Clinical Laboratory Science Program Research Articles

Preparing Faculty Using an Assessment for How Clinical Laboratory Students Learn

Purpose: Students interpret and learn information in different ways. Whether students develop deep or surface learning depends in large part on the transmission of information from their educator, which activates their domains of learning. Knowing students’ learning styles as either visual, auditory, psychomotor, or mixed, professors can develop teaching resources that benefit the learning diversity of their students by using different instructional delivery methods. This study examines survey results for how students learn best to enhance the student experience within the Clinical Laboratory Science (CLS) program at a university in Detroit, MI, USA. Method: To determine the resources needed to enhance learning for students and to prepare faculty, the cognitive learning styles of students within the last four cohorts of the CLS program were examined. To obtain this data, CLS students, from the 2018-2021 cohorts, participated in an online survey to discuss which cognitive learning styles they identified with based on the survey questions. Results: The majority of students did not just identify with one learning style. However, when presented with two or more learning styles, their retention of the material and experience was enhanced. Conclusion: Creating teaching resources for educators that revolve around multiple learning styles is necessary. Once established, the use of these resources can help enhance learning retention and thus encourage faculty members to thrive within the Clinical Laboratory Science program.

National Blood Foundation 2021 Research and Development summit: Discovery, innovation, and challenges in advancing blood and biotherapies.

National Blood Foundation 2021 Research and Development summit: Discovery, innovation, and challenges in advancing blood and biotherapies.

Current Antibiotic Resistance Pattern of Prevalent Uropathogens in Urinary Tract Infection of Diabetic Patients in Comparison with non-Diabetics

Introduction: Urinary tract infections (UTIs) are a common infectious disease worldwide. Bacterial resistance to antibiotics is one of the most challenging global health problems. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance patterns for empirical antibiotic treatment of the patients. This study aimed to explore the bacteriology and antibiotic resistance pattern of urological pathogens in diabetic patients compared to that in non-diabetics. Materials and Methods: A prospective study during the period from June 2021 to November 2021 in Khulna City Medical College Hospital was carried out including 347 diabetic and non-diabetic patients. Midstream clean-catch urine samples were collected from suspected UTI patients of age more than 14 years and inoculated in Mac Conkey & Blood agar media for semi-quantitative urine culture and sensitivity test. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Among the 347 inoculated samples, Culture positive were in 286 cases. Gram-negative E. coli was isolated from 119 (overall 41.6%, 51% in diabetics and 36.5% in non-diabetic patients) samples which were the most predominant bacteria, followed by Enterococcus, Pseudomonas and Klebsiella. UTI with E. coli was significantly at a higher rate in diabetic patients and Exhibits 100% resistance to Ceftriaxone, Nalidixic acid, Cefuroxime and Cefixime. Bacteria offered a high degree of resistance against commonly used antibiotics-Amoxycillin, Ciprofloxacin, Amikacin, Gentamycin, Levofloxacin, Nalidixic acid and Nitrofurantoin ranging from 7% to 93%. Conclusion: E. coli infection is significantly predominant in UTI cases in this study and exhibits a higher rate of resistance to all antibiotics in diabetic patients than that in non-diabetics. None of the antibiotics is 100% sensitive in diabetic patients. Imipenem, meropenem and Piperacillin remain .......

Bacteriology and Antibiotic Sensitivity Pattern of Sputum in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. Nowadays investigators need culture studies for proper selection of antibiotic, but it is a time consuming process. The choice of the antibiotic should be constituted on the bacterial sensitivity and resistance pattern. Objective: To identify the causative bacteriology and antibiotic sensitivity of sputum of chronic obstructive pulmonary disease patients with acute exacerbation. Materials and Methods: It was a prospective study in department of medicine Cumilla Medical College Hospital during the period of July 2019-2020. All the patients included in this study were above 37 years of age, diagnosed as acute exacerbation of COPD (AECOPD) were included in this study. Those patients were on antibiotic was advised to stop antibiotic for 48 hours and were included in this study. Fresh spot specimen as well as overnight collection of sputum samples were collected from each 257 patients of different age and sex groups in a sterile screw capped universal container. The specimen was labeled and transported to the microbiology laboratory for processing and cultured within half an hour of collection. Antibiotic susceptibility pattern was done following Kirby-Bauer disc diffusion method of clinical laboratory science (CLS) program. Results: Majority (45.5%) of the patients had growth of Klebsiella pneumoniae. All the isolated organisms except Acintobactor are mostly sensitive to Meropenum, Imipanum and Amikacin. In vitro sensitivity pattern against these antibiotics was more than 85%. Conclusion: Male is predominating and majority of them are older age group. Klebsiella pneumoniae, Pseudomonas and E. coli are common isolated organisms. Medicine Today 2022 Vol.34(1): 12-16

USING THE REQUIREMENTS OF TEACHING AND LEARNING STANDARDS TO ACHIEVE THE STANDARDS OF THE EDUCATION EVALUATION COMMISSION IN KSA: AN APPLICATION ON THE ACADEMIC PROGRAMS IN THE FACULTY OF APPLIED MEDICAL SCIENCES IN NAJRAN UNIVERSITY.

This study aimed to realize the extent of the fulfillment of the standard of teaching and learning according to the standards of the Education Evaluation Commission in KSA for the academic programs in the Faculty of applied medicine science - Najran University. These programs have already got the international accreditation from AHPGS in 2015 to 2020. Thus, the study has targeted the beneficiaries of this standard. These beneficiaries are students and the teaching staffs of the three programs (Clinical laboratory, physiotherapy and Radiation science programs) to disclose the differences of the fulfillment of this standard in the light of the variables of programs and categories (students and teaching staffs) in addition to the gender regarding the program of radiation science (track of male and female). The researchers have used the descriptive approach, the sample of the research are 37, 28 and 64 students, 16,17 and 9 teaching staffs from the programs of medical laboratory, physiotherapy and radiation sciences, respectively for the academic year 2018/2019 during the second semester. The researchers have used the questionnaire as a tool to collect data. Two questionnaires were designed. The first one is directed to the students in each program. This one contained 40 items, which distributed to 3 subjects. However, the second has directed to the teaching staffs, contained 49 items, which also distributed to 3 subjects. The most important results of this study is that the procedures regarding each sub-standard (study subjects) proved to be highly sufficient, especially from the teaching staffs’ point of view. The study has come out with some recommendations which will lead to fulfill the standard of teaching and learning well, among them the graduates’ characteristics should be announced, the targeted outcomes of learning from the students’ academic programs and the other service beneficiaries by various advertising means whether in paper or electronic, linking between the needs of labour market and the outcomes of the program through holding appropriate training agreements with the bodies in which students employed, promote the evaluation approaches used in the program to cope with the measurement of learning outcomes, the administration of the program should lay down appropriate mechanism to review the program and measure students’ acquirement of the outcomes of learning periodically and based upon the feedback from the evaluation process, care of integration of the students in the committees of organizing workshop and symposia and invite all students of the program, urging them to participate actively in these workshops. (Keywords: Academic standards, teaching and learning standard, Najran University)

Antibiotic Resistance in Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh-A Follow-up Study

Introduction: Bacterial resistance to antibiotics is one of the most challenging global health threats. Urinary tract infections (UTIs) are a common infection. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance pattern where empirical antibiotic treatment is the mainstay. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic resistance pattern among urological pathogens in comparison to similar study 5 years back.
 Materials and Methods: We performed a prospective study in Comilla Medical College Hospital, Bangladesh during the period of July 2015- June 2016. Midstream clean-catch urine samples were collected from 658 suspected UTI patients with age more than 12 years and inoculated in MacConkey& Blood agar media for semi quantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program.
 Results: Culture positive were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum found resistance against 0% to 12% of the urological pathogens. Bacteria offered high degree of resistance against commonly used antibiotics - amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, amoxiclav and reduced resistance for nalidexic acid, mecillinum and cefuroxime.
 Conclusion: E. coli infection is significantly increaseing in follow up study from 2011 to 2016 with no steady increase in resistance to all antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive while comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, and amoxiclave and reduced resistance for nalidexic acid, mecillinum, cefixime and cefuroxime.
 Medicine Today 2019 Vol.31(1): 9-14

Meeting New York State Requirements for Clinical Laboratory Science Licensure at a Liberal Arts College

<h3>ABSTRACT</h3> Clinical Laboratory Science (CLS) programs are most students’ sources of guidance for entry-level curricular content areas and their related coverage on the American Society for Clinical Pathology Board of Certification exams. However, in states that offer CLS licensure, such as New York, licensure eligibility requirements may not align with board exam eligibility requirements. The differences can include curricular expectations that may exceed the entry-level curriculum and a minimum number of hours of supervised clinical experience. This article will detail the licensure eligibility requirements for CLS programs in New York, and explore how those requirements affected the design of the CLS program at Nazareth College. Nazareth College’s program opened in the fall of 2014 with goals of meeting students’ educational needs, preparing students for certification exams, and meeting all requirements for licensure eligibility. Using a multifaceted approach to provide comprehensive didactic, laboratory, and clinical learning, the program met these goals within its initial four years.

American Society for Clinical Pathology First-time Pass Rate: A Comparison Between Clinical Laboratory Science Traditional (Face-to-face) Program Versus Distance (Online) Program

<h3>ABSTRACT</h3> The Texas Tech University Health Sciences Center School of Health Professions, in 2007, sought to increase enrollment in the Clinical Laboratory Science program by developing an online Clinical Laboratory Science program for those individuals who held earned bachelor’s degrees in a science field (biology, chemistry, microbiology, biochemistry, etc). Since 2010, the program received approximately 125 applications and accepted an average of 41 students annually. The last admissions cycle experienced its largest numbers to date, 389 applicants with 80 accepted. Participants in this presentation will be able to compare the pass rate for the different learning platforms. Data were collected using American Society for Clinical Pathology first-time pass rates for both the traditional (face-to-face) program and the distance (online) program starting the class of 2010, the first distance (online) cohort. The purpose of this study was to compare the success of both programs utilizing the Board of Certification first-time pass rate. It was determined that the average overall pass rates were 93% for the online cohort and 91% for the traditional cohort. Based on these findings, the distance (online) program appeared to be just as successful as its traditional (face-to-face) student counterparts.

Predictors of Medical Laboratory Science Students’ Scores on the Board of Certification Exam

<h3>ABSTRACT</h3> The faculty in the Clinical Laboratory Science (CLS) program at Louisiana State University Health (LSUH) Shreveport School of Allied Health Professions sought to identify variables to best predict students’ success on the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) Examination for Medical Laboratory Scientists (MLS). In January 2015, the CLS program purchased access to the MediaLab Inc Exam Simulator for all senior students. Prior to the use of Exam Simulator, the average BOC score at LSUH was 505. After student access to Exam Simulator was purchased, the average BOC score increased to 528. Multiple variables were considered as predictors of success on the BOC, which included all Exam Simulator sessions attempted by students, MLS computer-adaptive practices tests on Exam Simulator, LSUH grade point average (GPA), and overall GPA. Results from regression analysis revealed that the level of difficulty (<i>β</i> = 0.459, <i>t</i>(32) = 2.92, <i>P</i> &lt; 0.05), mean score (<i>β</i> = 0.366, <i>t</i>(32) = 2.23, <i>P</i> &lt; 0.05), and highest score (<i>β</i> = 0.484, <i>t</i>(32) = 3.13, <i>P</i> &lt; 0.05) on the MLS computer-adaptive practice tests were significant predictors of BOC scores. Likewise, graduates’ GPA at LSUH was also a significant predictor of the BOC score (<i>β</i> = 0.426, <i>t</i>(32) = 2.75, <i>P</i> &lt; 0.05). The findings of this study revealed the importance of providing computer-adaptive practice examinations for senior students prior to taking the ASCP BOC examination.

Measuring Attitudes of Clinical Laboratory Science (CLS) Students

<h3>ABSTRACT</h3> The current complex environment of healthcare demands a comprehensive and collaborative approach in which teamwork and collaboration are paramount. Recommendation by the National Academy of Medicine on improving diagnosis in healthcare is “Facilitate more effective teamwork in the diagnostic process among healthcare professionals, patients, and their families.” The objective of this study was to determine the readiness of Clinical Laboratory Science (CLS) students to participate in interprofessional simulation. The revised Readiness for Interprofessional Learning Scale (RIPLS) was chosen to assess CLS student’s attitudes toward interprofessional education before and after participating in an interprofessional simulation. We had 50 master’s degree CLS students participate in the simulations and complete the surveys. The simulation was a large-scale, multipatient interprofessional scenario that occurred in a simulated intensive care unit. In addition to the RIPLS items and demographics, we asked if students had previous experience with interprofessional simulation and if students have worked in healthcare. Data were entered and analyzed using SPSS. Our student population had an average age of 26.7 years (SD = 5.25; median age = 25; range = 20), was 70% female, and was 46% White. In addition, 26% had experience in interprofessional simulation, whereas 48% had worked in healthcare. Students’ scores were high in all questions of RIPLS subscales but the questions belonging to the Negative Professional ID (inverted scale) and for the Roles and Responsibilities subscales. University of Alabama at Birmingham CLS students seem ready to learn in interprofessional teams. Faculty in CLS programs should provide interprofessional experiences for their students.

Admissions Criteria as Predictors of CLS Student Success

<h3>ABSTRACT</h3> A passing score on the American Society for Clinical Pathology Board of Certification (BOC) exam is a metric of a student’s academic success in most Clinical Laboratory Science (CLS)/Medical Laboratory Science programs. It would be ideal if CLS/Medical Laboratory Science programs were able to predict a student’s success when an individual applies for admission to a CLS/Medical Laboratory Science program. This study aimed to demonstrate that there was a positive correlation between admissions scores at the Texas Tech University Health Sciences Center (TTUHSC) School of Health Professions and students’ performance on the BOC exam. Using simple linear regression analysis with Pearson correlation, specific criteria that are part of the application and admissions scoring process were used to determine the relationship. The results of the study indicated moderate positive correlation between certain criteria and BOC exam performance, but they provide enough information to make an admissions decision on students who would have the best chance of success in the TTUHSC CLS program and the profession.

A Follow up Study of Bacteriology and Antibiotic Sensitivity Pattern of Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh

Background: Urinary tract infections (UTIs) are a common infection. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic sensitivity pattern among uropathogens in comparison to similar study 5 years back. Materials and methods: We performed a prospective study in Comilla medical college hospital, Bangladesh during the period of July 2015-June 2016. Urine samples from 658 suspected UTI patients aged above 12 years inoculated for semiquantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby- Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Culture passivity were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum, found sensitive against 88% to100% of the uropathogens. Bacteria offered high degree of resistance against commonly used antibiotics-amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs. 2011 shows significant reduction in sensitivity for imipenum, ceftriaxone, amoxiclav and increased sensitivity for nalidexic acid, ciprofloxacin, mecillinum, colistin, cotrimoxazole. Conclusion: UTI with E. coli was significantly increased in the year 2016. This study failed to show a steady increase in resistance to all studied antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive in this comparative study. Comparative study of 2016 vs. 2011 shows significant increasing resistance for imipenum, ceftriaxone, amoxiclav and increasing sensitivity for nalidexic acid, ciprofloxacin, mecillinum, colistin, cotrimoxazole.

Strengthening the Clinical Laboratory with Simulation-Enhanced Interprofessional Education

1. Michelle R. Brown, MS, MLS(ASCP)CMSBBCM[⇑][1] 1. University of Alabama at Birmingham, School of Health Professions, Department of Clinical and Diagnostic Sciences, Birmingham, AL 2. Dana Bostic, MBA, MLS(ASCP)CM 1. Clinical Laboratory Science Program, DeVry University – Phoenix Campus, Phoenix, AZ 1. Address for Correspondence: Michelle R. Brown, MS, MLS(ASCP)CMSBBCM, University of Alabama at Birmingham, Assistant Professor, School of Health Professions, Department of Clinical and Diagnostic Sciences, 1705 University Blvd, SHPB 474, Birmingham, AL 35294 1. Explain the significance of interprofessional collaboration as it relates to patient safety and diagnostic errors. 2. Distinguish the difference between interprofessional education and multiprofessional education in healthcare simulation. 3. Align interprofessional core competencies with their fundamental principles. INTRODUCTION In 1998, the Institute of Medicine (IOM) published the report, To Err is Human, in which they stated that up to 98,000 people die each year due to medical errors.1 A more recent study, published in 2013, estimates that preventable adverse events contribute to nearly 210,000 premature deaths per year.2 The body of literature on patient safety and error prevention continues to grow with much of this literature focusing on effective communication and teamwork.3-5 In the report, Improving Diagnosis in Healthcare, the IOM recommends increasing collaboration among medical professionals to reduce diagnostic error. Working in interprofessional teams is also encouraged in the educational realm.6 Graduating students who are knowledgeable about and proficient in interprofessional teamwork and communication should be a priority in healthcare education programs, including Clinical Laboratory Science (CLS). Simulation-enhanced interprofessional education is one way to promote and practice effective communication and teamwork. Interprofessional Education Interprofessional education (IPE) is defined as people from different professions learning about, from, and with each other.7 This differs from multiprofessional education, where students learn side by side, but interaction is not required. The Interprofessional Education Collaborative (IPEC) was formed to promote and encourage interprofessional learning. They developed four core competencies for interprofessional collaborative practice to use as a framework for activity development and curriculum design in education (Table 1).8 The goal is to transform healthcare education and, in turn, have graduates of these programs change and strengthen the quality of patient care in our healthcare systems. As laboratory science students progress through… ABBREVIATIONS: IPEC – Interprofessional Education Collaborative, IPE - Interprofessional education, CLS – Clinical laboratory scientist 1. Explain the significance of interprofessional collaboration as it relates to patient safety and diagnostic errors. 2. Distinguish the difference between interprofessional education and multiprofessional education in healthcare simulation. 3. Align interprofessional core competencies with their fundamental principles. [1]: #corresp-1

Incorporating Clinical Laboratory Science Students into Interprofessional Simulation

1. Michelle R. Brown, MS, MLS(ASCP)CMSBBCM[⇑][1] 1. University of Alabama at Birmingham, School of Health Professions, Department of Clinical and Diagnostic Sciences, Birmingham, AL 2. Brianna V. Miller, MS, MLS(ASCP)CM 1. University of Alabama at Birmingham, School of Health Professions, Department of Clinical and Diagnostic Sciences, Birmingham, AL 1. Address for Correspondence: Michelle R. Brown, MS, MLS(ASCP)CMSBBCM, University of Alabama at Birmingham, Assistant Professor, School of Health Professions, Department of Clinical and Diagnostic Sciences, 1705 University Blvd, SHPB 474, Birmingham, AL 35294, 205-934-5987, michellebrown{at}uab.edu 1. Identify the barriers associated with incorporating students from multiple professional programs in interprofessional simulation. 2. Describe techniques used to allow CLS students to analyze specimens and communicate results within the timeframe of the simulation. 3. Describe debriefing a large, diverse group of students. INTRODUCTION The laboratory is a vital and dynamic participant on the clinical team in healthcare. However, the laboratory often exists behind the scenes, quietly providing answers to many diagnostic questions while providing a critical role in patient care. It is unfortunate that this hidden nature of the laboratory begins during professional education. In many educational institutions, interprofessional simulations are gaining ground as an excellent way for different professions to work together in a safe environment, preparing them for their future real life experiences.1,2 In order for these simulations to be effective and authentic, it is crucial for the laboratory to be included. This manuscript serves as an example of how the University of Alabama at Birmingham's Clinical Laboratory Science Program was able to partner with the Office of Interprofessional Simulation for Advanced Clinical Practice and create an interprofessional simulation that highlighted patient safety, teamwork, and communication. The Value of the Laboratory in Simulation Including the laboratory in interprofessional simulation is imperative. For starters, it is not realistic for lab values to be pulled out of one's pocket at the exact moment the clinician in the simulation orders a test. This provides unrealistic expectations of turnaround time for lab results. Waiting on results affords the opportunity for providers to determine appropriate measures to take while lab analysis is being performed. Bedside healthcare providers need experience in multi-tasking with patient care during a simulation. They may receive a call that a specimen is being rejected for one patient, all the while dealing… ABBREVIATIONS: ACLS – advanced cardiac life support, CBC – complete blood count, CLS – clinical laboratory science, CMP – comprehensive metabolic panel, COPD – chronic obstructive pulmonary disease, CT – computerized tomography, ICU – intensive care unit, PT – prothrombin time, PTT – partial thromboplastin time 1. Identify the barriers associated with incorporating students from multiple professional programs in interprofessional simulation. 2. Describe techniques used to allow CLS students to analyze specimens and communicate results within the timeframe of the simulation. 3. Describe debriefing a large, diverse group of students. [1]: #corresp-1

Small Scale, Low Resource Options for Introducing Clinical Laboratory Science Students to Interprofessional Simulation

1. Michelle R. Brown, MS, MLS(ASCP)CMSBBCM[⇑][1] 1. University of Alabama at Birmingham, School of Health Professions, Department of Clinical and Diagnostic Sciences, Birmingham, AL 2. Kristopher Maday, MS, PA-C, CNSC 1. University of Alabama at Birmingham, Physician Assistant Studies, Birmingham, AL 3. John Hurt, MS, PA-C 1. University of Alabama at Birmingham, Physician Assistant Studies, Birmingham, AL 1. Address for Correspondence: Michelle R. Brown, MS, MLS(ASCP)CMSBBCM, University of Alabama at Birmingham, Assistant Professor, School of Health Professions, Department of Clinical and Diagnostic Sciences, 1705 University Blvd, SHPB 474, Birmingham, AL 35294 1. Describe the use of SBAR as a communication tool. 2. Identify the phrases associated with the term CUS. 3. Construct a classroom-based interprofessional simulation for clinical laboratory science students. INTRODUCTION In the report, Health Professions Education: A Bridge to Quality, the Institutes of Medicine (IOM) has detailed a vision for preparing healthcare professionals.1 A focal point within this vision is teaching students to work in interdisciplinary teams. In a separate report, Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, the IOM calls for an alignment of education and healthcare delivery systems.2 The Clinical Laboratory Science (CLS) education community needs to readily embrace the IOMs vision and enthusiastically answer the call with innovative educational methods such as interprofessional simulation (IP). Some CLS programs are already considering interprofessional simulation, but may not have an existing simulation infrastructure or financial support from administration. Other programs have a laboratory with instrumentation, but have not yet made the leap from simulating a “day in the lab” with CLS students to including students from professions outside the laboratory to provide comprehensive situations that more closely mimic working in a healthcare environment. This manuscript offers small scale, low resource options to help a CLS program include IP simulation as an innovative educational method to teach interprofessional communication and teamwork. Getting Started: Know the Fundamentals While high fidelity mannequins, patient rooms, and instrumentation provide an authentic environment, they are not required to offer a quality IP experience. There are, however, fundamentals that remain the same whether designing intricate scenarios for students from several professional programs or simple scenarios with students from only two professions. This includes the alignment of content knowledge between students… ABBREVIATIONS: IOM – Institutes of Medicine, CLS – Clinical laboratory scientist, IP - Interprofessional, SBAR – Situation, Background, Assessment, Recommendation/request, Team STEPPS - Team Strategies and Tools to Enhance Performance and Patient Safety, APP – Advanced practice provider, WHO – World Health Organization, CUS – Concerned, Uncomfortable, Safety issue, SP – Simulated patient, PA – Physician assistant, UAB – University of Alabama at Birmingham 1. Describe the use of SBAR as a communication tool. 2. Identify the phrases associated with the term CUS. 3. Construct a classroom-based interprofessional simulation for clinical laboratory science students. [1]: #corresp-1

Healthcare-Associated Infections (HAI): The Perfect Storm has Arrived!

1. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 2. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 3. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 4. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 5. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu INTRODUCTION On any given day approximately 1 of every 25 inpatients in U.S. acute care hospitals has at least one healthcare–associated infection (HAI), adding up to about 722,000 infections in 2011. Pneumonia and surgical-site infection are the most common infection types, and Clostridium difficile is the most common pathogen.1 The CDC Multistate Point-Prevalence Survey of Healthcare-Associated Infections, published in the New England Journal of Medicine, used 2011 data from 183 U.S. hospitals to estimate the burden of a wide range of infections in hospital patients. That year, about 721,800 infections occurred in 648,000 hospital patients. About 75,000 patients with HAI died during their hospitalizations. The most common healthcare-associated infections were pneumonia (22%), surgical site infections (22%), gastrointestinal infections (17%), urinary tract infections (13%), and bloodstream infections (10%). The most common germs causing HAI by rank were C. difficile (12%), Staphylococcus aureus , including Methicillin Resistant S. aureus (MRSA, 11%), Klebsiella (10%), E. coli (9%), Enterococcus (9%), and Pseudomonas (7%). Klebsiella and E. coli are members of the Enterobacteriaceae bacteria family, which has become increasingly resistant to last-resort antibiotics known as carbapenems, typically referred to as carbapenem resistant Enterobacteriaceae (CRE).1 Practically, what this means is that over 200 patients will die the day you read this article and every day until the global community is able to address this healthcare crisis. If you do the simple math you will realize this results in about 4% of hospitalized patients who developed one or more HAI due to the care received in the hospital… ABBREVIATIONS: CAUTI – Catheter-associated urinary tract infection, CDC – Centers for Disease Control and Prevention, CLABSI – Central line-associated blood stream infection, EVS – Environmental services, HAI – Healthcare-associated infections, HCW – Healthcare Worker, MRSA – Methicillin resistant Staphylococcus aureus , SSIs – Surgical site infections [1]: #corresp-1

The Legal Landscape: HAI Public Reporting in the United States

1. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 2. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 3. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 4. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 5. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu 1. Discuss the role of federal influences on state-level HAI program initiatives and reporting activities. 2. Describe the progression of state-level initiatives to reduce HAIs from 2004 to the current date. 3. Describe core provisions of state HAI reporting laws: surveillance, collection system, healthcare settings subject to the laws, types of infections reported, public reporting requirements, and advisory committee structure. 4. Identify healthcare worker infection and illness reporting mandates. INTRODUCTION Since early 2000, there has been a “growing interest in the use of law as a tool to address” healthcare-associated infections (HAIs) in the U.S.1 All 50 states and two territories have HAI programs established within their public health agencies.2 Likewise, the majority of states have HAI public reporting laws.3-4 HAI data is being reported from hospitals in all 50 states, either voluntarily or under state or federal legal reporting mandates.5 Additionally, while the current national focus is on reporting HAIs in the patient population, requirements for reporting infections and illness in the healthcare worker population also exists. The purpose of this article is to provide a review of the federal and state-level legal environment applicable to HAI prevention in the context of the overall response to HAIs. Federal Influences To fully grasp state-level HAI program initiatives and reporting activities, it is important first to understand the many federal influences. Through the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), the federal government plays a central role in the control and prevention of HAIs. From 2004 to 2008, states began to recognize the need for state policies aimed at HAI prevention.4 Several states made significant strides toward HAI surveillance and prevention as the awareness of the public health impact of HAIs grew. However, due to budget constraints and the associated poor economic conditions starting in 2008, most states were unable to implement or further develop their HAI programs. Significant improvements… ABBREVIATIONS: ACA – The Patient Protection and Affordable Care Act, CDC – Centers for Disease Control and Prevention, CMS – Centers for Medicare and Medicaid Services, CLABSI – central line-associated bloodstream infection, CAUTI – catheter-associated urinary tract infection, CRE – Carbepenem-resistant Enterobacteriaceae, HAIs – healthcare-associated infections, HHS – U.S. Department of Health and Human Services, IQR – Inpatient Quality Reporting Program, MRSA -- Methicillin Resistant Staphylococcus aureus , NHSN – National Healthcare Safety Network, OSHA – Occupational Safety and Health Administration, VAP – ventilator-associated pneumonia 1. Discuss the role of federal influences on state-level HAI program initiatives and reporting activities. 2. Describe the progression of state-level initiatives to reduce HAIs from 2004 to the current date. 3. Describe core provisions of state HAI reporting laws: surveillance, collection system, healthcare settings subject to the laws, types of infections reported, public reporting requirements, and advisory committee structure. 4. Identify healthcare worker infection and illness reporting mandates. [1]: #corresp-1

The Changing Role of the Healthcare Environment

1. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 2. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 3. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 4. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 5. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu 1. Describe the role of the healthcare environment in its contribution to acquisition and transfer of microorganisms. 2. Discuss the role the environment has related to the risk of infection and illness in both patient and healthcare worker populations. 3. Summarize recently published scientific evidence related to transmission of microbes from environmental surfaces including textiles. 4. Explore laundering practices and procedures of healthcare textiles and uniforms. 5. Discuss new technologies and programs that can address reducing risk associated with contaminated environmental surfaces. INTRODUCTION The role of the healthcare environment and its contribution to acquisition and transfer of microorganisms that cause infection and illness in both patients and healthcare workers is not by any means straightforward. Considerations include potential contamination of hard surfaces like desks, sinks, beds, light switches, carts, walls, and floors, as well as porous surfaces like wheelchairs, bedding, linen, curtains, and upholstery. Historically the focus on managing the role of environmental variables was considered less critical because we knew less about the impact those surfaces had in infection prevention. Several factors are now monitored within healthcare settings that are considered environmental controls. One of the primary areas includes environmental surfaces. These have been categorized by the Spaulding Classification as “noncritical items” or those that do not come into contact with a patient's vascular system or body cavities, but rather simply by a brief or momentary touch from a patient or healthcare worker.1 Critical or semi-critical items, in contrast to environmental or touch surfaces, are medical devices that are either implanted into a patient like joints, stints or other devices used during medical or surgical procedures like scalpels, endoscopes or probes that are in contact with a patient for minutes, hours, weeks, or years. These items pose a higher risk than noncritical items because they come into direct contact with a patient's blood or body fluids. This year, the U.S. witnessed how improper cleaning and disinfection or sterilization or medical devices like endoscopes can result in serious patient illness and infection,… ABBREVIATIONS: ACHA – American College of Healthcare Architects, AHE - Association for the Healthcare Environment, CRE - carbapenem-resistant Enterobacteriaceae, CDC – Centers for Disease Control and Prevention, CDI – Clostridium difficile Infection, CFU – Colony Forming Units, EVS – Environmental Services, FDA - Food and Drug Administration, HCW – Healthcare Worker, HICPAC – Healthcare Infection Control Practices Advisory Committee, MDRO – Multiple Drug Resistant Organisms, MRSA – Methicillin Resistant Staphylococcus aureus , OR – Operating Room, OSHA - Occupational Safety and Health Administration, PPE – Personal Protective Equipment, VRE - Vancomycin-resistant Enterococci 1. Describe the role of the healthcare environment in its contribution to acquisition and transfer of microorganisms. 2. Discuss the role the environment has related to the risk of infection and illness in both patient and healthcare worker populations. 3. Summarize recently published scientific evidence related to transmission of microbes from environmental surfaces including textiles. 4. Explore laundering practices and procedures of healthcare textiles and uniforms. 5. Discuss new technologies and programs that can address reducing risk associated with contaminated environmental surfaces. [1]: #corresp-1

The Perfect Storm: Emerging Trends and Pathogens in Healthcare

1. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 2. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 3. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 4. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 5. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu 1. Explain how vulnerable populations, current healthcare delivery, and emerging pathogens have contributed to an increase in healthcare-associated infections. 2. Compare and contrast pathogens that occur in persons with HIV/AIDS, persons with cancer, and persons undergoing transplants. 3. Identify ways that community-based healthcare delivery may increase risk of HAIs. 4. Discuss the role of antibiotic overuse and international travel in the development of emerging pathogens. 5. Plan activities that are effective in preventing HAIs. INTRODUCTION In 1999, the article To Err is Human brought healthcare-associated infections (HAI) to the nation's attention. However, the risk posed by healthcare facilities to those who went there for healing had not developed overnight. Decades of changing demography, microbial evolution, and –ironically-- healthcare advancements had resulted in this perfect storm. Since the change in paradigm in healthcare that nosocomial or healthcare-associated infections are a natural consequence of treatment to a practice of surveillance and prevention, hospital acquired infections are no longer considered consequences of inpatient treatment. Prevention of healthcare-associated infections includes protecting patients, healthcare workers, visitors, volunteers and health science students. This paper aims to describe the contributory roles of affected populations with their attendant, diverse healthcare sites and healthcare workers, and emerging pathogens. Affected Populations Prior to the identification of the Acquired Immune Deficiency (AIDS) virus, persons with chronic immune deficiencies were anomalies—“bubble children” who were occasionally brought to the public's attention through the media. With the advent of HIV/AIDS, healthcare facilities faced the daunting task of caring for many individuals with immune deficiency on a long-term basis. Just as many infectious diseases seemed to have been conquered through vaccine or antibiotics, healthcare was called upon to manage a new infectious disease with no treatment and also to protect those individuals from other potential infections including pathogens that did not cause disease in persons with healthy immune systems. HIV/AIDS required healthcare facilities not only to protect their patients but their workers from a high fatality disease that was… ABBREVIATIONS: AIDS – Acquired Immune Deficiency Syndrome, CA-MRSA – Community-Associated Methicillin Resistant Staphylococcus aureus , CDC – Centers for Disease Control and Prevention, CRE - carbapenem-resistant Enterobacteriaceae, CMV – Cytomegalovirus, FDA - Food and Drug Administration, HA-MRSA – Healthcare-Associated Methicillin Resistant Staphylococcus aureus , HAI – Healthcare-Associated Infections, HCW – Healthcare Worker, HIV – Human Immunodeficiency Virus, KPC-Kp – Klebsiella pneumoniae Carbapenemase Producing, MERS – Middle Eastern Respiratory Syndrome, MDRO – Multiple Drug Resistant Organisms, MRSA – Methicillin Resistant Staphylococcus aureus , NICU – Neonatal Intensive Care Unit, NHSN – National Health Safety Network, PPE – Personal Protective Equipment, RSV – Respiratory Syncitial Virus, VRE - Vancomycin-resistant Enterococci 1. Explain how vulnerable populations, current healthcare delivery, and emerging pathogens have contributed to an increase in healthcare-associated infections. 2. Compare and contrast pathogens that occur in persons with HIV/AIDS, persons with cancer, and persons undergoing transplants. 3. Identify ways that community-based healthcare delivery may increase risk of HAIs. 4. Discuss the role of antibiotic overuse and international travel in the development of emerging pathogens. 5. Plan activities that are effective in preventing HAIs. [1]: #corresp-1

Cost Effective Implementation of a Doctorate in Clinical Laboratory Science Program

The establishment of an advanced practice level in clinical laboratory science, the Doctorate in Clinical Laboratory Science (DCLS), has been a goal of the clinical laboratory science (CLS) community for more than 10 years. CLS educators at institutions of higher education are challenged to find the resources needed to provide the high-level and relevant didactic and experiential learning opportunities for medical laboratory scientists (MLS) to enter this new career path. Implementation of a DCLS program was achieved using a three phase approach, first adding a CLS track in an existing MS program, then expanding the breadth and depth of the curriculum into a MS in CLS, and using that strong foundation to complete the ladder to the DCLS level. This model also includes interdepartmental collaboration, interprofesional education (IPE), and faculty, course, and resource sharing. The three phase strategic approach provided the faculty and developmental resources and curricular foundation to implement the DCLS program in a cost-effective manner. ABBREVIATIONS: American Society for Clinical Laboratory Science (ASCLS), Doctorate in Clinical Laboratory Science (DCLS), Clinical Laboratory Science (CLS), Master of Science in Health Sciences-Clinical Laboratory Science Track (MSHS-CLS), Master of Science in Clinical Laboratory Science (MSCLS), Medical Laboratory Scientist (MLS), National Accreditation Agency for Clinical Laboratory Science (NAACLS), Rutgers- School of Health Related Professions (Rutgers-SHRP)