Provider Orientation & Resources  



Note: open ALL links and attachments that are applicable to your area(s) of practice.

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Clinical practice: Coccidiomycosis serologies
Outlines orderables and rules regarding Coccy serology and CF titer testing.

Clinical practice: Diagnosis of diarrheal disease in clinical/ epidemiologic conditions
Outlines laboratory studies/evaluation of stools for diagnosing adult and pediatric diarrheal disease based on patient’s presenting condition and history.

Clinical practice: Pooling of multiple respiratory specimens collected via bronchoscopy (single episode) for mycobacteria, fungi, legionella, pneumocyctis, as well as for quantitative bacterial Culture for ventilator associated pneumonia
When multiple bronchoscopically obtained washings or bronchoalveolar lavage specimens (single episode) are sent on the same patient with requests for these tests, they will be pooled before processing for these organisms (with concentration where required)- rare exceptions will be made if clinically necessary. 

Clinical practice: Diagnosis of Clostridium Difficile Associated Diarrhea (CDAD)
Diagnosis will be done using molecular DNA toxin-determinating chromosomal or other appropriate targets by amplification methods (such as polymerase chain reaction) if available at the facility and all negative or indeterminate results obtained by alternative screening methods will be reflexed for testing by appropriate amplification methods.

Clinical practice: Guidelines for the treatment of clostridium difficile associated diarrhea
Recommendations for treatment of mild to moderate disease with Metronidazole for first line therapy, relapse, and recurrent disease and to consider using vancomycin as initial therapy in severe disease.

Clinical Practice: Appropriate use of fecal transplants for relapsing clostridium difficile infection in adults
As a recommended clinical practice, adult patients presenting with relapsing or refractory Clostrdium difficile infections, who have failed medical therapy, may be considered for fecal transplant to restore normal bowel flora. This clinical practice outlines patient selection criteria, donor selection criteria, and communicable disease screening requirements in order to ensure patient safety. 

Clinical practice: Discontinuation of autologous blood use in elective total joint replacement surgery - adult
It is an expected clinical practice that adult patients undergoing elective total joint replacement surgery will not receive pre-operative autologous blood donation in routine elective total joint replacement surgery. It also outlines the expected practice is to optimize hemoglobin pre-operatively with erythropoietin and iron therapy as clinically indicated prior to elective surgery to raise pre-operative hemoglobin levels and minimize the risk for blood transfusions. The expected practice is to use red blood cell saving techniques where appropriate during elective total joint replacement surgical operations to conserve red blood cell volume.

Clinical practice: Blood transfusion in elective total joint replacement surgery - adult 
It is an expected clinical practice that adult patients undergoing elective joint replacement surgery who are hemodynamically stable will not routinely receive packed red blood cells when the hemoglobin level is above 7.0 grams/deciliter with few exceptions. It also outlines pre-operative and perioperative assessment and management regarding potential blood transfusion.

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