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Electronic Surveillance is Key to HAI Investigation


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CKM Healthcare

Effective Communication and Collaboration Key to Improved Outcomes

With IPAC Administrator software from CKM Healthcare, a community-based hospital in Southern Ontario was able to quickly identify an outbreak, consolidate and evaluate data, as well as monitor, report and manage an outbreak for continued and improved patient safety.

On Jan. 25, 2010, at approximately 5 p.m., the infection preventionist (IP) on call was notified by the charge nurse from a medical floor that three patients were symptomatic with gastroenteric difficulties. Immediately, all three patients were placed in contact precautions and the unit was closed to further admissions. The index case was a patient whose symptoms had begun six days earlier, on Jan. 19, but since it was only the one patient exhibiting symptoms at the time staff were not overly concerned, attributing this case to something the patient ate. However, between the time the initial case was noted (Jan. 19) and Jan. 29, a total of 13 cases were reported and an outbreak was declared.

Within minutes of declaring the outbreak a line listing of all the symptomatic patients was entered, as suspected cases, in the IPAC Administrator including individual onset time, date and location. Using the IPAC Administrator’s Outbreak Management interface, a case definition was established to provide continuous unit surveillance. The outbreak management team easily created an automated daily epicurve, using the software, showing the number of new cases, as well as a cumulative record of all cases entered. Customized reports were created throughout the outbreak using the IPAC Administrator and distributed electronically via fax and email to the public health department and outbreak management team for their investigation. When two positive cases of norovirus were returned from cultures sent to the public health lab, a norovirus outbreak was confirmed.

While the IPAC Administrator provided ongoing automatic surveillance, control measures implemented by the staff included:

-- Enhanced cleaning of the department with bleach disinfectant

-- Limiting visitors

-- Closely observing healthcare workers (isolation practices and hand hygiene)

-- Staff and patient education

Because each member of the facility’s outbreak management team had access to the IPAC Administrator software, they were able to monitor the outbreak via real-time updates and with the assistance of the IPAC Administrator’s Outbreak Management and Contact Tracing tools, no additional cases were identified and the outbreak was resolved within six days.

The IPAC Administrator’s Outbreak Management tools enable healthcare facilities to automatically receive early warnings of potential outbreaks. Outbreak Line Listings and Epidemic Curves are automatically generated and kept up to date removing duplicate tracking efforts and staff time spent summarizing data results. The software also enables IPs to easily manage all outbreak (pandemic/epidemic/endemic) documentation and protocols including line listings, contact tracing, case definition, costs and control measures. Through the easy-to-use interface, outbreak documentation can be emailed, printed or faxed to provide direct communication to appropriate departments internally as well as off-site, to public health. Another feature of the IPAC Administrator is a real-time lab interface that enables the system to send an e-mail or system alert whenever a predefined threshold or condition (e.g., a positive norovirus culture) is received, enabling the IP to more quickly control an outbreak.

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