Superbugs (or multidrug-resistant pathogens) are being spread, as our treatment choices diminish. Diagnostic tests to identify the pathogen(s) responsible for an infection can improve a patient’s recovery and reduce the spread of superbugs in our hospital systems worldwide, as can a sterile healthcare environment. At the TedX Texas State University Conference on November 5, 2016, Dr. Rodney E. Rohde, a clinical microbiologist and professor at Texas State University, discussed the reality of superbugs in healthcare systems, and the important role of hygiene specialists and medical laboratory professionals in combatting these superbugs.
Approximately two hundred deaths every day can be attributed to healthcare-associated infections (HAIs). These deaths are due to antibiotic resistant pathogens, also known as superbugs. Many people are unaware of them, but these superbugs are everywhere, especially in healthcare settings, like hospitals.
One of the most well known HAIs and superbugs is MRSA (methicillin-resistant Staphylococcus aureus), a relative of the common ‘staph’ infection. Clostridium difficile, another potential superbug, infects half a million Americans annually1. Tuberculosis killed over 1.8 million people in 2015. While the number of deaths from tuberculosis have been dropping annually, we are seeing an increase in the prevalence of multi-drug resistant tuberculosis (MDR-TB) in patients as well (250,000 new cases of MDR-TB in 2015)2. The list of superbugs is disturbingly long, and consistently growing. The cause of antibiotic resistance is multi-factorial.
The use of antibiotics in agriculture has created a perfect environment for developing resistance, but this remains an abstract concept for many people. It was recently reported that bacteria containing a gene that confers resistance to a crucial class of antibiotics, called carbapenems, have been found in buildings on a pig farm in the Midwestern United States3. Carbapenems are used to treat multi-drug resistant bacteria, so bacteria that are carbapenem resistant , a troubling and mysterious discovery that should ring a warning bell over farm antibiotic use. This class of antibiotics is one of the few remaining that work against carbapenem-resistant bacteria, known as CREs, and are considered an “urgent threat” by the Centers for Disease Control and Prevention4.
Within our own communities, the actions of people around us have also unwittingly contributed to the rise of resistance. Patients are often prescribed antibiotics, but stop them after they’ve felt better. Sometimes, a person may be diagnosed with an infection without an appropriate laboratory test5, and pre-emptively provided antibiotics. These small actions all contribute to a global disaster. These situations place a stressor on bacteria, and their only choice, much like ours when put into a dangerous situation, is to adapt, or die. This is a man-made survival of the fittest, and superbugs are coming out on top.
10 million deaths by 2050. This is the equivalent of a new infection every three seconds
Dr. Margaret Chan of the World Health Organization (WHO) has stated that these “superbugs will have a financial/economic toll of $100 trillion dollars and a human cost of 10 million deaths by 2050.” This is the equivalent of a new infection every three seconds. This outpaces the mortality rate of cancer, HIV, or any other disease out there5. These microorganisms have evolved beyond what we originally dealt with, and could mean the end of medicine as we know it today. A routine operation, or even a scraped knee could be fatal.
High school and early college students are expected to choose a major and eventually a career path, and the visibility of an occupation factors greatly into the student’s decision-making. Common target professions include: engineers, doctors, IT professionals and lawyers, as these individuals are well-represented in the community and in the media. Many skilled jobs that are critical for public health are not seeing growth in numbers, and at least part of the problem is due to a lack of visibility.
Two such jobs are Hygiene Specialist and Medical Laboratory Professional. Students considering a career in science or medicine may want to consider this career path. Individuals in these positions work behind the scenes in the important fight against superbugs.
These professionals use multimodal strategies and algorithms to create a clean and sterile environment in our healthcare facilities. They achieve this through identifying the risk factors that endanger our lives through audits, and mitigating these risks through environmental hygiene, hand hygiene, automation, and UV sterilization training programs. This role is often overlooked by hospital administration, as our local understanding of clean is not sufficient. Looking clean or smelling clean is not sufficient, as microbes can still be present. The choice of high-touch surfaces and surface processing will also make a difference to the cleanliness of the healthcare environment. A hygiene specialist’s standard for clean is microbial clean or sterile, which is necessary to ensure patient safety. This oversight by administration can result in thousands of deaths annually6.
Medical Laboratory Professional
Medical Laboratory Professionals are not frontline workers. They work tirelessly to support doctors and nurses by providing them with the information to provide an informed diagnosis. It is estimated that medical laboratory professionals provide up to 75% of all laboratory data7. The ability to identify an infection, especially from a superbug, IS the difference between life and death. Correctly choosing the right antibiotic the first time prevents weeks of unnecessary illnesses, prevents the spread of superbugs, and most importantly, save lives.
“Without us medical laboratory professionals, doctors are basically guessing” – Rodney Rohde
The medical laboratory professional holds a unique position that brings together a number of fields. Clinical microbiology, clinical haematology, clinical chemistry, and immunohematology come together and inform the MLP on which tests to perform, and how to interpret the test results to present a clinical diagnosis. These tests can diagnose cancer, sickle cell anemia, or bacterial or viral infections (including Zika, Ebola, and all classes of superbugs). Without these professionals, up to 75% of patients could be in critical danger8.
The number of people entering the fields of medical laboratory professional and hygiene specialist is decreasing. This means that the workload of those currently in the field is heavier and results may take longer to process. Patients should be requesting more laboratory tests and pushing doctors to make informed choices supported by diagnostic tests, but there needs to be a person at the other end of that request to be able to run the tests. Likewise, MLPs are the “bridge” to explain which test is most effective to choose, as well as what those results mean to the doctor. MLPs are required to spend thousands of hours in the clinical and educational setting to become competent for thousands of medical laboratory tests, quality control, and the suspicions needed to correctly identify medical laboratory puzzles. Only MLPs have this type of training – no other college major goes through this type of extensive education to prepare to answer these medical problems – not medical school, not nursing school, not any other medical degree or major. Exposure to these careers needs to be increased at the high school and college levels to guide new entrants into the field. Doing so can save countless lives8.
Thousands of preventable deaths occur every year because a laboratory test is not performed to diagnose a patient’s illness. Pushing doctors to request more testing allows them to make informed choices and save lives, but we need professionals to both perform these tests, and prevent these infections in the first place. Spreading awareness of these tests and occupations sends a messages to decision makers that patients are demanding a higher quality of care. #WeSaveLivesEveryday
- Centre for Disease Control. Nearly half a million Americans suffered from Clostridium difficile infections in a single year. CDC Online Newsroom. CDC Newsroom. 2015 [cited 2016 Dec 1]. Available from: http://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html
- World Health Organization. Tuberculosis. World Health Organization; 2016 [cited 2016 Dec 1]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/
- McKenna, M. (2016, December 05). Bacteria with resistance to important class of antibiotics found on farm in Midwest – FERN’s Ag Insider. Retrieved December 06, 2016, from https://thefern.org/ag_insider/bacteria-resistance-important-class-antibiotics-found-farm-midwest/
- Biggest Threats. (2016). Retrieved December 06, 2016, from http://www.cdc.gov/drugresistance/biggest_threats.html
- O’Neil J. Tackling Drug-Resistant Infections Globally. Review on Antimicrobial Resistance. 2016 [cited 2016 Dec 1]. Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
- Rohde, R. E. (2016, January 11). 2 Laboratory Tests you Must Demand: Advice from MRSA Survivors and a Scientist. Retrieved December 06, 2016, from http://infectioncontrol.tips/2016/01/11/2labtests-mrsa/
- Rohde RE. MRSA model of learning and adaptation: a qualitative study among the general public. InfectionControl.tips. 2016 Apr;4:1–4.
- Rohde RE. The hidden profession that saves lives. Elsevier Connect. 2014;(February):1–8. Available from: https://www.elsevier.com/connect/the-hidden-profession-that-saves-lives