When a patient shows up at the emergency department with fever, coughing, wheezing and generally feeling terrible, it’s a good bet he or she has a respiratory infection. But a good bet isn’t good enough. Doctors need to know if the symptoms are caused by bacteria, virus, or something else altogether. And they need to know quickly. Time is the driving factor in much of medicine – the patient’s health, or even survival, often depend on starting treatment as quickly as possible.
The hospital laboratory is critical in getting that done. And in today’s lab, new technology is making a dramatic difference. “Advances in lab technology are revolutionizing patient care,” says Nicole Finke, M.D., medical director of the Community Medical Center laboratory. “A process that used to require multiple steps, sometimes over several days, is now finished before the patient leaves the emergency department. This new technology allows local laboratories to perform specialized testing that was once the purview of only large university or commercial labs.”
In the area of microbiology, the workhorse in this technological revolution is the BioFire FilmArray system. Taking up less space than the average microwave oven, this machine tests specimens from patients against the 20 most likely infectious respiratory organisms, and yields results in an hour. For the ER patient who is wheezing and coughing, that means the doctor can decide if antibiotics are necessary and start the right medication right way.
The BioFire can also identify over 20 causes of gastrointestinal (GI) infections, so people who come to the ER with severe diarrhea can get answers and treatment quickly. That’s especially important for young children, who can become dangerously dehydrated very quickly.
The ER isn’t the only place where new technology is making a difference. Rapid molecular testing is helping doctors quickly:
- Screen pre-operative patients for methicillin resistant Staphylococcusaureus, or MRSA. Many people have MRSA on the surface of their skin and in their nostrils without being sick. However, MRSA may cause significant harm when it gets an opportunity to enter the body.
- Find out if someone is infected with a highly contagious disease such as norovirus. This GI infection spreads easily from person to person and can be serious in children and older adults. It’s essential to diagnose it quickly, especially in places like day care centers and nursing homes, so that appropriate decontamination procedures and precautions can be taken.
- Determine if a GI infection could be from a food-borne pathogen. Identifying food poisoning quickly and reporting it to the local health department can help keep others from getting sick.
- Identify vaccine-preventable diseases such as pertussis. A quick diagnosis results in the right treatment, and helps officials take steps to avoid larger outbreaks.
- Minimize the spread of antibiotic resistant bacteria. When doctors aren’t sure which bacterium is causing an infection, they may prescribe a medicine that kills many types of bacteria – known as “broad spectrum” antibiotics – and switch to a more targeted antibiotic once the exact organism is identified. The delay associated with this two-step process promotes the spread of antibiotic-resistant bacteria, which are estimated to cause at least 2 million illnesses and 23,000 deaths in the U.S. annually.
The BioFire FilmArray is also a powerful tool to identify pathogens in the blood in just an hour. Bloodstream infections, called bacteremia, can lead to a serious and sometimes fatal condition called septic shock.
Modern hospital labs may also have other innovative technologies, such as the GeneXpert, which can identify infectious diseases such as chlamydia and gonorrhea while the patient waits. And the Alere i is starting to arrive in primary and urgent care clinics. This compact machine can positively identify the flu and strep throat right in the doctor’s office, without the need to wait for a lab culture to confirm the diagnosis.
The BioFire and other new technologies don’t replace the highly skilled lab workers who prioritize testing, perform quality checks on equipment and run tests that still must be done by traditional methods. But their work is becoming easier and faster.