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Aqueous vs. aqueous-free: Controlling pathogens on fresh produce and low-moisture foods
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Aqueous vs. aqueous-free: Controlling pathogens on fresh produce and low-moisture foods

For years now, the consensus in the food industry has been that washing fresh produce and low-moisture foods with water and a range of sanitizers serves to effectively inactivate pathogens and make food safe for consumption.
December 13, 2018

Aqueous vs. aqueous-free: Controlling pathogens on fresh produce and low-moisture foods

For years now, the consensus in the food industry has been that washing fresh produce and low-moisture foods with water and a range of sanitizers serves to effectively inactivate pathogens and make food safe for consumption.

But recent research has shown that, when it fails, the use of water actually causes more issues than it solves—most notably with regard to cross-contamination, where it can distribute both pathogens and pesticides from produce to produce. And there’s another pesky problem: when moisture is introduced to a low-moisture food, it can also lead to endemic populations of salmonella.

In light of such findings, researchers like Dr. Keith Warriner of the University of Guelph have been turning their attention to new aqueous-free technologies as a safe way to inactivate pathogens.  

By taking moisture out of the game, these alternatives—like forced-air ozone, advanced oxidative processes (AOP) and ethanol-peroxyacetic acid sanitizers—safely decontaminate food without leaving any residue behind or altering the product in any way.

“The common feature of these three technologies is that they can be easily incorporated,” says Dr. Warriner. “They can be continuous process, they can handle large batches, and they don’t spoil the product. It’s these technologies that I think will go far.”

But how do they align with the Food Safety Modernization Act and the Safe Food for Canadians Regulations? According to Dr. Warriner, “The big difference now is that we have something called preventative risk control.” What this basically means is that the produce washing process now has to be validated, that it must be proven that it won’t cross-contaminate. “And that’s why it’s a good time for these new technologies to come in, because regulators require it,” adds Dr. Warriner.

Though safe and cost-effective to implement, aqueous-free technologies in the produce and low-moisture food industry won’t replace aqueous treatments overnight. “Change is slow,” admits Dr. Warriner. “But it always starts with a first step. I would say five or six years down the road, the technologies we have will be more widespread.”

To learn more about Salmonella, please listen to our podcast with Dr. Warriner:

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Pathogenia: A new, innovative way to prevent food recalls
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Pathogenia: A new, innovative way to prevent food recalls

In recent years, the global frozen fruit and vegetable industry has had countless food recalls, and the latest originating from a virus is of particular concern. Feeding the planet with safe foods is an ongoing challenge that has led to the creation of Pathogenia, Canada’s first-ever lab accredited by the agri-food industry to provide virology services. How was Pathogenia able to turn these unfortunate events into an opportunity for innovation? Prasant Prusty, Director and Co-Founder of Pathogenia, reflects on the challenge in a recent interview with bioMérieux.
December 13, 2018

Pathogenia: A new, innovative way to prevent food recalls

In recent years, the global frozen fruit and vegetable industry has had countless food recalls, and the latest originating from a virus is of particular concern. Feeding the planet with safe foods is an ongoing challenge that has led to the creation of Pathogenia, Canada’s first-ever lab accredited by the agri-food industry to provide virology services. How was Pathogenia able to turn these unfortunate events into an opportunity for innovation? Prasant Prusty, Director and Co-Founder of Pathogenia, reflects on the challenge in a recent interview with bioMérieux.

Product recall: An unpleasant occurrence 

Prasant Prusty has been working in the global food industry for many years, holding various leadership positions. In his most recent role as Director of Quality for a large North American frozen food manufacturer, his team applied food safety best practices at every step in the supply chain, from production and sourcing to transporting, processing, packing and final delivery. 

However, he experienced his first food recall. “The recall was due to hepatitis A contamination, and it was a challenge that took us by surprise,” recounts Mr. Prusty. At the time, the company had already implemented a robust program to ensure food safety at every step in the supply chain—from harvesting to the plate.

This story emphasizes North America’s shortcomings in terms of food virology. Canadian agri-food companies cannot rely on virus-detection tools, and there are no clear guidelines to prevent contamination. At the time of the recall, no lab offered virus detection services in food matrices. There were two such labs in the United States, but they couldn’t test more than 10 samples a week.

Pathogenia: The first private lab to offer food virology services in Canada

A viral detection method is only effective if the sampling is done correctly. In the absence of standards, criteria or labs to conduct such tests, what is to be done? 

Seeing a real need to help manufacturers improve their food safety practices, Prasant Prusty and his team set out to create Pathogenia, Canada’s first-ever private food virology lab, developing their own internal tools and acceptability criteria based on FDA practices in the United States. Although FDA standards are intended for the pharmaceutical industry, they provide a solid framework that can be adapted to the food industry.

The lab is independent and employs a reliable, reproducible and statistically valid sampling model that delivers a confidence level between 90% and 99%. Pathogenia can analyze more than 100 samples per week to detect the presence of pathogens such as noroviruses GI/GII and the hepatitis A virus.

Taking innovation one step further

For Prasant Prusty, the next step was to achieve ISO 17025:2017 certification for the virus lab through A2LA, making Pathogenia the first Canadian laboratory to receive accreditation in food virology. Now certified to provide food virology services using reliable processes that comply with internationally approved standards, Pathogenia is looking to expand its client base in the global market.

To adopt a successful food safety program, companies need to apply a multipronged approach. Having access to new services such as those provided by Pathogenia can certainly help change the game for manufacturers and consumers alike. 

Prasant Prusty and Pathogenia acknowledge that Sophie Canobio’s technical expertise and bioMérieux’s assistance with the development of rigorous guidelines have been essential to their progress. This successful partnership is sure to have a bright future. 

 

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FilmArray® diagnoses meningitis and encephalitis faster for the Royal Victoria Regional Health Centre
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FilmArray® diagnoses meningitis and encephalitis faster for the Royal Victoria Regional Health Centre

Meningitis and encephalitis are potentially life-threatening infections of the central nervous system. When patients come to a community hospital and have a suspected case of meningitis or encephalitis, they are, after a cerebrospinal fluid (CSF) sample has been taken, administered empirical treatment—an antibiotic, antiviral or antifungal cocktail.
December 13, 2018

FilmArray® diagnoses meningitis and encephalitis faster for the Royal Victoria Regional Health Centre

Meningitis and encephalitis are potentially life-threatening infections of the central nervous system. When patients come to a community hospital and have a suspected case of meningitis or encephalitis, they are, after a cerebrospinal fluid (CSF) sample has been taken, administered empirical treatment—an antibiotic, antiviral or antifungal cocktail.

In community hospitals, microbiology labs have limited resources, and microbial culture is often the only diagnostic option available for CSF analysis. However, a culture-independent method is the preferred way to identify a viral infectious agent and to confirm the pathogen-specific diagnosis in a more timely manner. If a viral pathogen is suspected, a CSF analysis must be conducted by an external lab, which inevitably results in delays, clogging an already overloaded system.

In response, bioMérieux’s FilmArray® is a diagnostic system that uses a nucleic acid assay called “nested multiplex PCR” that can be easily performed with minimal hands-on time in the laboratory. In one hour, it tests for the presence of 14 different potentially pathogenic microorganisms, including the infectious agents most frequently and most importantly responsible for community-acquired meningitis and encephalitis.

The Royal Victoria Regional Health Centre is a community hospital in Barrie, Ontario. To assess the potential effects of implementing FilmArray® technology in its facility, the Royal Victoria team conducted an independent study funded by bioMérieux and led by Dr. Giulio DiDiodato and his colleagues. The study demonstrated that the quick and easy-to-use FilmArray® system reduces the time to diagnose the etiology of the meningitis/encephalitis syndrome, and, in turn, shortens the length of stay by an average of 36 hours per patient, saving money and reducing strain on human resources. FilmArray could also be a vital tool for teams monitoring and improving antibiotic usage in the hospital setting.

Overall, the FilmArray® system improves care for patients with infections such as meningitis and encephalitis in community hospitals like the Royal Victoria Regional Health Centre.

Watch this video to learn more about the study and how the in-house use of a multiplex test can benefit hospitals.

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The Global Point Prevalence Survey: An Ally in the Fight Against Antimicrobial Resistance
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The Global Point Prevalence Survey: An Ally in the Fight Against Antimicrobial Resistance

Antimicrobial resistance (AMR) is one of the biggest public health challenges of the century. It occurs when microorganisms develop the ability to render antimicrobial medication ineffective, and results in higher treatment failure rates. The development of AMR is largely driven by antimicrobial overconsumption. If appropriate measures aren’t taken, by 2050, more than 10 million people worldwide could die from AMR each year. So what can governments, hospitals and healthcare institutions rely on to develop effective measures?
December 13, 2018

The Global Point Prevalence Survey: An Ally in the Fight Against Antimicrobial Resistance

Antimicrobial resistance (AMR) is one of the biggest public health challenges of the century. It occurs when microorganisms develop the ability to render antimicrobial medication ineffective, and results in higher treatment failure rates. The development of AMR is largely driven by antimicrobial overconsumption. If appropriate measures aren’t taken, by 2050, more than 10 million people worldwide could die from AMR each year. So what can governments, hospitals and healthcare institutions rely on to develop effective measures?

According to Joanna Merckx, Director of Medical Affairs at bioMérieux Canada, the Global Point Prevalence Survey (G-PPS) is a first-of-its kind, validated and easy-to-use tool that documents and measures antimicrobial use and prescription practices in hospitals around the world. Although bioMérieux funds the G-PPS, it takes no part in preparing the study and collecting, analysing and interpreting data, nor does it have any access to the reports that are generated. This entirely independent project is developed in a hospital setting and conducted worldwide. Hospitals can use the tool to gather and analyze internal data on antimicrobial use, compare their practices to similar institutions, and develop measurable intervention methods. On a larger scale, the data are compiled to provide an overview of the situation, prepare publications, and inform decision-making and the development of solutions to combat AMR.

In 2015 and 2017, multiple hospitals across Canada took part in the initiative, providing useful data into this specific market. As surveillance is the cornerstone of the battle, the most effective way to move forward is joint participation and the creation of additional survey questions. By 2019, the survey will incorporate these questions for Canadian healthcare institutions while remaining a part of the larger global project.

Watch this video to learn more about the G-PPS and its contribution to the fight against antimicrobial resistance.

To participate in the G-PPS, please visit their website: http://www.global-pps.com/

 

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A 24% reduction in antimicrobial consumption at the Centre hospitalier universitaire de Sherbrooke
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A 24% reduction in antimicrobial consumption at the Centre hospitalier universitaire de Sherbrooke

LUMED, a major player in the health informatics industry, was co-founded by Louis Valiquette, a medical microbiologist and infectious disease specialist at the CIUSSS de l’Estrie – CHUS (Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke) and professor at the Faculty of Medicine and Health Sciences at the Université de Sherbrooke.
April 5, 2018

A 24% reduction in antimicrobial consumption at the Centre hospitalier universitaire de Sherbrooke

LUMED, a major player in the health informatics industry, was co-founded by Louis Valiquette, a medical microbiologist and infectious disease specialist at the CIUSSS de l’Estrie – CHUS (Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke) and professor at the Faculty of Medicine and Health Sciences at the Université de Sherbrooke. The company developed APSS, the first automated antibiotic prescription surveillance system in Canada. Its optimized algorithms—the cornerstone of this software—allow users to continuously monitor patients’ changing conditions and modify their prescriptions accordingly to provide the most appropriate treatment at all times.

Or, as Dr. Valiquette puts it, “The right drug, the right dose, at the right time, for the right duration.”

Every day, pharmacy departments receive an astounding number of prescriptions. There is not enough time to review each one manually, within a reasonable amount of time, without omitting critical data. LUMED’s intervention system is designed and tested to significantly reduce the number of potentially inaccurate prescriptions. The system can detect discrepancies in prescriptions and alert users, such as pharmacists and infectious disease specialists. Users can then make recommendations to prescribers based on relevant references and the APSS results. Users then document whether recommendations are accepted or rejected—all this while methodically prioritizing the most urgent interventions.

In addition to reducing the amount of intravenous antibiotics administered, the risk of multi-resistant infections and the associated costs, APSS gives healthcare staff members access to the latest clinical data so they can intervene faster. Patients, in turn, receive optimal service faster. This user-friendly, turnkey software can also be customized and adapted to the priorities of each centre.

After six years of use, APSS has made a number of positive impacts at the CIUSSS de l’Estrie – CHUS, where Dr. Valiquette integrated the software into the existing antimicrobial surveillance program. The net result: APSS helped reduce antimicrobial consumption by nearly a quarter, resulting in roughly $2 million in savings. An additional reduction in hospitalization by an average of two days in length of stay for patients receiving antimicrobials has potentially resulted in even higher savings. To date, more than 12,000 recommendations have been approved, with a physician acceptance rate of 91%.

Watch the video to learn more about Louis Valiquette, LUMED and APSS, and to find out how to optimize the efficiency and effectiveness of prescription programs.

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Promoting Continuing Education on Food Safety – a strong commitment!
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Promoting Continuing Education on Food Safety – a strong commitment!

bioMérieux Canada is proud to participate once again in continuing education on food safety in partnership with the University of Guelph’s Canadian Research Institute in Food Safety (CRIFS).
April 5, 2018

Promoting Continuing Education on Food Safety – a strong commitment!

bioMérieux Canada is proud to participate once again in continuing education on food safety in partnership with the University of Guelph’s Canadian Research Institute in Food Safety (CRIFS).

Our second symposium, in November 2017, drew no less than 100 industry participants to our latest venue at the Delta in Guelph for a lively and illuminating session. A panel of highly respected speakers provided deeper understanding and proposed innovative solutions aimed at improving Salmonella preventive controls both in the animal production and processing environment, share their experiences and innovative ideas to pursue our efforts towards having the safest possible food supply.   

Salmonella, The Next Frontier – Symposium Highlights

Dr. Frank Pollari, veterinary epidemiologist at the Food-Borne Disease and AMR Surveillance Division, Center for Food-Borne, Environmental & Zoonotic Infectious Diseases at the Public Health Agency of Canada, presented an overview of the increase in Salmonella-related public health issues in Canada over the past 10 years and the correlation with Salmonella rates and serotypes in the poultry industry. Dr. Pollari described recent changes implemented for public health surveillance across Canada, specifically, the introduction of Whole Genome Sequencing (WGS) which is enabling them to be more successful in linking outbreaks to the food items.

Dr. Daniel Leclair, National Manager, Epidemiology and Risk Analysis Section, Food Safety Science Program Services Division, Canadian Food Inspection Agency presented an overview of the results of the Salmonella National Microbiological Baseline Study in Broiler Chicken 2012-13, which will be used for the development of national risk management strategies. During his presentation, Dr. Leclair outlined the study design and process followed to gather the presented data and discusses potential approaches for setting performance standards.

Dr. Peter Gazdzinski, Director Veterinary Services at Cuddy Farms Ltd 2008, presented a detailed summary of the challenges they faced since Salmonella monitoring began in 1985 and solutions implemented in their barns in order to achieve long-term Salmonella control. Dr. Gazdzinski provided a concrete case study approach to the attendees identifying critical points, disinfecting procedures, monitoring sampling plan in their business, other vectors that can increase the risk of Salmonella contamination, and most importantly, some of the safety measures to put in place to mitigate these risks.

Mr. Christian Fuchs, Director, Food Safety and Quality Assurance, Maple Leaf Consumer Foods provided the audience with a comprehensive overview of Canada’s practices in the poultry industry compared to the US and Europe as well as some key factors in controlling Salmonella throughout the supply chain. Mr. Fuchs also stressed the importance of using data to evaluate the risk or better understand the shift in contamination (site, source, etc.) in order to keep fighting the uphill battle towards pathogen reduction in the poultry industry.

Mrs. Marcelle Lavergne, Director of Food Safety & Quality Assurance at Costco Canada presented a general overview of Costco’s specific precautions and processes in place in the different department found at each of their warehouse to control pathogens and any bacterial cross-contamination. Audits, training, appropriate signs, temperature monitoring, appropriate floor plan designs and colour coded material are some of the tools that are used to control Salmonella in a high throughput, high level of part-time and long hours of operation retail context.

Dr. Keith Warriner, Professor, Department of Food Science at University of Guelph provided an in-depth review of how water can increase food safety risks associated with fresh produce and low moisture foods. This has driven the need to find aqueous-free techniques to inactivate pathogens, such as Salmonella, thereby representing a firewall between contamination acquired during primary production and the consumer. The technologies covered included pre-existing methods (irradiation, ultraviolet light, steam) in addition to more recent advances (forced air-ozone reactor, LED’s Advanced Oxidative Process, ethanolic based sanitizers, gas plasma) in the area. Dr. Warriner expanded on the effectiveness of some of these technologies whether on produce and/or low-moisture foods as well as their commercial applications

Dr. Stan Bailey, Sr. Director Scientific Affairs, bioMérieux Industry presented an overview of the technologies available for Salmonella detection and their evolution over the past 10 years. He expanded on the more advanced methodologies used in the Epidemiological tracking of the pathogens by the different surveillance groups in the US (PULSE NET, CDC, USDA and FDA) namely Whole Genome Sequencing (WGS) and Metagenomics. Dr. Bailey’s strongest message to the audience was linked to the upcoming challenges the industry is facing relative to the analysis and use of the staggering amount of data available to them to become a more predictive pathogen management.

To learn more about Salmonella, please listen to our podcast with Dr. Bailey.

Stay tuned for the next issue of our podcast series with  Dr. Keith Warriner.

Don’t miss our 3rd Food Safety Symposium on October 30, 2018: “Anti-Microbial Resistance (AMR) in the food chain, it’s hard to resist!”

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FilmArray: Vancouver General Hospital is decreasing patient isolation by 4 days
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FilmArray: Vancouver General Hospital is decreasing patient isolation by 4 days

BioFire FilmArray® Respiratory Panels decreased isolation times by four days, according to study conducted at Vancouver General Hospital.
April 5, 2018

FilmArray: Vancouver General Hospital is decreasing patient isolation by 4 days

BioFire FilmArray® Respiratory Panels decreased isolation times by four days, according to study conducted at Vancouver General Hospital.

From December 2016 to May 2017, researchers at Vancouver General Hospital conducted a randomized control trial to evaluate the clinical impact, infection control impact and cost effectiveness of the BioFire FilmArray Respiratory Panel assay in 158 patients with respiratory infections.

More specifically, researchers were keen to see what effect this new technology would have on the amount of time that patients are kept in infection control isolation.

The results of the study were encouraging in this regard: Implementing the BioFire FilmArray Respiratory Panel decreased isolation times by approximately four days compared to routine testing.

“When a patient comes into the emergency room with any type of worsening respiratory illness, or if they come in with an abnormal chest x-ray, we put them in isolation right away because we don’t yet know what they have,” says Dr. Titus Wong, primary investigator of the study and Medical Microbiologist and Infection Control Physician at Vancouver General Hospital. “The sooner we can rule things out, the better for patient care, as well as for bed management and bed flow.”

The BioFire FilmArray Respiratory Panel is capable of detecting 17 viral and three bacterial targets in one hour—an accelerated diagnostic turnaround that Dr. Wong sees as a game changer.

“Once that swab gets into our hands, we can have a result ready for physicians in an hour, which is something that we’ve previously never been able to do. At best, we could give them a result for in-house work anywhere from a few hours up to a day. And if we had to send anything out to the reference centre, it could take anywhere from 24 hours to five days.”

“Having the certainty of being able to promise a result in an hour,” he continues, “is extremely powerful.”

The Microbiology Laboratory team and the Infection Control team collaborated hand in hand on this study, which Dr. Wong also says was key. “We have a very close working relationship between Medical Microbiology and Infection Control, as well as with our colleagues in Quality Patient Safety and Infectious Disease. These relationships allow us to advocate for each other in various areas and help articulate the needs of each group.”

Cost-effectiveness is, of course, of paramount concern in any hospital setting. “In a health care environment where there are always limited resources and competing interests, it’s really refreshing to work in an area—this whole infection area—where everyone can focus on mutually prioritized goals that can benefit us all,” says Dr. Wong.

Having diagnostic certainty a lot sooner in the patient journey is one such goal. “For the patient, this helps improve response times not only for treatment, but also for infection control. And for the hospital, it helps improve bed management and bed flow time. All of these things combined ultimately improve patient outcomes and satisfaction, and also help save hospital resources and divert them to other areas where they’re needed.”

With a quicker diagnostic response time, patients with negative results aren’t kept on isolation longer than necessary. “We want to keep patients in isolation to make sure that other patients and health care workers are protected from potential pathogens,” says Dr. Wong. “But only as long as it’s necessary. The fact that we’re only keeping a patient in isolation for hours as opposed to days is very impactful for patient care—and for the hospital.”

With a limited number of isolation rooms in the hospital, freeing up a bed for another patient who needs it is key.

Quicker response times also have a clinical impact on the most vulnerable patients in the hospital. “Everybody—especially our critical care physicians and transplant physicians—was extremely grateful for the turnaround time and the comprehensiveness of the panel,” says Dr. Wong. “There’s typically a plethora of potential etiologies, and being able to quickly rule something in or out helps us on that diagnostic pathway. It helps us direct hospital resources and human resources towards another diagnosis during these critical hours of care.”

According to Dr. Wong, many of the physicians wrote supporting letters advocating for the technology and its impact on patient care. “As the study went on, we’d get requests from certain critical care colleagues asking, ‘Could my patient get, quote unquote, randomized to the treatment on the test arm?’ And we’d say, ‘Sorry, it doesn’t work that way!’ But it speaks to how much they like the technology.”

With minimal hands-on time required, the BioFire FilmArray Respiratory Panel takes only a few minutes to run a sample, which Dr. Wong also sees as an effective use of resources. “It frees up the technologist to work on other tasks that require their expertise.”

What’s next for Dr. Wong and his team? “Well, first of all, we have a responsibility to share our experience, so we’re presenting at multiple conferences. We’re also working on a manuscript and that should be coming out very shortly.”

Dr. Wong can’t say enough about the teams within the hospital that advocated for the implementation of the BioFire FilmArray Respiratory Panel:

“When you’re in different areas of expertise, you might not be aware of the newest or latest or most advanced technologies available. And so you really need the people in the know—the diagnostic microbiology and infectious disease physicians and infectious control physicians—to speak up and advocate for them.”

“We’d also like to thank Quality Patient Safety and our administrators for really jumping on board and supporting this. They think that it’s good value for patient care and for the hospital.”

The use of the BioFire FilmArray Respiratory Panels won’t, however, be limited to Vancouver General Hospital. “We’re also a regional laboratory for multiple health care institutions, and we have a plan to roll out testing to these other institutions as well,” confirms Dr. Wong.

 

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Helping Canada’s Food Inspection Agency Go Lean
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Helping Canada’s Food Inspection Agency Go Lean

How bioMérieux helped Canada’s Food Inspection Agency increase productivity and reduce turnaround time
March 28, 2017

Helping Canada’s Food Inspection Agency Go Lean

The Canadian Food Inspection Agency (CFIA) is dedicated to safeguarding food, animals and plants, in order to enhance the health and well-being of Canada's people, environment and economy.

bioMérieux provides diagnostic solutions (reagents, instruments, software) that determine the source of disease and contamination to improve patient health and ensure consumer safety. Part of bioMérieux’s approach is also to look at laboratory workflow for its customers to answer the growing need for a leaner approach—to help them improve efficiency and productivity by working smarter.

Let’s take a look at a lean initiative undertaken with a CFIA laboratory to improve efficiency and reduce turnaround time.

The goal: improve turnaround time

Neil Vary was the Section Head of the Food, Feed, and Fertilizer Microbiology Section of the CFIA Ottawa Laboratory when he met with Mohammed Ahmed from bioMérieux. They discussed workflow optimization, with a view to reducing the time it takes to analyze samples for CFIA inspectors. Mohammed is a Six Sigma Black Belt in DMAIC (an acronym for Define, Measure, Analyze, Improve and Control) and an expert in helping companies improve efficiency by optimizing workflow.

“At the time, we had three distinct areas in the laboratory, each dedicated to working with specific pathogens: one area looked for Salmonella, another for Listeria and a third for other food borne pathogens,” Neil says. As a result, there was a considerable amount of duplication in routine tasks. For example, each laboratory accessed samples brought in from the field and prepared them for analysis, and there was little communication or interaction among the different areas. Neil felt there might be ways to make the laboratory more productive by improving the workflow.

After analyzing a year’s worth of data from the laboratory, Mohammed and another bioMérieux employee, Arlene Larson, literally followed scientists over the course of several days, observing each step in their work. Their objective was to identify bottlenecks and other opportunities to optimize workflow. They came back with a report containing a series of recommendations for Neil and his team.

Hallway huddles became a daily ritual

Neil says some of the ideas were strikingly simple. “For example, we implemented a hallway huddle every afternoon around a white board, which displays information on workload and deadlines, so we can shift resources to where they are needed.” He says the daily hallway huddles had multiple benefits: sharing information helped improve workflow, enrolled everyone in the process, and also had a social benefit in terms of team building.

Another recommendation from the bioMérieux team was to reorganize workflow in the laboratory, with a view to standardizing tasks. “At the time, each area was completely self-contained and independent. The report suggested that we eliminate these work ‘silos’ by grouping the laboratories by activity instead of by pathogen,” says Neil.

As a result, each laboratory took responsibility for one step in the process, with the first area dedicated to preparing samples for testing. “We also modified work stations to place materials within arm’s reach. Now we have five work stations with almost identical layouts, which has made the process much more efficient.”

Side benefit: cross learning among co-workers

“Another benefit is that technicians working on the same task at the same time also began to learn from each other by observing and adopting better work methods from their colleagues. So now we have more sharing of knowledge and techniques, which has led to further efficiency gains,” says Neil.

“The lean initiative complements quality assurance (QA),” says Neil. “QA is about ensuring that we always have high-quality results in the lab, but it’s not necessarily about improving efficiency, whereas the lean initiative is aimed at that. We saw these two approaches complement each other very well.”

Evidence-based outcomes create buy-in

Like QA, the lean initiative involves examining current practices, targeting certain areas for improvement, designing and implementing a plan, then measuring the results against a baseline. “The last step is to come back and assess the impact of the changes,” says Neil. “We are scientists, so we really need to see evidence; as time went along and we started to make changes and do evaluations, we got more buy-in because everyone saw the evidence.”

Impressive gains despite greater workloads

Neil says the results were quite an eye-opener: “Our sample turnaround time went from about six days to 4.4 days, a 27% reduction. We also had a 36% reduction in manpower requirements, which freed up time from sample testing for other high-value projects for the Agency. Coincidentally, as we were implementing these changes, the number of food samples that came to us went up by 38%. Thanks to the ongoing efficiency gains, our technicians did not even feel this increase since their work efficiency had improved throughout the year.”

Lean initiatives: a journey rather than a destination

Just as QA is an ongoing process, so is a lean initiative. Along the way, additional challenges and opportunities are often identified and noted for future optimization initiatives. The efficiency gains and other benefits of the first workflow optimization initiative in the CFIA laboratory led Neil to believe in the value of regularly undertaking lean initiatives as a sustainable project.

According to Neil, the key to carrying out a successful lean initiative has been to involve the entire staff in identifying problems and brainstorming over solutions. “Their input was critical to its success, and they were valued. Showing them the results reinforced the importance of their contributions and helped them believe in it.” 

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Reducing the time to diagnosis with BioFire FilmArray – Results from a clinical study
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Reducing the time to diagnosis with BioFire FilmArray – Results from a clinical study

It seems logical that obtaining test results more quickly from the hospital laboratory might ultimately help to improve patient outcomes, by reducing the time to diagnosis and treatment.
March 28, 2017

Reducing the time to diagnosis with BioFire FilmArray – Results from a clinical study

It seems logical that obtaining test results more quickly from the hospital laboratory might ultimately help to improve patient outcomes, by reducing the time to diagnosis and treatment. This logic has now been put to the test in a two-year study conducted at a major U.S. health centre.

Dr. Raquel Martinez presented the results of a study conducted at the Geisinger Health System in Pennsylvania, a multi-hospital group that includes a 560-bed facility in Danville and a total of eight hospitals and several outpatient clinics in the surrounding counties.

The study assessed the clinical benefits of a first-in, first-out (FIFO) approach to molecular testing using the FilmArray Respiratory Pathogen Panel (BioFire Diagnostics, a bioMerieux company) versus conventional once-daily batch testing.

Data were collected on the time from specimen collection to reporting of results, length of hospital stay, number of days in the ICU, patient mortality at 28 days, bacterial and viral antimicrobial use, plus other variables. Priority for testing was given to the ICU and Emergency departments.

In addition to implementing the random-access or FIFO approach to laboratory testing, the team developed various protocols and testing algorithms designed to aid in clinical decision-making and to improve the efficiency and timeliness of testing.

Using the FIFO approach with BioFire FilmArray was associated with significant improvements:

  • Shorter Emergency department wait times (mean reduction of 1.2 hours, p<0.02)
  • Fewer days spent in the ICU (mean reduction of 3 days, p<0.0001)
  • Shorter hospital stays (mean reduction of 2.1 days, p<0.03)
  • Improved survival (relative rate improved by 10%, p<0.02)
  • Fewer days on antibiotics (mean reduction of 1.9 days, p<0.002)
  • Fewer total tests and fewer days on ventilation (both p<0.05)

 

It is also worth noting that rapid and more sensitive testing methods were associated with a significant reduction in antibiotic use, which should contribute to improving antimicrobial stewardship and minimizing overall healthcare costs.

While more rapid turnaround time in laboratory testing has many benefits, there are no shortcuts to actually acquiring state-of-the-art testing equipment, such as FilmArray, in the first place. According to Dr. Martinez, the process starts by preparing a solid business plan for the hospital’s leadership.

“Once we receive the instrument, we collect data to demonstrate its utility. For example, we demonstrate how the instrument simplifies workflow, or reduces turnaround time, or even better, how faster turnaround time can positively impact patient care.” Hence the need for evidence-based medicine to validate current practices, make informed decisions about future investments in new technology, and continue improving performance in the clinical laboratory.

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Promoting Continuing Education on Food Safety
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Promoting Continuing Education on Food Safety

bioMérieux Canada is proud to participate in continuing education on food safety in partnership with the University of Guelph’s Canadian Research Institute in Food Safety (CRIFS).
March 28, 2017

Promoting Continuing Education on Food Safety

bioMérieux Canada is proud to participate in continuing education on food safety in partnership with the University of Guelph’s Canadian Research Institute in Food Safety (CRIFS). 

Our first symposium, in November 2016, drew no less than 85 industry participants to the University of Guelph for a lively and illuminating session. A panel of highly respected speakers provided deeper understanding and proposed innovative solutions aimed at improving the early detection and control of food-borne pathogens, with a focus on Listeria in the food production environment.

Listeria Hysteria II - Symposium Highlights

Jeffrey Farber, PhD, Director of CRIFS and a professor in the Department of Food Science at the University of Guelph, presented an overview of Listeria-related outbreaks in dairy, meat and poultry, produce and fish that have occurred in recent years. Dr. Farber explored the root causes of these outbreaks and described the lessons learned.

John Mills, Senior Staff Scientist for Industry Scientific Affairs at bioMérieux, presented an in-depth review of Listeria monocytogenes as a food supply contaminant. He also described a model environmental control program that meets the criteria for Listeria risk assessment from the United States Food and Drug Administration (FDA), supported by a case study.  Mr. Mills also presented the rationale for strict microbiological control, and outlined what manufacturers should consider when selecting the type of analysis used to detect Listeria in their facilities.

Steven Tsuyuki, Senior Director, Sanitary Design and Corporate Sanitation at Maple Leaf Foods, presented a detailed summary of the devastating Listeria outbreak at Maple Leaf Foods in 2008. He described food safety requirements at the time of the outbreak, what caused the outbreak, and how safety practices have been upgraded to improve Listeria detection in their facilities.  He concluded by noting that the company’s attitude today is to assume that Listeria is present and that it’s their job to find and eliminate it.

Angela Tellez, PhD, Director of the Food Science Technical Group at the University of Guelph, focused on prevention and control of Listeria in the dairy industry. She presented an analysis of Listeria outbreaks linked to the dairy industry and proposed corrective actions that should be deployed in the production and manufacturing process.

To learn more, listen to this podcast from Dr. Farber.

Look for our 2nd Food Safety Symposium in November 1st 2017!

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Bringing innovation to healthcare: a slow and bumpy road
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Bringing innovation to healthcare: a slow and bumpy road

Managing the health of our aging population is putting pressure on the healthcare system to do more with less. How will we meet this growing challenge?
June 6, 2016 - Healthcare

Bringing innovation to healthcare: a slow and bumpy road

Managing the health of our aging population is putting pressure on the healthcare system to do more with less. How will we meet this growing challenge?

Given our aging population, it seems inevitable that healthcare costs will keep climbing for the foreseeable future. At the same time, healthcare technology is evolving "faster than our system can make room for it," says Joanne Castonguay, an economist with the Center for Interuniversity Research and Analysis of Organizations (CIRANO), who has a special interest in public policy in healthcare.
Considering some of the sticker prices associated with ‘better and faster’ medications and machines, it’s not surprising that decision-makers in the healthcare system are not exactly rushing to embrace innovation. It doesn’t help that, in some cases, "new technology has been brought into play without really understanding its impact on the system," adds Ms. Castonguay. 

Cost-based procurement impedes the integration of new technology... 

Another barrier to the adoption of newer healthcare technologies is institutional inertia: for the most part, purchases are based on competitive bidding, with the order going to the lowest bidder. Cost-based procurement is simple to explain and easy to justify. Problem is, this bottom-line approach makes no allowance for indirect savings that could accrue from implementing a new technology. 

...and centralized decision-making doesn’t reward innovation

Ms. Castonguay explains: "In other parts of the world, two forces are at work simultaneously: the first is the trend towards healthcare integration that considers the full range of services required to treat a patient and get them back to full functioning. The second is a growing tendency for governments to become policy makers rather than service providers. In contrast, the Government of Quebec is currently the policy maker, service provider and payer."

"As an example, look at our FilmArray® analyzer," says Xavier Nouvelot, General Manager of bioMérieux Canada. "We have a respiratory test panel capable of identifying up to 20 viral and bacterial pathogens from a single sample, with results in one hour—and a total time of about 4 hours from sampling to results at the bedside." 

Certainly sounds more efficient than conventional laboratory tests that take a day to complete and as many as four days to get results back to the patient’s bedside. "Four hours versus four days: think of the cost savings we could achieve by avoiding unnecessary hospital stays and unnecessary use of antibiotics," adds Mr. Nouvelot. 

But according to Ms. Castonguay, the way hospitals are financed now actually discourages innovation. "When you implement innovation, cost savings don’t accrue to the innovator; usually, they migrate back to the payer," she says. As a result, there is no net benefit to the innovator and no incentive to innovate.

Inching toward a brighter future

"I think the decision-making process is going to improve; there is now greater understanding that looking at new technology from a straight cost perspective is taking a narrow view—and that more enlightened decision-making will benefit patients, governments and society," says Ms. Castonguay. "This is an evolutionary process. Our payment system won’t be overhauled all at once. The next step will be to look at payment per patient; this value-based approach determines a dollar value that should be assigned not just to a treatment, but to a patient, from the time of diagnosis to his return to normal living." 

"Sooner or later, there will have to be a major shift in the political culture [concerning healthcare]; we have no choice in light of our changing demographics." - Joanne Castonguay, CIRANO

 

Joanne Castonguay is vice president at CIRANO and associate professor, Pôle Santé at HEC Montréal. 

 

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What is the syndromic approach? Why does it matter?
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What is the syndromic approach? Why does it matter?

George had been feeling under the weather for days when he finally dragged himself to the hospital, looking for help.
June 6, 2016 - Healthcare

What is the syndromic approach? Why does it matter?

George had been feeling under the weather for days when he finally dragged himself to the hospital, looking for help. 

When poor George arrived at the hospital Emergency Room (ER), he didn’t tell the triage nurse he was suffering from pneumonia; all he could do was reel off his symptoms. “I feel miserable, I feel weak, I have no appetite and I’ve been coughing for four days,” he said. “Help me. Please.”

In George’s case, as in most, it takes more than a list of symptoms to arrive at a diagnosis. Health care professionals (HCPs) also look for signs of illness—indicators that can be detected or measured objectively, like a heart murmur heard through a stethoscope, or a fever measured by placing a thermometer under the tongue.

A syndrome consists of symptoms and signs

“When you put symptoms and signs together, this is called a syndrome,” says Dr. Mark Miller, Chief Medical Officer of bioMérieux Inc. “The concept of a syndrome is important because this is how a patient presents to their doctor or nurse.”

Does George have pneumonia, the flu, heart failure, or another type of respiratory infection or disease? Dr. Miller says there are several good reasons to get the diagnosis right:

  • George is suffering: he has the right to expect a timely diagnosis and effective therapy and relief
  • Identifying the precise cause of George’s problems facilitates the selection of the appropriate therapy
  • Having a definite diagnosis determines the appropriate infection control for George and those with whom he has been in contact

We can add one more item to this list: having the means to quickly identify pathogens will also help George get out of the hospital and back home sooner, which is win-win for both George and the hospital. Clearly, the ability to pinpoint the pathogen responsible for a syndrome of signs and symptoms is key to achieving a successful outcome.

bioMérieux leads in taking the syndromic approach

bioMérieux is a world leader in applying the syndromic approach to diagnostic testing. “Our approach mimics the way a patient presents in the hospital or clinic,” reveals Dr. Miller. “The most common syndromes are respiratory and gastrointestinal (GI), with others down the list, like sepsis syndromes and meningitis. We have panels that include 20 or more pathogen tests for each of these syndromes.”

Accurate test results in a fraction of the time

George appears to have a respiratory syndrome, so the HCP takes a simple and easily-obtained sample from George’s nose and sends it to the lab to be tested using the respiratory panel in the FilmArray® system from bioMérieux. Compared to conventional testing, results from the FilmArray® test can be back in the HCP’s hands in about an hour (versus up to several days) and, using this single sample, can positively identify any one of 20 different respiratory pathogens.

A syndromic approach isn’t always necessary: if a patient has been hospitalized for two weeks and develops diarrhea, we know the most likely cause is C. difficile. Because the list of potential pathogens is very long, syndromic testing is more appropriate for patients who, like George, just come into the ER with respiratory or GI symptoms.

“Conventional testing can result in a lot of waiting and, of course, ongoing discomfort for the patient—perhaps even an unnecessary hospitalization,” says Dr. Miller. “It becomes very cost-effective to simultaneously test for multiple pathogens that could be responsible for a syndrome, rather than just look for one cause at a time.”

“The ability to test for multiple pathogens in a single procedure results in better management of the patient and better infection control.”

- Mark Miller, MD

Having a diagnosis can be reassuring 

A syndromic approach to testing is also helpful because patients are reassured when they receive a precise diagnosis rather than an educated guess. “Being able to say, ‘We have a positive test for a virus. You can go home and rest without the need for unnecessary antibiotics’ gives patients a great deal of comfort and is more rewarding for the HCP,” says Dr. Miller.

In addition to shorter hospital stays and less unnecessary time in isolation (which is very expensive), taking a syndromic approach encourages the responsible use of antibiotics.

Preserving antibiotics’ effectiveness

“Antibiotic resistance is a growing problem around the world. Antimicrobial stewardship means giving the right antibiotic in the right dose to the right patient at the right time. You can do that when you have definitive test results that come back rapidly,” says Dr. Miller. “Reducing the inappropriate use of antibiotics is important. FilmArray® is one of the major tools hospitals can use in their antimicrobial stewardship program.”

Getting back to poor George. How long will he wait, and how many tests will be ordered to diagnose the cause of his illness? We can only hope the ER he visited is served by a laboratory that has adopted the syndromic approach, so that he can look forward to a quick recovery.

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bioMérieux Canada building a strong case for innovation
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bioMérieux Canada building a strong case for innovation

bioMérieux Canada is spearheading an effort to persuade stakeholders that innovation adds value to the healthcare system.
June 6, 2016 - Healthcare

bioMérieux Canada building a strong case for innovation

bioMérieux Canada is spearheading an effort to persuade stakeholders that innovation adds value to the healthcare system. 

The FilmArray® diagnostics system, an unimposing unit about the size of a desktop printer, is at the centre of a paradigm shift in how patients presenting to the Emergency Room (ER) are assessed. While physicians currently use educated guesswork or order one lab test after another to help make their diagnoses, the FilmArray® system can test for 20 or more pathogens from a single specimen in about an hour.

Replacing guesswork with clinical certainty

This innovation, called a syndromic approach to diagnostic testing, complements the way physicians work through the process of making a diagnosis. “Having the ability to obtain test results and to quickly make a diagnosis has benefits for both patients and physicians,” says François Turgeon, Senior Clinical Marketing Manager at bioMérieux Canada.

Studies seek to bolster evidence

The company is currently supporting studies to test the hypothesis that a syndromic approach to laboratory testing will add sufficient value to justify its cost. In a clinical study at Montreal’s CHU Sainte-Justine pediatric hospital, children presenting to the ER with respiratory symptoms (about 280 patients so far) provide a specimen for testing using FilmArray®. The diagnosis—and the right course of action—are determined right on the spot, versus the conventional approach that would keep the child in observation for the time it takes to go through a battery of tests (up to three or four days).

Will users see the value?

“This innovation is more expensive, so we hope to show that it saves hospital resources and improves patient care,” says François. “We also want to know if physicians and laboratory personnel appreciate having the means to quickly obtain reliable results. Do they see an increase in patient satisfaction? Do technicians find the equipment easier to use?”

The goal of this research is to help persuade stakeholders that innovation can make a significant contribution to improvements in the healthcare system, from multiple perspectives:

  • Less waiting and uncertainty, better outcomes and greater satisfaction for patients

  • Fewer delays and more precise decision-making for physicians

  • Greater efficiency and simplicity for laboratory technicians

  • More rational use of scarce hospital resources, for administrators

A second study, involving adults with respiratory symptoms at Vancouver General Hospital, will have a more limited objective: to determine if reducing the time to diagnosis yields a cost advantage to the system due to spending less time on the ward, avoiding unnecessary tests, and so on. 

Rapid diagnosis of GI complications

A third study, at Maisonneuve-Rosemont hospital in Montreal, uses the syndromic approach to diagnose gastrointestinal (GI) symptoms. Study participants, about 100 so far, are bone marrow transplant recipients whose immune systems have been wiped out by anti-rejection drugs, so they are vulnerable to developing GI issues.

When these patients develop symptoms, the challenge is to determine whether they are having an adverse reaction to their medications or to the transplanted marrow, or if they caught a virus or picked up a bacterial infection. Physicians have been using FilmArray® to help them make a diagnosis.

Early results from this study indicate that about 25% of patients had a change in their management as a direct result of testing; the next step will be to review patient files to assess the clinical impact and cost savings attributable to these changes.

“So far, every clinical oncologist we have spoken to wants to keep using FilmArray®. The final analysis will tell us if it makes economic sense.”

- François Turgeon, bioMérieux Canada

Encouraging signs of collaboration

Healthcare in Canada is fragmented because funding is provided by the federal government, but budgets are set by each province—and some provincial regimes are more progressive than others. François likes what is happening in Alberta. “They gathered suppliers together in 2015 and announced that they had identified areas, such as critical care and cancer, where they saw room for improvement. They challenged companies to propose innovative solutions.”

According to François, this is a more enlightened approach than exists in other provinces, where companies can propose a new technology but usually have no idea where problems exist that their technology could address. By comparison, Alberta’s approach is more collaborative. “It would be great to have this kind of approach in Quebec, because we could help our partners in healthcare find innovative solutions.” 

François says this type of initiative could also move the conversation forward in more provinces, once bioMérieux recruits local advocates who understand the value of the syndromic approach. “If we get the results we hope for, it will confirm that bioMérieux is at the forefront of infectious disease diagnosis, specifically with respect to taking a syndromic approach.”

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Extra pepperoni with that?
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Extra pepperoni with that?

Chances are you never gave a second thought to the pepperoni on your pizza – but you will after you read this.
June 6, 2016 - Industry

Extra pepperoni with that?

Chances are you never gave a second thought to the pepperoni on your pizza – but you will after you read this. 

The last time you chowed down a pizza at half-time or during movie night on the couch, it’s all but certain that the pepperoni and some of your other pizza toppings were made by Les Produits Alimentaires Viau Inc., a Laval, Quebec based food company. An international pizza chain is just one of dozens of customers Viau supplies with sliced meats, Italian sausage, meatballs, steak and so on. What’s more, Viau was the first company in Canada to produce dry cured pepperoni, which makes the ideal pizza topping.

And this has to do with bioMérieux because…

Didier Leroux, Director of Operations at Viau, credits a long-standing collaboration with bioMérieux for some of the company’s success. “For as long as I can remember we’ve had an in-house laboratory to do our own quality and safety testing. It’s part of our mentality. We think of the lab as an essential step in the process of meat transformation, just like the slicers and grinders,” says Didier. 

Most of the laboratory test equipment is from bioMérieux. Didier says “they have a good team and their products work well and are very reliable. Every time a client visits our plant they come away impressed with the laboratory. We have been well served over many years by bioMérieux and it has been a great partnership.”

Accredited in-house laboratory is a win-win for Viau

  • Fast test results help reduce costly production downtime
  • Allows protection of proprietary information
  • Ensures consistent product quality
  • Demonstrates a commitment to food safety

“When Viau was still a small enterprise, having our own laboratory was a way of showing potential customers that we take food safety very seriously. It’s not a stretch to say it was partly a marketing tool,” says Didier. As he sees it, some fast food restaurants are very demanding because they cannot afford to jeopardize their brand name. “It’s hard to quantify the impact of having our own lab in dollars and cents, but it reassures our clients and gives us peace of mind as well. How do you place a value on that?”

Viau was the first company in Canada to invest in an industrial microwave oven to thaw their meats and in infrared technology to analyse their products on the line.  “We are constantly on the lookout for new technology that can improve our ability to detect problems as quickly and precisely as possible; the cost of this technology is a secondary concern,” he says.

Build it and they will come?

The plant in Laval includes five new slicing rooms, each with its own completely independent plumbing and ventilation system, an array of UV lamps to provide continuous air purification – and production workers suited up like astronauts – all with the aim of reducing the risk of cross-contamination. Viau is the only meat transformation company in Quebec to offer high pressure pasteurization (HPP), which is performed after products are packaged.

According to Didier, part of the current business plan is to offer slicing, packaging, pasteurization and laboratory testing for companies with private label brands. “We think that sooner or later, a number of large supermarket chains could come knocking. It really is a ‘vision thing’ and we are ready today to take on new growth.”

Look for Viau Italian-style prepared and sliced meats at your grocers under the Fantino & Mondello brand name. Visit fantinomondello.ca to learn more and to see mouth-watering recipes.

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Detect to protect
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Detect to protect

The Canadian food supply is one of the safest in the world, but an estimated 4 million Canadians get sick each year due to food-borne diseases.
December 16, 2015 - Industry

Detect to protect

Virus or bacteria, which is to blame?

The Canadian food supply is one of the safest in the world. However, the Public Health Agency of Canada estimates that each year approximately 1 in 8 Canadians gets sick due to domestically acquired foodborne diseases. No food safety system can guarantee zero risk. At any point in the production system, food can become contaminated with bacteria, viruses, parasites, chemicals or undeclared allergens.

Viruses account for about 65% of known cases of foodborne illness in Canada.

To help address the issue of foodborne illnesses, the Government of Canada recently announced the establishment of the Food Virology National Reference Centre at the Canadian Food Inspection Agency (CFIA) laboratory in St. Hyacinthe, Quebec. The Centre will be part of the Food Safety Information Network (FSIN) announced earlier this year. The FSIN will be implemented incrementally over five years, linking federal and provincial food safety authorities and accredited laboratories across the country. The Centre will further enhance Canada's ability to effectively detect viral contaminants in food, such as noroviruses and hepatitis A.

The Food Virology National Reference Centre will:

  • Develop strategies to detect, quantify and characterize foodborne viruses in complex food conditions;
  • Study foodborne, emerging and zoonotic viruses in the food chain;
  • Research viral indicators to assess food and water safety;
  • Evaluate prevention approaches, risk mitigation and analyses; and
  • Provide testing services and scientific advice on potential foodborne contamination.

Did you know?

An estimated 4 million Canadians get sick each year due to foodborne diseases.

bioMérieux’s Industry Unit has a wide range of microbiological control solutions dedicated to food safety and quality. In January 2015, bioMérieux added to its already broad food testing solutions portolio by acquiring CEERAM (European Centre for Expertise and Research on Microbial Agents), an innovative virology laboratory specializing in the detection of foodborne and environmental viruses. CEERAM has developed internationally recognized expertise for the detection of foodborne viruses using molecular biology techniques. The company has a comprehensive range of molecular virology reagents, in particular focused on the identification of noroviruses and hepatitis A and E viruses in foods.

There is still work to be done to prevent and control foodborne illness in Canada, to focus efforts on pathogens that cause the greatest burden, and to better understand foodborne illness without a known cause. bioMérieux hopes to help reduce this burden through its technologies and ongoing research.

References: 
Government of Canada. Backgrounder: Government of Canada establishes centre for food virology: http://www.inspection.gc.ca/food/action-plan/backgrounder/eng/1437602715302/1437602947865.
Government of Canada. Food safety investigations: http://www.inspection.gc.ca/food/information-for-consumers/food-safety-investigations/eng/1332299626115/1332299812611.
Public Health Agency of Canada. Estimates of foodborne illness in Canada: www.phac-aspc.gc.ca/efwd-emoha/efbi-emoa-eng.php
bioMérieux Press Release

Biomérieux Annual Report, 2014.pdf

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More knowledge, less risk.
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More knowledge, less risk.

Antimicrobial resistance (AMR) occurs when antibiotics completely lose or have diminished effectiveness to treat infections.
December 16, 2015 - Healthcare

More knowledge, less risk.

Counter the global public health threat of antimicrobial resistance

What is antimicrobial resistance (AMR)? AMR occurs when antibiotics completely lose or have diminished effectiveness to treat infections. This happens because microbes change by mutating or acquiring genetic information from other microbes to develop resistance. Unfortunately, AMR is a natural phenomenon accelerated by the overuse and/or inappropriate use of antimicrobial agents in both people and livestock. As a result, resistant strains survive and aggregate, limiting treatment options for common infections.

Why is AMR a concern? Because the risk of morbidity and mortality is higher in patients infected with resistant strains. And because the overall societal costs associated with the treatment of AMR are staggering. In the US alone, it is estimated that AMR results in up to $20 billion in direct costs and up to $35 billion in indirect costs. 

Antimicrobial resistance is recognized as a global public health priority by healthcare organizations, including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).

Advanced knowledge of microorganisms is crucial to fight back and bring them under control. The contribution of microbiology is essential at each step in the fight against AMR. With over 40 years of expertise in microbiology, bioMérieux is committed to the fight against AMR and works in close partnership with healthcare professionals to provide the most relevant solutions. One example of the company’s commitment is their funding of the Global Point Prevalence Survey, which was created by a group of worldwide experts at the 4th World Hospital-Acquired Infections (HAI) Forum in 2013. This study, launched in 2014, is designed to provide a global snapshot of antimicrobial resistance and utilization. Unprecedented in scope, it is being coordinated by the University of Antwerp Hospital (Belgium). In 2015, they expect to mobilize more than 700 hospital centres in more than 70 countries across all continents. The information obtained will be used to initiate a global database dedicated to tracking the consumption of antibiotics and antimicrobial resistance in hospital settings.

In June 2015, bioMérieux participated in the United States’ White House Forum on Antibiotic Stewardship to discuss possible ways of implementing changes over the next five years directed at slowing down the emergence of antibiotic-resistant bacteria, preventing the spread of resistant infections and preserving the efficacy of existing antibiotics.

Through measures such as these, bioMérieux hopes to assist hospitals and patients worldwide in combating AMR, improving outcomes and retaining the value of microbial treatment options.

References: 
World Health Organization
Antimicrobial resistance: global report on surveillance, 2014
bioMérieux Press Releases
Global experts engage in the fight against antimicrobial resistance during the World HAI/Resistance Forum organized by bioMérieux.
bioMérieux Annual Report, 2014.pdf

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How LEAN is your lab?
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How LEAN is your lab?

Did you know that the vast majority (87%) of process time in the average hospital microbiology laboratory is not spent on “core value” activities?
December 16, 2015 - Healthcare

How LEAN is your lab?

Greater efficiency for better patient care

Did you know that the vast majority (87%) of process time in the average hospital microbiology laboratory is not spent on “core value” activities? This statistic is worrying, as the lab is the linchpin for nearly every treatment decision within the hospital, and the speed and accuracy with which results are provided is critically important to the well-being of patients. 

What contributes to “wasted” time in labs? On average, process time is spent as follows:

  • 5% on backlog requests
  • 23% on extra work performed because of missing information
  • 27% waiting to complete the next “core value” step due to unavailable staffing or equipment
  • 4% on unnecessary motion (e.g., walking to the next task)
  • 12.5% on review and quality assurance
  • 7% on call or log information
  • nearly 10% on correcting quality issues

In our approach, waste actually refers not to the true value proposition offered by the microbiology laboratory: its expertise, time and capital,” said Anne Beal, Manager of the Workflow Optimization Team at bioMérieux. “[The waste] is not a tangible thing, but the relationship of the laboratory as a resource and the members of the laboratory staff. This is not the kind of waste that ends up in a garbage can, but it is in a very real sense a missed opportunity to improve the core value of the microbiology laboratory.

LEAN Lab Design is a service offered by bioMérieux. The service applies LEAN®/Six Sigma® principles to the microbiology lab. This service involves observation of the lab in its current state, such as the physical layout and the manner in which samples are processed. At the end of the process a roadmap is provided, outlining how the lab can improve processes to reduce waste and improve efficiency, while simultaneously increasing the quality of results and reducing errors.

For example, when the LEAN Lab assessment was performed at the Children’s National Medical Center in Washington, DC, it was discovered that approximately 20-25% of their workload was collected during the time of day when the lab had limited staff to process specimens. This issue was illustrated in a “Pareto diagram,” as shown in Figure 1.

Figure 1: Analysis of staffing and specimen volume

As a result of this analysis, the lab adjusted their staffing patterns in an appropriate fashion. Once this and other adjustments were made to the lab after their LEAN assessment, turn-around times (TATs) were compared from identical six month periods, pre- and post-LEAN. The results revealed that there was a significant improvement in TATs, with the Center gaining on average a complete day in their positive culture TATs post-LEAN (see Table 1). 

 

Table 1: Days of the week: pre- and post-LEAN positive culture TATs

LEAN lab assessments can prompt thought evolution among lab technologists, because they are made to be part of the process and are part of the desire to provide better services to their physicians and patients.

References:
Campos J. LEAN Lab Implementation Improves Turnaround Times and Leads to Faster Results and More Confident Clinical Decision Making: http://www.biomerieuxconnection.com/11-15-11-lean-lab-implementation.html.

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Is antibiotherapy necessary?
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Is antibiotherapy necessary?

Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) technology can provide rapid microbiological identification faster than traditional methods at an affordable cost.
December 16, 2015 - Healthcare

Is antibiotherapy necessary?

State-of-the-art technology for your ASP

Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) technology—better known as Mass Spec—is used for rapid microbial identification. With this technology, organism proteins are analyzed to generate unique fingerprint patterns that are matched against a comprehensive database of relevant organisms.

VITEK® MS technology is providing rapid microbiological identification faster than traditional methods at an affordable cost. Rapid identification is key in enabling physicians to implement the right antibiotherapy. The technology has sped up identification time and it helps to get patients on appropriate antibiotics sooner, when they are needed.

Most larger health institutions in Canada have experience with such systems. One such lab is that of Dr. Victor Leung, the Medical Director of Infection Prevention and Control and the Physician Lead of Antimicrobial Stewardship at Providence Health Care, at St. Paul’s Hospital in Vancouver, British Columbia. Several years ago, his lab began using the Mass Spec technology from bioMérieux (VITEK® MS), and developed a business plan to support the acquisition of this new technology and clinical guidelines for improving patient care. He and his team have been using it clinically for about a year and a half.

Dr. Leung’s centre has developed an impressive, multifaceted Antimicrobial Stewardship Program (ASP) that incorporates technologies, processes and people. The ASP, including VITEK® MS, has significantly decreased the antibiotic spending within the institution. The program involves a team that is very supportive at all levels of the organization and includes physicians, microbiologists and pharmacists who all have a vested interest in microbial utilization in their hospital. There is a clinical working team, which consists of a physician and a pharmacist, who track and review cases of patients on antibiotics and make recommendations on how they should be managed. The bacteremia program incorporates the use of the Mass Spec technology and the test results are texted to the research team. “Our vision is really to ensure people are on appropriate antibiotics at the right time,” says Dr. Leung. He also believes that the technology, in conjunction with his ASP, has improved internal dialogue, enhancing education for both clinicians and the laboratory staff.

But what does all this mean for patients? According to Dr. Leung, “It means that sometimes they are not getting an antibiotic they don’t need. Sometimes they are getting an antibiotic sooner. Sometimes they are getting more comprehensive review from the ASP early on, because the team has more input about the case. This rapid identification can allow them to be on the best antibiotics as soon as possible with a better management strategy review.”