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Electronic Surveillance is Key to HAI Investigation


Electronic surveillance is becoming a critical tool in an infection preventionist's arsenal of tools with which to fight healthcare-acquired infections (HAIs). ICT presents the following case studies to highlight the benefits of using informatics in infection prevention and control efforts.


Infection Control Software Facilitates Rapid Analysis and Intervention for Acinetobacter Outbreak

Rhode Island Hospital, a 719-bed facility affiliated with Brown University, has been using infection control software (TheraDoc's Infection Control Assistant™) since 2005 for infection surveillance, investigation, prevention and reporting. In 2006, routine surveillance identified hospital-acquired Acinetobacter isolates in two intensive care units (ICUs). Infection prevention staff responded by researching and confirming the presence of an outbreak and developing an infection control plan. The software, with data interfaces to systems such as laboratory, pharmacy, and patient registration, efficiently obtained data, including unit-specific, real-time antibiograms, resulting in rapid analysis and timely intervention.

Following a suspected increase of Acinetobacter isolates in two ICUs, infection preventionists (IPs) at Rhode Island Hospital developed a case definition using infection control software from TheraDoc to efficiently search all positive Acinetobacter cultures obtained in the previous year. The software’s programmed logic allowed for immediate sorting by first positive isolate and "possible hospital-acquired" isolate (positive growth from a culture obtained more than 48 hours after admission). In contrast, review of microbiology results for a second year (prior to the use of the software) had to be reviewed manually. This time-intensive process included requesting reports from microbiology, reviewing patients for possible hospital-acquired Acinetobacter, and manually creating a line list for analysis.

Data collection and analysis for an eight-month period took just three days using the software. In contrast, manual data collection and analysis for the 12-month period using paper microbiology reports took two weeks. "With TheraDoc, it was a huge benefit to have a repository of data readily available to help us determine if there was a problem," says Kerry Blanchard, MT, CIC, infection preventionist at Rhode Island Hospital.

In addition, the system provided real-time, unit-specific antibiograms to aid the investigation—important since hospital-wide antibiograms, created by the microbiology lab, are only published annually. Antibiogram data were generated and available for analysis within one day, with antibiograms from late 2005 showing increased antibiotic resistance among Acinetobacter isolates in both ICUs.

Armed with data suggesting clonal spread of Acinetobacter, the IPs created an infection control plan, focusing on staff education, compliance with hand hygiene and housekeeping procedures, bathing ICU patients with cutaneous antiseptic agents, and implementing contact precautions. Additional microbiology reports generated by the software updated infection rates and showed the plan’s success.

According to Julie Jefferson, RN, MPH, CIC, director of the department of epidemiology and infection control at Rhode Island Hospital, and clinical assistant professor of community health at the Warren Alpert Medical School of Brown University, the automated system showed that the antibiogram for Acinetobacter in the two ICUs changed during the outbreak. "Access to real-time antibiograms suggested that something new was introduced," Jefferson says. "After the outbreak was over, the antibiogram reverted back to previous sensitivities. With this tool, we demonstrated that the outbreak was most likely caused by a new organism, and that we eliminated it."

This outbreak investigation confirmed that infection control software can be invaluable not only for routine surveillance, but for investigating suspected infection clusters and outbreaks. The software allowed IPs at Rhode Island Hospital to maintain control of key data, rather than having to rely on other departments. As a result, they were able to:

-- Obtain and analyze data in a more time-efficient manner

-- Create real-time antibiograms for specific organisms in specific units

-- Reduce duplication and increase efficiency

In addition, quickly eradicating the outbreak took on added urgency since one of the units was moving to a new location, and the IPs needed to ensure that the new unit was not contaminated. "The TheraDoc system allowed to us to manage the outbreak, which allowed us to keep the move on schedule," Blanchard says, "thus preventing the introduction of Acinetobacter to the new unit."

Jefferson agrees. "We controlled this outbreak in a matter of weeks. Had we been doing it manually without TheraDoc, we wouldn’t have had the quality or quantity of information, and it probably would have taken weeks to months to resolve."

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