Assessing the Laboratory, Clinical and Cost Impacts of Twenty-four-hour Molecular Microbiology on Gram Positive Bacteraemia Cases at Whiston Hospital

Abstract

The National Health Service (NHS) is under growing pressure to improve patient care and clinical outcomes while also reducing costs. Debates are on-going regarding how to modernise the service which include making use of new technologies and offering a twenty-four-hour, seven days a week service. The Microbiology department is an important diagnostic service which is now at a point where twenty-four-working is a viable option due to advances in rapid molecular testing such as polymerase chain reaction (PCR). One of the areas of Microbiology which can most benefit from this type of testing is the diagnosis of blood stream infections which can be life-threatening, developing into sepsis and septic shock resulting in 44,000 deaths each year in the UK. Antibiotics should be administered within one hour of sepsis being suspected, with each hour of delay being associated with a 9% increase in the odds of mortality. The GeneXpert MRSA/MSSA PCR test is a diagnostic test introduced to Whiston Hospital for the detection of Staphylococcus aureus which is an important pathogen implicated in blood stream infections. This test can also differentiate resistant MRSA strains from sensitive MSSA strains directly from a blood sample. Due to implementing a twenty-four-hour shift system this test can be run twenty-four-hours a day. A single-centre retrospective analysis was conducted comparing the period 01/07/2016 to 31/12/2016 prior to the introduction of twenty-four-hour molecular working with the period 01/07/2019 to 31/12/2019 post introduction of twenty-four-hour molecular working. There was found to be a statistically significant longer turn-around time in the post intervention group (Mdn = 114.5 hours, n = 389) compared to the pre intervention group (Mdn = 88.65 hours, n = 244) (P =

Date of Award	13 Jun 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Gemma Shields (Main Supervisor) & Guoqing Xia (Co Supervisor)