MICROBIOLOGY
1800 1600 1400 1200 1000 800 600 400 200 0
January February BioFire BCID Laboratory MALDI-ToF TAT
and discharges. Inappropriate use of antibiotics can also result in side effects and leads to poor patient experience and outcomes. Giving antibiotics to patients who do not need them is also undesirable in terms of antimicrobial resistance, while delay in diagnosis further impacts hospital resources.
March April Fig 1. Improved turnaround time (TAT) – sample collection to pathogen identification. Month Patient ID BioFire ID result Lab ID result Comment
False ID laboratory A re-test by laboratory method confirmed
January 415010 Bacteroides fragilis Streptococcus constellatus BioFire result 3027630 None
February 1397613 None March
1435262 None 9507075 None
Rhizobium radiobacter Klebsiella pneumoniae Actinotignum sanguinis Bacillus cereus
Non Panel Pathogen False negative BioFire Non Panel Pathogen
1095200 Streptococcus sp. None 1662626 None 1621240 None
Non Panel Pathogen False negative laboratory result, based on clinical symptoms Patient treated based on BioFire, recovered and discharged
Clostridium perfringens Coagulase Negative
Staphylococcus Table 1. High level of agreement between methods
45 40 35 30 25 20 15 10 5 0
Non Panel Pathogen False negative BioFire
The solution
The adoption of technology to resolve these issues was key to driving improvement at the Royal Berkshire Hospital. The proposed solution, BioFire TORCH, would provide an on-site, 24/7 service, capable of ensuring identification in just over an hour. The service would be provided by trained staff in the Blood Sciences Rapid Response Laboratory with oversight from biomedical scientists in collaboration with the microbiologist at the Wexham Park site.
“It is not just about using the technology. You must ensure the governance is in place, so that the results are trusted,” commented Olubunmi. A business case was presented to the
Board, with input from the clinical leads, and the technology was approved for a six-month trial.
The pilot aims included the following:
n Compare BioFire technology with the conventional laboratory method
n Review the impact on the patient pathway
n Determine whether the following three primary metrics are achievable: n Reduction in time to identify the pathogen (improved process).
n Reduction in time to effective therapy (improved patient outcome).
n Blood culture contamination rate <3% (reduced wastage).
Fig 2. Source of infection Pilot findings
Berkshire Hospital is a ‘spoke site’, which meant that the microbiology laboratory was situated off-site at Wexham Park Hospital. This inevitably presented some challenges. For example, the turnaround time for identification of pathogens with antimicrobial sensitivity was between one and five days (five-day turnarounds were not uncommon). Some of the issues were as a consequence of transport. “The service hours for the main laboratory are 7am to 8pm, Monday to Friday, and 7am to 5pm on Saturday and
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Sunday, so it is not open 24/7. There are a number of limitations in terms of using the laboratory, therefore. This is significant as there is a potential for increased risk of mortality – risk of death increases 1.2- fold each day of delay in microbiological diagnosis,” Olubunmi pointed out. She added that delay in diagnosis
also results in increased hospital length of stay, while patients are put on empirical antibiotics, which may not work effectively for the infection that they have. This ultimately impacts on flow
A total of 183 patients were tested using BioFire between January and June 2022. The majority were from the emergency department.
The pilot found:
n Improved turnaround time – sample collection to pathogen identification.
n BioFire time to result was around four hours compared to around 27 hours for the centralised offsite laboratory.
n Using BioFire, the average reduction in time to pathogen identification was 17 hours per patient.
MAY 2024
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If the hospital does not have a diagnosis for the infection, the patient may need to be isolated, which can cause pressures, as the hospital has limited side rooms. Delays in diagnosis can also lead to escalation and patient transfers to level 2/3 care (HMU/ICU) – an expensive and limited resource.
Number of cases
Minutes
Urinary Other
Unknown Biliary Skin
Abdominal Chest CAUTI Line
endocarditis
Cellulitis Infective
Abcess Leg ulcers Pyelonephritis CAP
Contaminant
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