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Electronic Surveillance is Key to HAI Investigation


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Using Informatics for MRSA Containment

In 2008, University Health System, San Antonio, made the decision to partner with bioMérieux to bring the ICNet infection prevention and control platform into its main campus. One of the best examples to illustrate the added efficiency and safety ICNet has brought to UHS is repeat-admission methicillin-resistant Staphylococcus aureus (MRSA) patients. If a previous patient with MRSA is readmitted, this may have been overlooked in the admissions paperwork. The infection preventionist (IP) may not have learned about this for hours, perhaps days. Now, they know immediately and can make sure all proper precautions are implemented.

"Knowing this in real time is incredibly valuable," says Beth Ann Ayala, director of infection prevention for UHS. "Previously, this was next to impossible. Some hospitals try to do this using a tag to the patient’s medical record number so that readmission of a MRSA patient comes up on the admission screen, but that still doesn’t mean the information will reach the IP. Some hospitals actually keep hand-written log books, which are only as good as the staff who perform the hand-written data entry. And some hospitals are starting to screen every patient for MRSA, but they are abandoning all of this historical data that exists in their system because they just can’t find it. It’s also very expensive to screen every admission. I’ve also heard of hospitals hiring 'MRSA nurses' just to track and trace MRSA, but this is incredibly wasteful when so much of the most important data exists within the system."

Aside from the main campus, UHS operates clinics across Bexar County. All lab data from these satellites are pulled into ICNet LabStore database and help inform the IPs when clinic patients are admitted. ICNet provides an automatic tagging process, which is particularly useful when one of its clinics generates a positive MRSA test. When that patient shows up at the hospital – which is not uncommon if they need surgery at the wound site – the IPs know immediately. This is particularly valuable to UHS because it serves as the Bexar County hospital.

ICNet facilitates the management and surveillance of HAIs at a local level, while enabling regional-level surveillance. It uses laboratory-based data, complemented by unit/ward-level surveillance and links to the hospital information system, thus incorporating alert organisms (e.g., MRSA) detected by the laboratory, alert conditions (e.g., wound infection) detected by clinicians, and alert admissions (e.g., MRSA carrier) detected by the hospital information system, into a single, easy-to-use database.

A case is a period of infection-monitoring interest in a patient. If a patient has an open case, new results are added to the existing case; otherwise, a new case is created. The case is closed when an IP decides that the period of monitoring interest has ended. ICNet can achieve significant time-savings on data entry because a patient's demographic details, ADTs (Admission, Discharge, and Transfer), and organisms are downloaded via electronic interface. The infection prevention team specifies the risk factors and associated features to be collected for action and reporting. The program provides customizable early warning alerts of specific admissions or clusters of results prompting action (e.g., screening or isolation). It provides very rapid outbreak reporting and has been demonstrated to achieve significant time-savings on report creation, as ICNet supports on-demand, customizable data and graphical reporting via a customizable dashboard.

"I rely on it. It’s the first thing I look at each morning and it’s very easy to navigate," says Ayala.

Prior to adopting ICNet, the infection prevention staff would have to wait for all reports to be finalized in order to minimize information overload. With ICNet, they now see preliminary reports, which provide an early alert about an infection or outbreak. The infection prevention staff believes that they now know of critical events, such as MRSA infections, at least 24 hours faster than under the old system. This gives them a huge jump on any clusters, allows them to take action much sooner, and has helped change their perception on the floors. Instead of finding out after-the-fact, they now often deliver the news to clinicians on the floors, as well as initiate the solution.

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