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Electronic Surveillance is Key to HAI Investigation


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Identifying Trends and Investigating Clusters of VRE and LRE Leads to Changes in Policy and Practice

Preventing and controlling infections from multiple-drug-resistant organisms (MDROs) requires timely identification of outbreaks and emerging resistance, as well as antibiotic stewardship and compliance with best practices. Effective hospital-wide surveillance is key. As demonstrated by the experience at Mobile Infirmary Medical Center (MIMC), a 704-bed hospital in Mobile, Ala., the use of technology is essential.

Joyce Roberson, RN, MSN, CIC, was given the responsibility of managing infection control at MIMC in 1979, when manual data entry and analysis for routine surveillance were time consuming and laborious. "I had reams of data but no way to make sense of it all," Roberson reports. "I needed information that I could act on, hospital-wide, in as close to real time as possible."

In 2005, MIMC implemented an automated, electronic surveillance service (CareFusion’s MedMined™ Services, Patient Event Advisor, Data Mining Surveillance Service [DMSS]). Novel data-mining tools and artificial intelligence identify clinically meaningful trends in complex data sets and markers for potential infections.

"The customized alerts inform us right away," Roberson says. "Before, there was always a time lag between when something happened (trends) and when we might be able to identify it – or possibly miss it in the midst of all the data." DMSS provides monthly trends that can include possibly inappropriate antibiotic prescribing. These data-based reports provide actionable information, as well as recommendations for reinforcing evidence-based practices proven to be effective in helping reduce the risk of infection.

MIMC’s laboratory, admission, discharge and transfer data are sent to DMSS around the clock (24/7). NIMS (nosocomial Infection markers scorecards) are updated weekly and provide hospital-wide rates that are unit- and site-specific. Monthly pattern reports can reveal clusters that may have been missed by routine surveillance.

From April 2009 to January 2010 DMSS reports showed continuing increases in patterns associated with vancomycin-resistant Enterococcus (VRE). In January, while investigating the trend, Roberson identified an even bigger problem.

"The antibiograms for cultures identified by DMSS showed that some VRE was also linezolid-resistant," Roberson says. "I asked MedMined™ Services to assist me in developing a report to detect vancomycin and linezolid resistance. That report showed increasing linezolid resistance at our facility." Further investigation using the system showed that from summer 2007 to winter 2009 vancomycin use had doubled and linezolid use had more than tripled.

"Our pharmacy was already stretched to the limit," Roberson says, "but the DMSS data documented the urgent need for a medication utilization evaluation (MUE) for linezolid." The MUE results showed inappropriate use of linezolid by some physicians that was undoubtedly contributing to the increasing resistance to this agent. "To preserve linezolid as an effective antibiotic, it was imperative that inappropriate use be stopped," Roberson adds. The DMSS reports and MUE findings were then sent to the pharmacy and therapeutics and infection control committees.

Based on the DMSS data and recommendations, Roberson reinforced with hospital staff the need for compliance with best practices for infection prevention and control. Particular emphasis was given to the recommendations noted by DMSS and to the patient care areas associated with VRE or LRE clusters.

Based on both DMSS and MUE data, the P&T and infection control committees recommended to the medical staff that linezolid ordering be restricted to infectious disease and critical care specialists. Any other physician ordering the agent would be informed that linezolid could not be used or that an infectious disease consult must be obtained.

The recommended policy change, along with the data, is progressing through the necessary committees for approval and implementation. Initial follow-up data on linezolid usage and VRE and LRE patterns are encouraging, and surveillance continues to help assess the long-term impact of policy and practice changes.

At MIMC the ongoing use of CareFusion’s MedMined™ automated data mining surveillance service helped identify an unsuspected problem with LRE, as well as continuing increases in VRE. Roberson says, "DMSS allows me to conduct timely, effective hospital-wide surveillance without the burden of manual data-entering and traditional analysis. I can now spend more time reinforcing best practices, educating staff and monitoring outcomes."


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