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.

1. Beutler E. Iron storage disease: Facts, fiction and progress. Blood Cells Mol Dis. 2007;39:140-7.2. Higgins T, Beutler E, Doumas BT. Hemoglobin, iron, and bilirubin. In: Burtis CA, editor. Teitz Fundamentals of Clinical Chemistry. 6th ed. Saunders Elsevier, 2008.3. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia and inflammation. Blood 2003;102(3):78-8.4. Andrews NC, Schmidt PJ. Iron homeostasis. Annu Rev Physiolo. 2007;69:69-85.5. Murtagh LJ, Whiley M, Wilson S, et al. Unsaturated iron binding capacity and transferrin saturation are equally reliable in detection of HFE hemochromatosis. Am J Gastroenterol. 2002;97(8):2093-9.6. Haddy TB, Castro OL, Rana SR. Hereditary hemochromatosis in children, adolescents, and young adults. Am J Pediatr Hematol Oncol 1988;10:23-4.7. Edwards CQ, Ajoika RS, Kushner JP. Hemochromatosis: A genetic definition. In Barton JC, Edwards CQ, eds. Hemochromatosis: Genetics, Pathophysiology, Diagnosis and Treatment. Cambridge, UK:Cambridge Univ Pr 2000:8-11.8. Whitlock EP, Garlitz BA, Harris EL , et al. Screening for Hereditary Hemochromatosis: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2006; 145: 209-23.9. Wallace DF, Subramaniam VN. Non-HFE haemaochromatosis. World J Gastroenterol. 2007;13(35):4690-8.10. Tavill AS. Diagnosis and management of hemochromatosis. Hepatology. 2001;33:1321-811. Qaseem A, Aronson M, Fitterman N, Snow V, Weiss KB, Owens DK, et al. Screening for hereditary hemochromatosis: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2005;143:517-21.12. Phatak PD, Bonkovsky HL, and Kowdley KV. Hereditary Hemochromatosis: time for targeted screening. Ann Intern Med. 2008; 149(4): 270 – 2.13. Brissot P, deBels F. Current approaches to the management of hemochromatosis. Hematology Am Soc Hematol Educ Program. 2006:36-41. 14. Guidance for industry: Variances for blood collection from individuals with hereditary hemochromatosis. http://www.fda.gov/cber/gdlns/hemchrom.htm Accessed 12/17/08.

The major determinant of prognosis in cases of hereditary hemochromatosis (HH) is the degree of organ damage from iron overload at the point of diagnosis. The presence of liver cirrhosis reduces life expectancy. Damage that has occurred to tissues and organs is irreversible, but further damage can be halted with treatment. When there is no evidence of cirrhosis at time of diagnosis, life expectancy may be equal to that of persons without HH. With proper management of HH through treatment, affected individuals have good long-term outcomes. Hepatocellular carcinoma associated with cirrhosis, hepatic failure, and cardiac failure are the most common causes of death in persons with HH. Compared to the normal population, liver cancer is many times more prevalent as a cause of death in persons with HH. Cardiomyopathy, diabetes, and cirrhosis are all more common causes of death among persons with HH than among normal persons. The earlier HH is detected, before the onset of severe organ damage, the lower the risk of mortality.

Education Learn proper techniques for lifting, stretching and limiting repetitive motion Learn how to use ergonomic aids properly and be compliant Exercise Participate in exercise programs Perform gentle stretching exercises prior to your shift Keep physically fitEngineering Redesign your work area by arranging items properly within the work zone. Examine and improve lighting and noise levels whenever possibleEquipment Watch for ergonomic alternatives and make management aware of available options. Wrist support, mouse, keyboards and keyboard drawers, cart, lamps (less expensive equipment) Furniture, chairs, workbenches, desks (more expensive equipment)

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 samples Diluting a test sample incorrectlyIn 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.

Management personnel (managers and supervisors) are the laboatory's first line of defense against allegations of fraud and abuse. They have a responsibility to protect the company from illegal and unethical actions by employees. Management personnel can be sanctioned for the actions of employees who report to them and they can be sanctioned for failure to detect violations. Management personnel have these responsibilities: Ensure that lines of communication remain open with employees. Ensure that employees understand their responsibility to report problems. Respond with appropriate seriousness when a problem is reported. Always follow-up on employees' questions and reports. Ensure proper documentation is kept concerning reported problems and report them to the next level of authority when appropriate.

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 facility's management department. Space heaters are not permitted in hospital sleeping areas or in laboratories containing flammable liquids or gases.

Formaldehyde exposure as low as 0.1 ppm (parts per million) may cause: Skin irritation Eye irritation Airway irritation Headaches and dizziness Symptoms possibly related to formadehyde exposure should be reported immediately to management.

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.