TY - JOUR
T1 - Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria
T2 - Implementation and initial results
AU - Rosenman, Marc Brian
AU - Szucs, Kinga A.
AU - Finnell, S. Maria E.
AU - Khokhar, Shahid
AU - Egg, James
AU - Lemmon, Larry
AU - Shepherd, David C.
AU - Friedlin, Jeff
AU - Li, Xiaochun
AU - Kho, Abel N.
N1 - Publisher Copyright:
© 2014 by The Society for Healthcare Epidemiology of America.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - objective. To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.Design. Observational, retrospective study.Setting. Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).Patients. During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO.Methods/Intervention. A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).Results. The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn). conclusions. It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
AB - objective. To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.Design. Observational, retrospective study.Setting. Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).Patients. During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO.Methods/Intervention. A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).Results. The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn). conclusions. It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
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U2 - 10.1086/677833
DO - 10.1086/677833
M3 - Article
C2 - 25222897
AN - SCOPUS:84907998050
SN - 0899-823X
VL - 35
SP - S40-S47
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
ER -