MICROBIOLOGY
vancomycin-resistant Enterococcus (VRE); and discontinuation of antibiotics and safe discharge of a baby found not to have sepsis. The full details of these success stories can be viewed in Tables 2-4. “We are really excited about how this has impacted our patients’ lives,” she commented. With regards to the patient identified as having an invasive GAS infection, Olubunmi also pointed out that this: “didn’t just help to improve the outcome for the patient but also helped to protect their loved ones.”
Summary In summary, BioFire technology transformed diagnosis and management of sepsis at the Royal Berkshire NHS Foundation Trust. The pre-analytical stage of the process was optimised in terms of blood collection, compliance with the four-hour standard, and ensuring the integrity of the sample. In terms of the analytical stage of the process, the trust saved significant amounts of time – a minimum of 17 hours and, in some instances, even more. The post-analytical stage of the process requires further optimisation and the trust is currently working on automatic data transfer of the results, which will make the process even quicker.
Olubunmi pointed out that early pathogen identification facilitates early multidisciplinary team (MDT) conversations around: n Therapy (microbiologists/clinicians) n Source control (surgeons/IR) n Investigations (Echo/radiologists) n Infection prevention and control (IPC) and antimicrobial stewardship (bed management/tracing/isolation)
n Giving confidence to ambulate (virtual ward).
“When a patient comes through ED, we use Sepsis Six, take two sets of blood cultures, put them on empirical antibiotics, put them in AMU, and carry out effective, targeted treatment in 6-8 hours. Then, from AMU, they can go back to their care home or their own home. It is very multidisciplinary and involves microbiologists working very collaboratively with the medical team,” Olubunmi explained. “We have rarely had to bring patients back in. The key
Date 09.04.22 Event
Admitted to Dolphin ward via Paediatrics ED Presenting: fever, diarrhoea since the morning of 09.04.22
Mum and dad had had days of feeling unwell this week and has older sibling who had a fever at nursery this week. O/e upset and crying
Lumbar puncture performed as part of sepsis screen CSF cell count: WCC: 443 x 106
– 85% lymphocytes 15% polymorphonuclear cells
PH micro team retrieved the CSF sample received in the blood sciences laboratory for CSF glucose and protein
Blood sciences BioFire squad run the sample on the BioFire ME panel and detect Enterovirus
10.04.22
All antimicrobials stopped and anxious parents re-assured Discharged home
Table 4. Meningitis case; two-month-old baby.
has been getting a result right there and then, saving the patient from having to go to elderly care – we know that, when they are moved there, it can lead to an increased risk of deterioration. “We presented our findings to the
Board and they have approved the funding, so this is now ‘business as usual’ for us. This is saving patients’ lives and it is improving patient flow and discharges. We have achieved this by following our trust’s values: by being compassionate, being aspirational, and being earlier adopters of technology. It took hard work in convincing our multidisciplinary team and the executive team, writing reports and getting the data, but if we put the effort in and get the right people on board, we can adopt technology earlier,” Olubunmi continued. She urged the audience not to wait for NHS England to instruct them to adopt innovative technology: “We can do this locally and share our experiences and knowledge with others. Oxford are now sending their doctors to us to see what we are doing. NHS Improvement are also visiting us to see what we are doing. Technology implementation works better ‘bottom up’ rather than ‘top down’ – you get better buy-in this way,” she commented.
Next steps The next steps are to implement IT for result auto-transfer and to take the BioFire Meningitis and Pneumonia Panels, from the point of care, back into the laboratory where they have the technical staff and infrastructure.
“This will allow the clinical leads to focus on the patient while we do the testing. We know that best practice is
The pre-analytical stage of the process was optimised in terms of blood collection, compliance with the four-hour standard, and ensuring the integrity of the sample
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not always followed with point-of-care testing by clinical staff, so it is better that it is done by the laboratory staff – as long as the result is provided on time. We can provide due diligence and ensure better governance, oversight and transparency for all care groups. “So, where do we want to be? We need to ensure that, if I or a loved one has sepsis, I would want them to come to Royal Berkshire Hospital,” she concluded.
Acknowledgements Olubunmi Martindale-Sheldon highlighted the importance of collaboration and credited the valuable contribution of her collaborators: Claire Burnett – Sepsis Lead Nurse, Critical Care Outreach Nurse Shabnam Iyer – Microbiology Consultant and Clinical Lead Andy Walden – Trust AMS Lead, Acute Medicine and Intensive Care Consultant Manish Thakker – Trust Sepsis Lead, Emergency Medicine
n This article first appeared in The Clinical Sciences Journal (Faster diagnostics key to improving sepsis care. CSJ. 2024 Jan; 23 [1]: 41-4) and is reproduced here in edited form by kind permission.
The UK Sepsis Summit featured a comprehensive programme that examined the importance of engaging with all stakeholders of the pathway. To improve patient outcomes and minimise the impacts of AMR, the sepsis pathway must be streamlined and consistent in hospitals and laboratories across the UK. The Sepsis Summit allowed delegates to share best practice and feedback new innovations and processes that have led to successful outcomes and patient care. If you were unable to attend the UK Sepsis Summit, and you are a healthcare professional wanting to find out more, please email:
ukmarketing@biomerieux.com for access to the event recordings.
MAY 2024
WWW.PATHOLOGYINPRACTICE.COM
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