John Carvalho: Shortage of Microbiologists Would Cause Dire Health Care Shortfall

The nursing shortage in the United States has been well documented and reported; however, there is another segment of the health care industry workforce that is in decline – clinical laboratory scientists, also known as clinical microbiologists. According to John Carvalho, assistant professor of biology at California State University, Dominguez Hills, if the number of these scientists continues to fall, the potential impacts could include increases in bacteria-related infections– the very things CLS professionals are trained to detect.

John Carvalho, assistant professor of biology (at left) and John Vu, graduate student, are exploring low-cost methods of identifying bacteria for hospitals in developing countries.

In his article, “Importance of Clinical Microbiologists for U.S. Healthcare Infrastructure,” published in the July issue of Clinical Laboratory Science,  Carvalho posits that within a five-year window, the United States could be in danger of being in a similar situation as many developing countries that currently lack CLS professionals in their hospitals and clinics.

“There’s no surveillance in the hospitals because of the workforce shortage,” he says, talking about the health care infrastructure in such countries, “and that is causing the rise of disease-causing organisms, which are gaining resistance against antibiotics.”

“After that five-year window, when we see a lot of the CLS workforce start to retire, we’ll see some strain on the health care system in the United States, especially in areas that are economically disadvantaged,” he continues. “There are hospitals in the United States right now that are beginning to see new kinds of infections that they should not normally be seeing. For example, Los Angeles County-Harbor UCLA Hospital serves a lot of economically disadvantaged individuals who may not have quality healthcare. They are more likely to have exotic diseases and infections because of that.”

Clinical laboratory scientists are the behind-the-scenes professionals who take a patient’s blood or skin sample and conduct tests and analyze the results to detect infection, cancers, and genetic diseases, among other things. Carvalho says that the diminished CLS workforce will increase the time that patients spend in the hospital waiting for lab results, which ultimately results in superficial diagnoses and antibiotics being prescribed ineffectually.

“When clinical microbiologists are not available, the physicians who are treating the patients will prescribe broad spectrum antibiotics that should be able to kill anything,” he says. “But the patient may have an infection that is not responsive to those antibiotics and therefore, the organism could spread or mutate. If the patient doesn’t use the antibiotics correctly or if they are weak antibiotics, you can have a situation where the bacteria develop a resistance to the antibiotics. And then you get antibiotic-resistant bacteria floating around where there are simply no antibiotics that can stop them.”

The decline in CLS professionally is seen as largely due to aging professionals who are nearing retirement and the lack of advanced training and certification programs at universities. He says that many of these programs have been closed because there are no professionals available to teach students.

According to Carvalho, CSU Dominguez Hills and Loma Linda University are the only two California institutions that offer a Bachelor of Science degree in clinical laboratory science. He says that the eventual shortage of qualified professionals will be catastrophic in the long run, not just to California but the entire nation.

“For example, in Arizona, you’ve got 6.6 million people,” he says. “Many of them are elderly and need clinical laboratory scientists in their hospitals. But the reality is there are no academic programs in the entire state of Arizona that are teaching clinical laboratory science to their students at the [baccalaureate] level.

“California can’t give up our clinical lab science majors to Arizona because we need them right here. So the whole nation is facing a crisis of the clinical microbiology workforce.”

In his article, Carvalho also addresses the potential threats of bioterrorism and pandemics that without the availability of qualified CLS professionals, can reach epic proportions.

“In the case of potential bioterrorism, the country has to be ready,” he says. “One way it can be ready is to have a robust clinical microbiology workforce, people who can go into the hospitals to diagnose patients rapidly. If they are not there, then any kind of attack with anthrax or some other contagious disease-causing organism can be a problem.

“It doesn’t have to be about terrorism,” Carvalho says. “It can be the pandemic influenza attacks, or an E. coli outbreak that occurs from contaminated food in a particular area. Listeria is an exotic organism and a lot of tests have to be run to find out what that organism is in patient samples. If it takes a long time, the patient will get sicker by the minute. The [current] cantaloupe issue is an example of where we have a major outbreak and it took a while to get an idea of what was really happening. In a larger bioterrorist attack or a pandemic hitting the whole world, more people will be suffering in different areas, [putting] a greater strain on hospitals that are trying to diagnose those patients.”

Carvalho says that the CLS shortage will also allow the proliferation of diseases that are transported to the U.S. from other countries, with examples of drug- resistant micro bacteria that exist in cases of tuberculosis in Peru, Russia, and Eastern Bloc countries. He notes that diseases from abroad can easily be spread without a vigilant workforce of CLS professionals identifying and monitoring foreign strains of disease-causing organisms.

“Problems in other countries will become problems in the United States because the diseases in those other countries can eventually make their way here,” he says. “With air travel, things can happen kind of quickly, not only with viruses but also with bacteria-caused diseases. If a patient from one of those other countries comes to the United States, [they] can spread the disease-causing organism to other individuals here.”

Related to CLS’s function in disease detection, Carvalho and his graduate assistant, John Vu, have been researching low-cost ways for developing countries to identify two different types of enterococci, an intestinal flora that is normally present in humans and animals, but can cause serious infections involving the abdomen, pelvic region, and heart if it deviates from its usual location in the body.

“We not only need to be able to identify the genus of the organism, but also the species of the organism,” says Carvalho. “In a lot of places, that can’t be done because the speciation work we do in the United States is too costly and in the developing world, they don’t have that kind of money [or] the tools available.”

Carvalho and Vu have developed strategies that can distinguish Enterococcus faecalis from Enterococcus faecium using rapid and inexpensive methods with simple tools like agar plates and citrates that distinguish the color difference between Enteroccocus strains.

“We extended the study to incorporate clinical isolates that I retrieve from my workplace,” says Vu, who is a laboratory associate at Focus Diagnostics in Cypress. “We did work on strains we bought from a repository, but those were strains that were kept constant, and did not infect anyone. Now we have patient samples, bacteria that is actually out there right now, infecting people.”

Vu and Carvalho had some of their findings published with the article, “Enterococcus: Review of its Physiology, Pathogenesis, Diseases, and the Challenges It Poses for Clinical Microbiology,” which appeared this summer in the journal Frontiers in Biology. Their project was funded by a mini-grant from the CSU Dominguez Hills Emeritus Faculty Association and the university’s Sally Casanova Memorial Research, Scholarship and Creative Activities Program Grant.

Vu, who earned his undergraduate degree in biology from UC Irvine and is working on his masters in microbiology here, says that his studies at CSU Dominguez Hills are a direct complement to what he sees on the job.

“I find what we are working on [here] really relevant because I do work in a reference laboratory,” says Vu. “I do see all the things [Carvalho] is talking about in the article, about the workforce shortage, because all the clinical lab scientists I encounter at work are near retirement age and I don’t see a lot of younger people in the workforce.”

Carvalho earned his doctorate degree from Washington University School of Medicine and did postdoctoral work in virology at Harvard Medical School. He served a three-year National Research Service Award Postdoctoral Fellowship from the National Institutes of Health from 2004 to 2007, and was honored with the Cardinal Spellman Award For Potential in Graduate Program in Science, while an undergraduate at the University of Dallas.

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