Milwaukee microbiologist earns national HeRO award

Robert Olson, a medical technologist with the Milwaukee VA Medical Center’s microbiology department, will receive the national High Reliability Organization HeRO Award for his role in identifying and helping eliminate the source of a pseudo-outbreak stemming from bronchoscopies.

In July and August of 2023, Olson noticed an organism on fungal cultures from three separate patients who had a bronchoalveolar lavage, a diagnostic procedure that involves collecting a fluid sample from the lungs to examine for infections, lung conditions, and other abnormalities. The cultures were sent out to a reference laboratory and were all identified as the same organism, mycobacterium chelonae (M. chelonae). M. chelonae can be found in soil, water, and aquatic animals, and is an atypical growth in fungal cultures.

Olson started follow-up work to determine if other patients could potentially be affected by the organism or even if there had been potential contamination within the lab leading to the growth. He learned that each procedure that resulted in the abnormal growth involved different physicians and different bronchoscopes. Even the lot numbers on the media used in the lab cultures were different.

“The only thing that was very similar was that the procedures were all done in the same kind of clinical area,” Olson said.

By November, four additional patients had the same organism grow on their fungal cultures. Around the same time, Olson attended an annual statewide conference hosted by the Wisconsin Mycobacteriology Laboratory Network, part of the Wisconsin State Laboratory of Hygiene. While networking, he learned of a similar situation elsewhere with a different rapid-growing mycobacterium organism. The colleagues at the conference discussed their follow-up, which included looking at the rooms, bronchoscopes, procedures for sterilization, and any potential water exposure.

“Ice machines are very often found to be the culprit in addition to sinks,” Olson said. “In fact, there was another examination that we did back in 2015 to 2017 that an ice machine at Jesse Brown VA was associated with a potential pseudo-outbreak of another mycobacterium species, so that was kind of our thinking with the potential water source on there.”

Olson took his findings and the information from the conference to Jeanna Donkle, the microbiology supervisor.

Donkle worked with infectious disease, the pulmonologists, the cytology supervisor, and other key players to determine the source of the organism – an ice machine.

“When they were examining during the follow-through, kind of looking at the procedures, what we found was if there was a bleed during a broncho lavage procedure, one of the ways that they can stop the bleed is using ice cold saline,” Olson said. “They were using the ice and putting the saline on it.

“With everything that they found, they changed the procedures. They completely wrapped saline into a container which then separates it from the ice. It’s still keeping cool, but it’s not being exposed to any of that water, any of the ice.”

Olson said his biggest concern was that patients could be exposed to something potentially leading them to get an actual infection. Fortunately, none of the Veterans who had positive M. chelonae cultures showed signs of infection.

Donkle recognized the significance of Olson’s work and findings and submitted him for the HeRO award.

“He really has the Veteran and the clinician in mind when he’s working, and if he sees something, he feels comfortable saying something,” Donkle said. “He’s definitely dedicated to doing quality work and providing that best service.”

Olson was surprised to be recognized at the national level, and said he feels good because his work helps Veterans. He also said any of the techs working within the microbiology department would have seen the same thing and reacted similarly. Donkle agreed on the professionalism of her team but showed pride and excitement in Olson’s work and contributions.

“Medical technologists, we’re behind the scenes, and I think sometimes we’re forgotten a little bit,” Donkle said. “But they are dedicated to quality, and they do really good work. They really support our clinical staff and our Veterans here. I just wanted to highlight this. This was a really big thing. It was nice to have a medical technologist recognized for doing good things.”

Following the discovery, the findings and solution were presented during Patient Safety Awareness Week in March and at senior leadership meetings within the VA Great Lakes Health Care System, ensuring updated standard practices for cooling saline.

Milwaukee’s fourth HeRO award

Before earning a national HeRO Award, a recipient must be nominated at the local level, then win at the VISN level before winning again at the national level. 

Awards are given each quarter in five categories — two for individuals (clinical and non-clinical) and three for teams. Olson’s award is for non-clinical individual.

This is the Milwaukee VA’s fourth national HeRO award in the past two years. Registered Nurse Jeremy Sauld won a clinical individual award in 2022 for catching a defective syringe, Registered Nurse Meghan Lorbiecki and Simulation Program Manager Tina Smith won in 2023 for their innovative work in teaching new alcohol withdrawal treatment protocols, and Licensed Practical Nurse Ariel Wenstadt won a clinical award in 2024 for her actions that led to a Food and Drug Administration MedWatch report for a potential look-alike medication.