The generation and utilization of bacteriology information by members of the health care team

The ordering, collecting, transporting and the reporting of bacteriology specimens in hospitals are the least standardized of the practices surrounding the request for laboratory services (Bartlett, 1974; Lorian, 1982; Sanders, 1983). The reason for requesting an investigation ranges from the need to isolate a causative agent in an infected patient, to curiosity about what bacteria might be colonizing some particular body site or environmental niche (Edwards, Levin and Bulagtas, 1973). Studies aimed at physicians and their use of this type of service have addressed issues relating to clinical relevance (Sanders, 1983), result interpretation (Bartlett, 1974; Ackerman, 1979), and result utilization (Lee and McLean, 1977). As health care teams in hospitals continue to increase in size, the lines of communication and responsibility with respect to ordering the collection of specimens become more and. more vague. Today, it is not uncommon for specimens to be ordered by non-medical personnel and perhaps this is one reason for the inappropriate application of bacteriology results to patient care. It might be argued that the appearance of additional laboratory information in patients records will eliminate diagnostic delay and contribute to early treatment when infection is suspected. On the other hand unless the information is relevant to the particular infection, the result is without merit. With the growing concern over the high cost of laboratory tests, it seemed important to give some attention to the issue of the ordering and collecting of specimens in our hospital, with the view of educating those persons who are the principle users of the laboratory. Over the past 2 years, the Royal Victoria Hospital has experienced a 27.8 per cent increase in the number of bacteriology specimens processed. At the same time, the overall infection rate dropped from 4.6 to 4.0 per cent despite a 2 per cent increase in the number of patient days. Thus a second reason for this investigation was to get a better understanding of the relationship between the increasing numbers of specimens and the pattern of specimen collection at ward level. For the purpose of the survey, specimens collected