Early morning on Friday, May 31st. A child is admitted to an Andalusian hospital with a case of acute meningitis, and his mother is visibly distraught with worry. The microbiology service, which works on the night shift, can detect bacteria in an hour and a half, and pediatricians treat a serious condition, stabilize the child and calm the mother. This situation can no longer be controlled in the same way because, since June 1, the 24-hour, seven-day-a-week clinical microbiology service that was established in Andalusia with the pandemic has stopped working. Specialized technical staff have been left out in all provinces of the region, and the night shift has been canceled in the provinces of Cádiz and Jaén due to the exhaustion of covid funds intended to hire these professionals. The heads of microbiology of the Andalusian hospitals have warned of the serious consequences of the interruption of this service and are demanding that the board of directors reorganize the priorities of care and restore the 24/7 provision.
“Ending the contracts of laboratory technicians specializing in clinical microbiology and interrupting 24/7 care is critical both for the quality of public health and for the care and treatment of patients with serious infectious diseases,” says Federico García, head of the microbiology service at San Cecilio Hospital in Granada and President of the Spanish Society for Infectious Diseases and Clinical Microbiology (SEIMC). García emphasizes how the generalization of the 24/7 service in Andalusia was decisive during the pandemic and warns of the negative consequences that a return to the previous organization would entail: “We cannot return to the medicine of the 20th century. “We can’t go back to pre-pandemic.”
The 24/7 service increases the ability to rapidly identify pathogens with epidemic potential, thus favoring immediate diagnosis (necessary to administer adequate treatment to each patient), as samples are analyzed at the moment of patient admission – without the need to wait for the laboratory to open at eight in the morning or for a specialist technician to start a work shift—making it possible to take public health measures to prevent or control outbreaks much more quickly, in addition to reducing hospital stays. “Without a 24/7 active service, diagnoses will be delayed, causing increased morbidity and mortality for patients with serious infections,” warns the SEIMC president. “It has been shown to reduce mortality by 35%,” he adds.
Ministry of Health sources point out that microbiology and clinical analysis coverage is fully guaranteed in Andalucia and acknowledge that the 24/7 service has been suppressed in Cádiz and Jaén, where activity ends at 10:00 p.m. and localized services are available at 8:00 p.m. if needed guards. However, since June 1, the number of laboratory technicians at various hospitals in the community has decreased by at least 28 specialists, according to data that has been collected. “The response of the hospitals varied, depending on the manager’s interest in microbiology, in some the guard was maintained, in others the staff was reduced and in Cádiz or Jaén they were eliminated completely. It doesn’t make sense that one province has two hospitals with 24/7 service and another has none,” says Álvaro Pascual, president of the Andalusian Society of Clinical Microbiology and Infectious Diseases.
“We have techniques that allow us to diagnose meningitis or adjust antibiotic treatment in an hour and a half or two hours,” says Manuel Rodríguez Iglesias, head of the microbiology service at Puerta del Mar Hospital in Cádiz. Rodríguez recalls that the use of all these technologies was extended to 24 hours in all hospital centers during the pandemic. “There is no longer such a pressure to diagnose covid, but to diagnose meningitis in a child and to provide adequate treatment, right? This can cause the diagnosis we make to prompt a therapeutic change or send the child home because we know the development will be good,” he explains. In your case, this ability to respond at any time is much more important because serious pediatric cases from the rest of the province come from Puerta del Mar. However, the decision to close the laboratories of all Cádiz hospitals at 10 p.m. will limit this ability to respond. “That means they’ll have to keep the samples. Mr“Analyze them starting at eight o’clock in the morning, when in one night, in two hours, we can identify whether the bacteria is dangerous, whether it has resistance mechanisms…”
Rodríguez warns of the consequences this decision may have on the detection of the Nile virus, a mosquito-borne disease that has consistently targeted the banks of the Guadalquivir, especially in the provinces of Cádiz and Seville. “We are now in the seasonal period and ready to detect more meningoencephalitis agents, including West Nile virus, but if there is nighttime intake, it will have to wait,” he suggests.
A hasty decision that deepens inequality in health care
From June 1, measures limiting laboratory hours or leaving laboratory microbiology technicians came into force. Pascual is promoting negotiations with the Ministry of Health for a “reasonable and fair” emergency system that is developed based on the characteristics of hospitals and their capacity. “We have to reorganize the system, if there are economic constraints, we will have to negotiate,” he says. He also disputes that the cuts were announced in the last week of May without prior negotiation. “We didn’t have time to react to the reorganization,” he explains.
The reduction in the number of laboratory technicians has forced service managers to restructure their staff to guarantee night service. “At the cost of prioritizing and postponing other issues that are also important,” says García. 24-hour availability has proven crucial in the hospital, according to a study presented this weekend at the XXVII. SEIMC National Congress. Among the conclusions, a high percentage of blood cultures are positive between 10 pm and 8 am, and that much of the activity of the microbiology service during this time period had direct consequences for the patient at that time. . “Without this continuous activity, results and interventions would be delayed in half of the cases,” it said.
In addition to the reduction in the quality of health that these cuts bring, experts condemn the situation of inequality in citizens’ access to basic services. “Patients do not have the same rights or the same opportunities to receive an accurate diagnosis and adequate treatment,” says Pascual. “In a hospital where the microbiology service does not operate around the clock, the delay that would occur if you wait all night can lead to complications or death,” warns García.
Since the end of the pandemic, SEIMC has insisted on the importance of maintaining a 24/7 microbiology service in the event of the closure of laboratories in the Basque Country, Valencia or Madrid. “It has become a fundamental pillar of the health system that is present in all the countries around us, we cannot allow something that worked well and was useful to be dismantled in Andalusia,” its president suggests. Pascual, for his part, hopes the board will “reconsider.” “We are essential. We demonstrate this on listeriosis and pandemics, but also daily in the fight against antibiotic resistance and whenever there are periods of high frequency. Then they will ask us to reorganize the guards,” warns Pascual.
