I been in the lab, with a pen and a pad...

So said Dr. Dre, and he’s a doctor, so he must know something. And I think he’s right.

 I was speaking with a colleague last week who has been an ICP for a few years, and she mentioned that she needs to go get her certification soon.  I’m nervous, she says, pulling her CIC study guide off her desk.  Without really even thinking, I said, Don’t be.  You’re a lab tech.

There are several paths into Infection Control, and I am unique in that I came to it having traveled three routes.  I am a medical technologist, or clinical laboratory scientist. It was my first degree, and it has served me very well.  I am a registered nurse.  I went into nursing when I realized I wanted to know more about those people whose names were on the samples I tested.   I have a Master’s in Public Health/Epidemiology, which was my goal from early on, but life derailed my plans for 15 years until I finally finished it.

So here I am in Infection Control, and on many days I wonder how most people do it without a lab science background.  CAN you do it?  Of course! You can learn anything.   And I recently discovered while reading an ICP salary survey that the overwhelming majority of ICPs have a nursing degree, and far fewer a lab science degree.  So that’s proof right there.  But I wonder how hard it is, and after a very long conversation with our reference lab last week discussing their methodology and requirements for CRE testing, I wonder if some new ICPs struggle trying to learn or get comfortable with the microbiology that is embedded in our daily work.

A huge portion of what I do each day, I do with ease because of my lab tech education.  I review cultures and antibiotic patterns almost mindlessly.  I know where diptheroids  and bacillus are normal and where they might not be.  I’ve never confused the flu with Haemophilus influenzae,  or Enterobacter with enterococcus.  I know what strep groupings are, and the difference between mycoplasma and mycobacteria.  And I don’t need to think about it.

Now nurses know microbiology.  They read patients’ lab reports all the time, and administer antibiotics.  All nurses take a microbiology class.  But it’s often not the same as the kind the lab techs take.  Lab techs take general micro, clinical micro, virology, parasitology, immunology, and bunch of other stuff.  Most of those classes are lectures with labs.  I remember our small class bringing in our own samples for labs—throat swabs, urine and stool cultures, etc.  Almost as much fun as learning phlebotomy on each other.  If your micro class was a long time ago, or was pretty basic, it might be time for a refresher.

I know that if you come to infection control from a lab background, you’ve got other things to learn, like nursing practice, surgery, and sterilization. If you came from a public health background, you’ve got statistics, study design, interventions, and community health practice under your belt, but the clinical application might be your challenge.  And in none of my education did I learn enough about antibiotics to prepare me for how much I need to know now. (Desperately waiting for an ICP-focused, soup-to-nuts, antibiotics course to become available from someone.  APIC? Pharmacists?  Anyone.) [crickets]

Maybe I’m wrong, maybe it’s just my own experience, but I do meet ICP’s (experienced ones) who still seem to struggle with some basic concepts.  Maybe they don’t know what they don’t know.  When I hear that people are evaluating a disinfectant by the number of organisms listed on the label, I know they need a micro class.  Or that they refuse a product because Staph aureus is on the label but MRSA isn’t.  When it’s not clear why non-enveloped viruses are harder to kill than enveloped viruses, you need a micro class.  If your lab lets you know about a change in their test methodology and you don’t know how it affects your infection rates….  When you don’t know which organisms are non-fermenters in a research paper….Why Hepatitis A doesn't need to be in your post-exposure blood panel...The difference between α-hemolytic strep and group A strep in a blood culture... That you’ve failed the CIC exam more than once.  These are all actual things that have come up in conversations I’ve had with ICPs.  

I might sound like a lab snob, thinking that my lab education is soooo much better than your nursing degree.  But I’m not, because I can tell you from experience that I came to infection control far better prepared with a lab degree than a nursing degree.  They are a very nice complement to each other, but if I had to pick one to recommend, it would not be nursing.  I write this so that it might be helpful to someone out there.  

I’ve worked in different environments, but mostly outside of the academic medical centers (by choice).  I went to a meeting once as an affiliate hospital of a large medical center.  We were supposed to send our IP staff.  All the community affiliates sent their one or two ICPs, while the flagship site sent their 7 ICPs, 3 hospital epi MDs, 2 fellows, and their ID pharmacist.  Um, wow.  I can see that if you work in a place with that much support, you might not need to know everything.  But most of us don’t work like that.  We work alone or in pairs.  We may or may not have an ID doc with any hospital epi experience.  He may even be a consultant off-site.  You’re on your own, and you’d better know your stuff.

I’d like to know if CBIC keeps track of who does better on the exam, or is more likely to pass it on the first try—the lab techs, the MPH’s, or the nurses.  I could be totally wrong.  But I’d like to see that data.  You could learn everything from a book.  You could use your CIC study guide and maybe get it all.  But learning for a test, and really getting it, are different and some stuff is just easier to learn in a structured setting.  If you’re thinking a micro class is what you need, find your nearest center of higher education that runs a clinical laboratory science program, and get yourself into that class.  Make sure it includes a lab where you put clinical specimens on plates and you learn to read them and make Gram stains.  Bring a pen and a pad. Then come back and tell me if I was right.  

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