1. DAVID R. WOODARD MSC, CIC, CPHQ, CLS Hospital Ecology

2. What is it all about What is normal What is unusual What is totally weird What is OMG

3. Usual or Normal Organisms that are encountered with some degree of frequency Antimicrobial susceptibilities that are common Usual organisms in usual places ICU Rehab MRSA

4. MRSA and VRE Are all MRSA equal? Community acquired Hospital acquired VRE Faecium Faecalis Cohort Screen

5. Unusual Organisms that you know occur infrequently in your populations Organisms with uncommon susceptibilities but you recognize Common organisms in unusual settings

6. Totally weird Organisms with names you cannot pronounce Organisms that Micro calls you about Organisms in places they shouldnt be – Salmonella in spinal fluid Chyrsobacterium in sputum

7. OMG Lots of the same bug in an inappropriate setting 6 sputum cultures positive for Echinobacteria all in the same day All AFB from the same day all positive for M. gallinarium Bugs you have never heard of or were just on Good Morning America

8. Antibiotics Know your antibiogram Is amikacin resistant E. coli normal in your hospital How many carbepenemase producing Klebsiella do you see in a time interval Induceable clindamycin resistance in MRSA Pan-resistant organisms

9. ANTIBIOGRAM A cumulative table comparing bacteria to the antibiotics that are used for testing Expressed a % susceptible Compare year over year when possible Prepared by microbiology/infection control/pharmacy

10. Antibiotic susceptibility Standards are published by CLSI Breakpoints The point (concentration) where an antibiotic is determined to be no longer effective Change per CLSI Effect isolation practices – 2010 Cephalosporin/enterobacteriaceae major changes

11. So what Do you have a good communication system with your lab Critical values Bugs Drugs Authority Confidence

12. Authority Implement isolation protocols Enforce isolation protocols Hand hygiene Consequences

13. Confidence Know and understand your program Know and access your resources Library Internet State Carry your expertise – just in time education

14. Where do bugs come from Sources of organisms Patients normal flora Patients transient flora Other units/hospitals Outside facilities Environment Equipment Supplies

15. Patients own flora Gut Prior hospital exposure Medical Tourist (KPC) Delhi metallo-enzyme Antimicrobial resistant strains from far away places with strange sounding names

16. Imported flora Acinetobacter calocaceticus Klebsiella pneumoniae (KPC) Salmonella sps (food) Living in unusual environments Peace corps Military

17. Equipment Equipment is mobile Rental Vendor/total joints Specialty procedures Rectal probes Eye instruments Follow-up to outside cases

18. Exogenous stuff Fried Rice Plants Fountains Animals Feral cats Turtles Stuff

19. Endogenous stuff Fingernails Skin and soft tissues Back packs OR caps Clothing and other attire

20. Environmental Biology Labs not qualified to do testing Water – Dialysis Drinking Equipment and medicines Air ? What is normal

21. Supplies Manufacturers contamination Alcohol pads – Bacillus cereus IV solutions Heparin flushes – Serratia marcescens Pseudomonas aeruginosa & mouthwash Equipment Sutures Dressing

22. Recalls Hospital recall system Products that maybe contaminated Internal processing Tracking and looking Hoarders! Hidden cabinets Procedure carts (locked)

23. Questions