The Necessity of Prerequisite Undergraduate Microbiology Courses for Pre-Allied Health Professionals.

To the Editor,

Recently, on the American Society for Microbiology (ASM) microedu listserv, an email thread developed in which a number of microbiology instructors expressed concern that many colleges and universities are dropping the requirement for microbiology for pre-nursing and pre-allied health students. As a parent of a disabled child and a microbiology educator, I would like to give you my perspective on why the microbiology prerequisite, and the microbiology lab in particular, are vital components of any pre-allied health education. At face value, the microbiology lab is not unlike any other biology lab, giving students hands-on experience in aseptic transfer of microbes, isolation of bacterial colonies, Gram staining, analysis of biochemical reactions to determine microbial species, and other lab activities. On the surface, these activities may seem superfluous to a pre-nursing student—rarely, if ever, will nurses be required to perform a Gram stain, inoculate a Petri dish, or analyze a biochemical sample. These are all activities performed in the clinical laboratory. However, what pre-nursing students do learn in the microbiology lab is proper aseptic technique and use of personal protective equipment (PPE), and they gain an awareness of the ubiquity of microbes in the environment. All it takes is one contaminated Petri dish or ruined experiment to teach students that microbes are everywhere. Properly administered, students in microbiology labs learn proper hand-washing techniques and gain the fundamental knowledge necessary for proper aseptic technique and infection-control practices critical to the clinical setting.

Allied health professionals are the main line of defense against healthcare-associated infections (HAIs), which are a major threat to patient safety (2, 3). It has been estimated that there are approximately 1.7 million cases of HAIs annually, resulting in healthcare costs between $28 and $33 billion and 99,000 deaths (8). The most common HAIs are catheter-associated urinary tract infections, central catheter-associated infections, and ventilator-associated pneumonia infections (7, 8), the majority of which are contracted at the hands of healthcare workers using improper aseptic technique and infection-control procedures. Guidelines for prevention of HAIs include hand hygiene before and after patient contact and using sterile techniques when performing invasive procedures such as urinary catheter placement, intravenous (IV) line placement, and central venous catheter placement (5). Studies suggest that attitudes toward prevention of hospital infection vary among “frontline” technicians, such as nurses, nurse practitioners, and phlebotomists, who perform these types of routine invasive procedures and are engaged with the greatest amount of patient contact (1, 6). Other studies also suggest that there is wide variation between hospitals with respect to infection prevention (4). Even with microbiology as a foundational prerequisite in allied health programs, the culture of the hospital may have an impact on the practice of proper aseptic technique. Nevertheless, it is vital that an appropriate foundation in proper aseptic technique and infection-control measures be laid in undergraduate prerequisite courses for pre-nursing and pre-allied health students.

As the mother of a severely disabled and medically fragile child, I spent a great deal of time in the pediatric critical care and intensive care units of the hospital where my son received care at the hands of these frontline caregivers. Additionally, nurses worked in my home for six years assisting us in caring for our child, who was prone to respiratory infections, gastrointestinal infections, and pressure sores. My knowledge of aseptic technique and infection control as the result of my training in microbiology aided me in improving the quality of life of my son and also informed my teaching practice, because I was able to use personal real-world examples to reinforce the relevance of microbiology to my students. I will never forget the day when my son was hospitalized for an extremely low hematocrit. I had just signed the consent forms for a blood transfusion, and sat next to his bed in the pediatric critical care unit, watching a stranger’s blood flowing into the arm of my child, remembering all of the lessons I taught in blood typing in my microbiology classes. It was during this moment of contemplation that the nurse came into my son’s room and blithely announced, “Ok! We need to put you on contact precautions because he has tested positive for C-diff.” In an instant, my professional and personal worlds collided. All I could think of was gram-positive endospore-forming bacillus, pseudomembranous colitis, hemorrhagic colitis, explosive diarrhea… Forefront in my mind were the endospores that were undoubtedly colonizing the surface of his bedroom, our washing machine, and other surfaces in our home, not only threatening my disabled child, but my other two children, my husband, our nurses, and all of the therapists, teachers, and guests who entered our home. I also came to the realization that my disabled, medically fragile child most likely contracted this infection at the hands of the healthcare workers who cared for him in the hospital. At that moment, the necessity of microbiology lab became intensely personal. No longer was Clostridium difficile some abstract organism discussed as part of the gastrointestinal infections chapter in my lecture section or in the endospore stain in the lab, it was currently the organism causing massive blood loss in my son and threatening his life. From that moment on, my role as a microbiology educator took on an entirely new dimension.

It is essential that pre-nursing students gain an awareness of the ubiquity of microbes in the environment, of proper aseptic technique, and of infection-control practices because someday they may be taking care of a child like my son and could prevent this type of HAI in an intensely medically fragile patient. I lend my voice and my personal experience to the multitude of microbiology educators who understand the vital role of the microbiology prerequisite for pre-nursing and pre-allied health students. I also call for greater activism on the part of microbiology educators and administrators alike to advocate the necessity of microbiology as a prerequisite for all pre-allied health students as well as the continued training and emphasis on proper aseptic technique to reduce HAIs.

Sincerely,