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Nascent Regional System for Alerting Infection Preventionists about Patients with Multidrug-Resistant Gram-Negative Bacteria: Implementation and Initial Results

Published online by Cambridge University Press:  10 May 2016

Marc B. Rosenman ,
Kinga A. Szucs ,
S. Maria E. Finnell ,
Shahid Khokhar ,
James Egg ,
Larry Lemmon ,
David C. Shepherd ,
Jeff Friedlin ,
Xiaochun Li  and
Abel N. Kho
Marc B. Rosenman
Affiliation:
Indiana University School of Medicine, Indianapolis, Indiana Regenstrief Institute, Indianapolis, Indiana
Kinga A. Szucs
Affiliation:
Indiana University School of Medicine, Indianapolis, Indiana
S. Maria E. Finnell
Affiliation:
Indiana University School of Medicine, Indianapolis, Indiana Regenstrief Institute, Indianapolis, Indiana
Shahid Khokhar
Affiliation:
Regenstrief Institute, Indianapolis, Indiana
James Egg
Affiliation:
Regenstrief Institute, Indianapolis, Indiana
Larry Lemmon
Affiliation:
Regenstrief Institute, Indianapolis, Indiana
David C. Shepherd
Affiliation:
Shepherd Internal Medicine, Indianapolis, Indiana
Xiaochun Li
Affiliation:
Indiana University School of Medicine, Indianapolis, Indiana Indiana University School of Public Health, Indianapolis, Indiana
Abel N. Kho
Affiliation:
Regenstrief Institute, Indianapolis, Indiana Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S40 - S47
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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