A Simplified but Comprehensive Laboratory Curriculum for Microbiology in Nursing and Allied Health (MINAH) Courses.

Some U.S. nursing programs have considered or already have removed microbiology courses from their curriculum. In response to this, the American Society for Microbiology (ASM) published in 2018 the Microbiology in Nursing and Allied Health (MINAH) Undergraduate Curriculum Guidelines. Parts of these guidelines include competencies and skills, which are best taught in a laboratory setting. Recognizing that some programs face a burden of running nursing/allied health microbiology lab classes, we have designed a curriculum of seven laboratories that covers the concepts in the MINAH guidelines. These labs cover aseptic technique and proper specimen collection, microscopy, enumerating microorganisms, and diagnostic tests in identifying unknowns. In addition, we provide some tips and tools for keeping down the costs of offering a microbiology lab. It is our goal that these tips and the suggested guidelines will allow microbiology to remain in the nursing and allied health curriculum. ©2019 Author(s). Published by the American Society for Microbiology.

INTRODUCTION

It is extremely concerning that some nursing programs have considered removing—or already have removed—microbiology courses from their curriculum given the rapid increase in hospital-acquired infection (HAI) rates. This increase can be attributed to factors such as increasing antibiotic resistance, overcrowding of hospitals, and poor compliance with infection prevention and control precautions by healthcare workers (1). A strong background in microbiology can protect both patients and practitioners in the healthcare setting. This is not a novel concept. Even in 1928, nursing training programs suggested that nurses take a course in microbiology in order to better treat patients (2). Beyond the intrinsic desirability of being the best healthcare professional possible for the patient, there are also now serious monetary penalties for 30-day readmissions due to some infections, including pneumonias, and even longer for total hip arthroplasty and/or total knee arthroplasty (3). These facts make a case for more education for nurses rather than less. To this end, ASM published a curriculum designed for microbiology for nursing and allied health (MINAH) programs (4). These MINAH guidelines covered topics in both lecture and laboratory.

PROCEDURE

The science laboratory is an excellent pedagogical environment (5). It allows students to see the environment where scientific knowledge is constructed (6). It develops a student’s observational skills and promotes collaboration between individuals. This laboratory setting is the perfect place for future healthcare workers to learn aseptic techniques that will follow them into their careers and can effectively improve patient outcomes by managing the spread of infection. It helps healthcare workers to become decidedly conscious of the pathogenic agents and of principles used in controlling these agents (7). The laboratory also allows for nursing and allied health students to see how (a) specimen sampling is properly collected, (b) diagnostic tests are performed, and (c) how susceptibility to antimicrobial agents is determined. With this knowledge, healthcare workers can better protect themselves and their patients from the spread of disease and the increasing concern of antibiotic resistance. It also allows them to explain to patients what they are doing and understand what test results mean and how proper diagnoses can be determined from those results. The nurse or physician assistant may be the sole knowledgeable person the patient or their family has any meaningful contact with.

Given the importance of the microbiology laboratory classroom and recognizing the burden of offering laboratory sections, we suggest a condensed laboratory curriculum of seven experiments (Table 1). These have been generated in accordance with the ASM’s MINAH curriculum guidelines and are activities common to healthcare setting protocols. Outlines of each laboratory activity are provided (Appendix 1). Most of these labs can be found in published lab manuals, which readers are encouraged to use when implementing these lessons. Appendix 2 provides detailed information on how each laboratory addresses each MINAH guideline. The ASM Guidelines for Biosafety in Teaching Laboratories should be reviewed before performing any of these activities.

TABLE 1

Condensed MINAH laboratory curriculum.

Lab #	Activitya	ASM MINAH Guidelines (4) Covered in Lab Activityb	Significance in Healthcare/Hospital Settings
1	Microscopy— Bacterial and Nonbacterial pathogens (fungi); The Gram Stain	1, 4a, 22, 23d, 24c	Properly preparing and staining specimens for microscopy allows health-care workers to recognize the diversity in pathogens Microscopy can lead to presumptive identification of potential pathogens
2	Aseptic Technique (Plating on Selective/Differential Media) & Koch’s Postulates	2a, 8, 9b, 14, 22, 23c, 23e, 24c	Understanding that pathogens can thrive and survive in different environments through different techniques. Being able to identify, treat, and prevent the spread of each pathogen based on metabolic properties Identifying whether a particular microorganism is a pathogen through Koch’s Postulates
3	Case Study on Vaccines and/or Microscopy	3, 7a, 10, 12, 22b	Learning the importance and effectiveness of vaccines on immunization, and how they protect society via herd immunity Gaining knowledge on how to examine the emergence and/or reemergence of infectious diseases and manage outbreaks, while also having a comprehensive understanding of how disease can spread Practicing identification via microscopy
4	Kirby-Bauer Assay/Physical control of microbial growth (oxygen, temperature)	5, 7a, 15, 16, 17, 24c	Identifying techniques to control microbial growth to understand the function of antimicrobials Knowing the importance of limiting antimicrobial drugs to fight resistance to these pharmaceuticals
5	Enumeration of Microorganisms	19, 22a, 23e, 24c	Using proper aseptic technique to grow microorganisms Gaining practice gathering and interpreting data
6	Specimen Collection; Biochemical Tests & Molecular Tests to Identify Unknowns	1, 2b, 4a, 4b, 4d, 9, 11a, 13, 22a, 23a, 23b, 23c, 24b, 24c, 25	Examining characteristics of the microbiome and how its condition can affect the balance of microbes Observing the diversity of microbes and how they can thrive in and colonize certain areas of the body, having a beneficial, neutral, or detrimental effect on their host Learning how to identify, treat, and prevent the spread of infectious agents through several methods of control Using correct biosafety techniques, including personal protective equipment, when gaining exposure to lab equipment and techniques to reach diagnosis Conducting proper waste management to reduce the spread of pathogens, and conducting proper record keeping and specimen labeling
7	Enzyme Linked Immunosorbent Assay (ELISA)	9, 23a, 23c	Using an immunological/serological diagnostic method to identify potential pathogens

Refer to Appendix A for details on each activity.

Refer to Appendix B for details on each guideline.

This shortened lab curriculum supports programs offering microbiology with limited budgets. Instructors in these programs can spread out each lab over a two-week period. Students can set up and perform their experiments during the first week and collect and analyze their data during the second week. The same bacterial strains and growth media can be used for multiple laboratories. For example, Escherichia coli and Staphylococcus aureus can be used for labs 1, 2, 4, 5, and 6. The same selective and differential growth media can be used for labs 2 and 6. Using prepared slides in lab 1 allows programs to reuse slides each semester, thus cutting down some costs. Alternatively, for programs that are not limited in time or budgets, instructors can further expand upon the activities published here and/or add additional microbiology laboratory activities. The seven labs suggested in this paper would give the nursing and allied health student a solid foundation to understand the importance of microbiology in healthcare settings.

When possible, lab professors are encouraged to seek out inquiry-based activities for the labs in this proposed curriculum. Many textbooks and laboratory manuals present students with “Clinical Focus Boxes” (8) and case studies where they learn about a fictional patient’s signs and symptoms, and they are expected to suggest and understand a course of treatment. Approaches such as these can be applied to microscopy, or to streak plate methods, where students are expected to understand the morphological characteristics of bacteria in identifying unknown pathogens (9). Furthermore, instructors can easily apply this approach to other lab procedures beyond microscopy and streak plate methods. For example, for a lab involving a Kirby-Bauer assay, a student could be presented with yet another fictional patient and asked to identify the most effective antibiotic for the patient’s bacterial infection. Overall, an inquiry-based approach when constructing a lab manual can help students to grasp how each test can be applied in hospital and healthcare settings.

CONCLUSION

The removal of labs from a curriculum is an easy cost-saving method. However, as microbiology instructors, we all know the importance of having our students work in the lab. Allowing nursing and allied health students to have experience in the lab gives them a chance to (a) practice aseptic technique, (b) learn how to properly collect specimen samples, and (c) learn how pathogens can be identified in the lab. They can take this knowledge with them when they begin working in the healthcare setting. Therefore, we hope that these lab exercises will allow the microbiology laboratory to remain in the nursing and allied health curriculum.

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