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Chapter 13.2 : Laboratory Support for Infection Control: Optimization by Policy and Procedure
The discipline of infection control had its formal beginnings in the 1970s and was refined in the 1980s. This discipline will continue to evolve, becoming part of the health care providers' overall program of continuous quality improvement. Super-imposed on the evolution of infection control programs has been the rapid evolution of the health care field, introducing new modalities of care that are prone to high rates of nosocomial infection. Fewer patients are hospitalized, but in general, those who are hospitalized are sicker than similar populations in previous years. The numbers of indwelling lines, implanted devices, and complex procedures have greatly increased, as have the numbers of patients compromised by cancer chemotherapy regimens or transplant immunosuppressive therapy. Transfusion practices have evolved to include a variety of processed subsets of blood, and transplantation now includes many solid organs, bone, bone marrow, corneas, and various connective tissues. In addition, special patient populations such as the elderly, neonates, women, or ethnic minorities are being evaluated for their special health care needs that might require unique services. The microbiology laboratory is increasingly being asked to perform cultures that support the needs of these new programs. The involvement of the laboratory must be optimized by appropriate policies and procedures and the appointment of the chief microbiologist to the Infection Control Committee. With early patient release and with multiple hospitals often served by the same microbiology core laboratory, it is imperative that the laboratory develop methods and communication tools to assist in serving the patients' infection control needs. The Institute of Medicine in 2000 addressed the issue of patient safety, and although it did not specifically focus on health care-associated infections, these are clearly critical areas for improvement and monitoring.