Management Information and Courses from MediaLab, Inc.

Podschun R. Ullmann U.: Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors Clinical Microbiology Reviews. 11(4):589-603, 1998Bacteria belonging to the genus Klebsiella frequently cause human nosocomial infections. In particular, the medically most important Klebsiella species, Klebsiella pneumoniae, accounts for a significant proportion of hospital-acquired urinary tract infections, pneumonia, septicemias, and soft tissue infections.The principal pathogenic reservoirs for transmission of Klebsiella are the gastrointestinal tract and the hands of hospital personnel. Because of their ability to spread rapidly in the hospital environment, these bacteria tend to cause nosocomial outbreaks. Hospital outbreaks of multidrug-resistant Klebsiella spp., especially those in neonatal wards, are often caused by new types of strains, the so-called extended-spectrum-beta-lactamase (ESBL) producersThe incidence of ESBL-producing strains among clinical Klebsiella isolates has been steadily increasing over the past years. The resulting limitations on the therapeutic options demand new measures for the management of Klebsiella hospital infections.While the different typing methods are useful epidemiological tools for infection control, recent findings about Klebsiella virulence factors have provided new insights into the pathogenic strategies of these bacteria. Klebsiella pathogenicity factors such as capsules or lipopolysaccharides are presently considered to be promising candidates for vaccination efforts that may serve as immunological infection control measures.

JCAHO has a very important role in cause analysis of medical errors. Since 1995, it has been increasing its focus on patient safety by requiring in-depth analysis, Root Cause Analysis, to determine the underlying causes of every adverse event. Root causes are specific reasons that contribute to medical errors. They cause mistakes that lead to great patient harm (adverse events). Usually they can be identified. Examples: Using a wrong calculation factor Neglecting to use directions for complicated tests Reporting the wrong test result Using outdated reagents Testing clotted or partially-filled samplesDiluting a test sample incorrectly In most cases, management has the authority and means to resolve root causes. Root Cause Analysis also recommends actions to prevent reoccurrence of an adverse event.

Promptly clean up spills using appropriate equipment and protective apparel. Dispose of waste properly.

Electrical space heaters are prohibited unless they are approved for use and inspected by your facilities management department. Space heaters are not permitted in hospital sleeping areas or in laboratories containing flammable liquids or gases. The heating elements in the space heater cannot exceed 212 degrees Fahrenheit, and cannot be exposed elements. Heaters with hot elements, even with guards, are not allowed. The approved heater must be connected directly to an outlet without the use of an extension cord. Reference: NFPA 101 Life Safety Code. National Fire Protection Agency. Paragraph 18/19.7.8. Quincy, MA: 2006.

Any review of a peripheral smear is highly subjective; therefore, each laboratory must establish its own guidelines for quantitating observations and issuing reports in a consistent format. The key question for the laboratory is "How will the clinician use the terms of qualitative results in the reports issued to decide on the next course of action with this patient?" Formats for reporting have been geared more toward the needs of instrumentation facilitation and computer management than toward needs of access and understanding by clinicians working to improve patient care outcomes. Evidence based medicine (EBM) is the formal term used for the process by which research evidence, collective clinical experience, and the user friendly rendering of testing results are integrated to evaluate patient care outcomes.