on the agar!

I was always curious as to how they determined on cultures in Powerchart if  bacteria were (+1, +2, +3 etc). They simply divide the plate into four  and see if there is growth in each quadrant!  For urine cultures they determined the number of CFU per mL simply by “eye-balling” the number of colonies on the plate. It was more subjective than I would have thought.

It was also interesting to note that sometimes mistakes do happen and things get reported incorrectly.  There was one culture that they incorrectly identified as Enterococcus sp. but after double checking it was actually S.aureus!

A few other interesting facts I learned:

* Gram positive cocci in pairs is usually indicative of Streptococcus sp.
* Gram positive cocci in clusters is usually indicative of Staphylacoccus sp.
* Pseudomonas aeroginosa smells like grapes when it grows on agar!
* Proteus mirabilis smells like chocolate cake batter.

Infection Control

Today I attended a session with Joanne Bains from Infection Control. She gave a powerpoint presentation and here are a few facts that she told us that I never knew before:

–    The chain of infection → infection can be prevented by breaking any link in the chain
–    30% of the population are S.aureus carriers
–    Up to 30% of patients who are infected with Norwalk are asymptomatic (and potentially could be shedding the virus!)
–    1st and 2nd generation cephalosporins and fluroquinolones are the main culprits for causing C.difficile-associated diarrhea at VIHA
–    C.difficile spores can live in the environment for months!
–    Patients who are colonized with C.difficile can excrete spores for months after infection
–    For enteric related organisms (i.e. C.difficile and Norwalk virus) it is recommended to cleanse hands with soap and water rather than alcohol.

• 1/3 of the population are MRSA colonizers and MRSA can live in dust for up to a year!
• Most people don’t wash their hands correctly. We did an experiment where we washed our hands and looked under a special light to see the areas which we “missed”. I discovered that I don’t do a great job of washing my finger tips and my wrists. So I need to remember to take off my watch and to ensure I remember to adequately cleanse my finger tips!
• The proper gowning/gloving/masking procedure
  Entering room: mask → visor (if using) → gown → gloves
• Exiting room: mask +/-visor → gloves → alcohol on hands → gown → alcohol → leave room → remove mask → soap water- Take home message: BE A ROLE MODEL
• Washing hands or using alcohol gel prior to interacting with ALL may remind other staff members to do the same.