scope:

PREFACE

Our book differs in various ways from standard texts in medical microbiology, as its main purpose is to approach the subject by addressing the needs of primary care physicians, nurses, and medical microbiology staff, and how these needs relate to each other.

While the day-to-day problems of diagnosis and treatment apply equally in primary care and in hospital medicine, doctors and nurses in primary care are separated from the on-site microbiology services available in hospitals. There is inevitably less frequent contact between the primary care physician and the laboratory and, when there is, it often addresses a specific problem involving a single patient. Yet these issues and problems are recurrent, and in our opinion a more comprehensive and systematic approach would help deal more effectively with them.

Not infrequently, for example, a specimen is taken without good reason, initiating a chain of events that can end with the patient being given an antibiotic for no clinical reason. This may not only be unsafe; it is also a waste of resources.

The key to using the laboratory effectively is to employ three basic principles:

• Is there a valid clinical reason for taking the specimen?

• What is the quality of the specimen, and has the patient been given clear instructions on specimen collection?

• How is the laboratory report interpreted?

These principles require an understanding of the fundamental difference between, for example, bacteria colonizing a site such as a chronic leg ulcer, and their ability to cause infection.

Our book is structured to help put these principles into practice. Each chapter opens with a scenario to identify key steps in processing a particular specimen type. In Chapters 3-10, these are followed by Quick Action Guides which, together with the information in the scenarios, can be used as a template for meetings to assess current practice and implement changes (protocols) where appropriate. As part of this, guidelines produced by the UK's Health Protection Agency (HPA) and National Institute for Clinical Excellence (NICE) have been adapted in the Quick Action Guides.

The key chapters, accounting for more than 80% of the bacteriology specimens submitted by primary care practices, are the urine specimen (Chapter 3), the genital specimen (Chapter 4), and the swab of the chronic leg ulcer (Chapter 5). If all primary care services could develop and maintain a high standard for these specimens, this would immediately bring about a significant improvement in patient care. The full benefit will be realized when primary care services and the local laboratory work together to ensure all the critical steps outlined in the scenarios are effectively managed.

The fundamental purpose of our book is to help improve patient care. We hope that adherence to its precepts may also bring economic benefits to primary care and to microbiology laboratory services.