Imagine if Holmes had to track down bad guys smaller than the naked eye can see. How hard would that be? How long do you think that might take? That’s why a shoe sole with a hole in it is the epidemiologists’ symbol. It represents "shoe-leather epidemiology," because it can take a lot of footwork to track down the source of an outbreak.

Now imagine that, all during the time Holmes is tracking down these almost-but-invisible bad guys, they relentlessly continue to claim more victims. Time is of the essence when an outbreak strikes. People may be dying while the investigation labors on.

The cost of an outbreak surely can be high in patient morbidity and mortality, but it doesn’t do the hospital’s image or pocketbook any favors either. The sooner the pattern is broken, the happier patients, staff, and administration alike will be. Faster pinpointing of the source of an outbreak makes for a safer patient environment and a healthier bottom line.

Until recently, much of the investigative work was done manually, a tedious and monumentally time-consuming task. Fortunately, technology has stepped up with some solutions for tracking hospital-
acquired infections (HAIs). These tools can make the jobs of infection control professionals easier and use of their time more efficient.

Healthcare Purchasing News talked to a few of the vendors of infection tracking systems and asked them to explain how their product, system, or service works; how it can help infection preventionists (IPs) to identify and analyze outbreaks; how it can help IPs to develop strategies to prevent outbreaks; and what kind of an impact use of their product, system, or service has had on facilities that have used it. Here’s what we found out.

An infection preventionist using MedMined services to review infection rates in real-time at his hospital

MedMined

Description: Patrick Hymel, MD, vice president and general manager of MedMined services for Cardinal Health, Birmingham, AL, described an electronic infection surveillance system that pores through laboratory, pharmacy, and patient movement and demographic data to identify infections across the hospital, as well as post-discharge, flagging anomalies and identifying trends of concern, enabling hospitals to deploy resources at the earliest sign of infection-prevention breakdowns. "If an anomaly is detected," said Hymel, "the system alerts the IP to investigate further."

How it contributes to reduced infections: "Laboratory, pharmacy, admission, discharge, and transfer data are captured and sent to a MedMined services data center where it is standardized and analyzed," said Hymel. Standardizing the data is critical, explained Hymel, because it ensures that accurate comparisons can be made between hospitals or between different units within the same hospital. "Once the data is standardized, it is analyzed through a method known as the nosocomial infection marker (NIM). The NIM provides a high-level view of a hospital’s infection rates and serves as an essential tool for internal and external reporting of HAIs. Users are able to annotate each NIM with additional relevant clinical information." The NIM scorecards generate reports of HAIs by infection type and location, demonstrating the scope of infection control’s impact in improvement efforts throughout the hospital. National and regional benchmarking capabilities allow hospitals to compare infection-prevention performance by unit or hospital-wide to other facilities throughout the country in a fair and severity-adjusted way."

MedMined also provides a financial analysis of each facility to clinical and executive management at least once per year. "Financial reports can compare patients in the same diagnosis-related group and identify the cost differences in treating patients with and without an HAI. The system can also report on the difference in cost to treat each different type of HAI." Cases can be correlated to cost, loss, and length of stay (LOS) to "yield a reliable accounting of HAI costs to executive management, so that intervention costs can be justified on an ongoing basis," said Hymel.

Anecdotal evidence: "One New York hospital, with 2 years of service, had a 42% decline in their hospital-wide HAI rate, which avoided 181 NIMs, 1,101 patient-days, and $868,000 in direct costs," illustrated Hymel. "This translates to a $1.2 million improvement to the bottom line. Another customer, a hospital in Georgia with 3 years of service, had a 23.4% decline in their hospital-wide HAI rate, which avoided 472 NIMs, 5,212 patient-days, and a $3.98 million improvement to the bottom line."

"In a recent internal MedMined services analysis of just under 200 customers with multiple years of using MedMined services, the median decline in HAI rates was 7.5% per year of service (ie, 3 years=22.5% reduction). Across these same facilities, the 95th percentile achieved an average HAI reduction of 53%."

Hymel continued: "MedMined services has been certified by the Healthcare Financial Management Association (HFMA) as producing a significant return on investment (ROI). The service has repeatedly produced a 300% ROI within the first year for hospitals who implement the service. If the hospital doesn’t realize value in MedMined services after the first year, the contract for services may be terminated."

TheraDoc provides single-page access to real-time patient information and alerts

Description: Another high-tech tool for tracking infections is TheraDoc’s Infection Control Assistant and Antibiotic Assistants. Features of TheraDoc’s system include but are not limited to clinical confirmation and documentation to Centers for Disease Control and Prevention (CDC) standards; isolation surveillance and management; real-time alerts to clusters, multidrug-resistant organism (MDRO) readmissions, and surgical-readmissions; radiology report searches; electronic surgical data; electronic data submission to CDC and to states; micro-reporting to clinicians; real-time antimicrobial recommendations, monitoring, and alerts; on-demand antibiograms; patient/disease-specific drug-dosing engine; real-time vaccination alerts; intervention tracking and monitoring with automated reporting.

How it contributes to reduced infections: Scott A. Walker, vice president, strategic development, Salt Lake City, UT, described their system: "The Expert System Platform (ESP) is an interoperability platform that accepts data from a comprehensive array of a hospital’s information systems and departments." TheraDoc’s surveillance system enhances decision making by screening data from sources including but not limited to laboratory, pharmacy, radiology, surgery, and physician notes, to look for situations of potential harm to patients or where interventions can be effective, such as HAIs, antibiotic-resistance patterns, and potential adverse drug events. When these events are identified, clinicians, infection control professionals, and pharmacists are notified, so that they can intervene in the patient’s care to improve clinical and financial outcomes and patient satisfaction."

Walker believes that TheraDoc’s strength is that it works in real time. "If your system is built on a retrospective review of data, it’s like trying to solve current issues through
archeology. Reports should be a by-product of the process of care and not the primary focus in the surveillance, identification, and treatment process. Real-time, actionable data is the key to prevention and management of infectious disease." TheraDoc alerts, reminders, and automated surveillance enable "clinicians to intervene in the patient’s behalf to make a difference now."

TheraDoc’s tools Bed Trace and Patient Trace identify infection clusters, allowing IPs to research and analyze the event, identify and document interventions, and report the outbreak investigation findings to the infection control committee. "Access to a comprehensive collection of data in one streamlined workflow speeds investigations and reduces wasted time hunting and gathering data," stated Walker.

Walker noted that, because "real-time alerts and notifications constantly screen for events of interest to the IP, instances of MDROs are communicated rapidly, patients are automatically flagged as a
methicillin-resistant Staphylococcus aureus (MRSA) or MDRO carrier, and appropriate isolation precautions are assigned," to break the chain of infection. "Without the right information getting to the right person at the right time, the hospital will be unable to make the changes it needs to prevent and manage infections," said Walker.

Anecdotal evidence: Walker noted that IPs who use TheraDoc experience a 30% to 50% efficiency gain. "TheraDoc has had several clients to calculate an ROI post-implementation. These have been calculated with several different methods, but consistently show that within a 12- to 18-month time frame of the project start, they are realizing a net positive return on the technology. A number of these show a return that is not measured in percentages but rather multiples of the cost."

An example of rule results in Sentri7 for possible HAIs
that could appear on an infection preventionist’s dashboard

Description: "Sentri7 is an easy-to-use, high-tech, web-based, software-as-a-service tool that monitors laboratory, microbiology, medication, and patient demographic information in real time," explained Charles Westergard, BSPharm, MBA, vice president of clinical affairs, Sentri7, Bellevue, WA. "Sentri7 can be set up by IPs to identify a myriad of clinical situations that require their intervention." For example, explained Westergard, "A set of parameters can be put into Sentri7 that identifies all patients that have positive blood cultures where the status on the culture is ‘final’ and the organism identified is ‘MRSA.’ This same clinical rule can be set up to display pertinent decision-making data, such as the date of admission (is it a healthcare-acquired condition?) and current antibiotics (are we treating it appropriately?)." The rule, which can be set up in minutes, also can contain a suggested course of action to guide the IP to the appropriate next steps. The system is intended to act as a real-time sentry that looks for any patient matching the conditions of the rule.

How it contributes to reduced infections: One of the functions that Sentri7 performs is to look for patients who did not have a high white blood cell (WBC) count upon admission but whose WBC is rising or currently high, because it is an indicator of infection. "This information, paired with real-time culture results, gives the IP and infectious disease management team the information they need to treat these patients in the timeliest manner," said Westergard. "Sentri7 reporting assists in outbreak detection and management by identifying how often these reportable organisms arise, thus facilitating state and national reporting. The trended data on cultures also allows for detection of outbreaks down to the level of nursing units, giving the IP the data they need to drive change and implement training to reduce infections in the future."

Anecdotal evidence: Westergard related that use of Sentri7 allowed Washington County Hospital, Hagerstown, MD, to restart a robust antimicrobial stewardship program without additional staffing. "The software is a major component to comply with the various elements of performance of NPSG 7.3.1—prevent HAIs," said Christopher Virgilio, PharmD, clinical coordinator, pharmacy services." Westergard added: "Our customers also save money through reduction of antibiotic costs and productivity gains with their staff workflow."

Another Sentri7 client, Thomas Burke, director of pharmacy, St. Mary Medical Center, Langhorne, PA, said: "The reports generated by Sentri7 will save us countless hours needed to build and sort data. By interfacing with multiple clinical systems, Sentri7 will allow the pharmacy and other clinical departments to generate clinical rules that can assist in compliance with Pennsylvania’s Act 52 and other quality measures in real time."

"According to the CDC," pointed out Westergard, "6% of all patient admissions will become infected, and 90,000 will die from the infection. On October 8, 2008, the Centers for Medicare and Medicaid Services stopped reimbursing costs associated with certain HAIs. Zhan and Miller (JAMA 2003;290:1868–1874) reported that each HAI is associated with an increased LOS of 9.58 days and $38,656 in extra charges. Clearly, anecdotal evidence suggests that reducing these expensive events will save money."

Description: According to Cathy Spencer, product marketing manager, clinical applications, 3M Health Information Systems, Salt Lake City, UT, "3M Clintrac Infection Control Manager is a database-driven electronic surveillance system that interfaces with laboratory, pharmacy, and operating room systems to help hospitals track infections using the CDC’s NHSN or custom criteria for infections and comparative benchmarking. The software allows infection control staff to collect, analyze, interpret, and disseminate data regarding a health-related event."

How it contributes to reduced infections: Spencer said that a stand-alone system, without interfaces to other hospital systems, can be deployed initially to support retrospective tracking and trending of infection rates, as well as support state and CDC reporting, but the beauty and power of an automated system is in its ability to aggregate information from a variety of hospital systems for early identification of HAIs.

"The software includes automated alerts, work lists, and patient-review reports, which promote consistent and timely identification and tracking of HAIs," said Spencer. "By enabling rapid access to information on spikes in infection rates, as well as the ability to identify locations of affected patients within the facility, the software helps infection control staff isolate infections. The 3M application also automates the labor-intensive task of assembling case findings and tracking of trends. By promoting early identification of infections, appropriate treatment can be initiated sooner, which helps reduce patient LOS."

The value of reports and benchmarking was emphasized. "Reports may be used to support early identification of infections and comparative analysis to help identify the root cause of infections. For example, the system can generate a report that examines possible links between prior surgical procedures and infection incidents, helping to prevent future infections. Reports also can be used to benchmark infection rates against state and national norms or to support internal analysis of reimbursement rates," noted Spencer.

Anecdotal evidence: "The impact of HAIs on healthcare is significant, both in terms of quality of care and cost," continued Spencer. "For example, the CDC estimates that 126,000 people are hospitalized with MRSA infections each year and about 5,000 die, with MRSA-related costs totaling $4 billion. Electronic surveillance of infection incidents can help hospitals reduce HAI rates, patient mortality, antibiotic overuse and underuse, and patient LOS. Automated systems like 3M Clintrac Infection Control Manager can help hospitals protect patients, healthcare workers, visitors, and others in the healthcare environment in a timely, efficient, and cost-effective manner."

Description: Infection MonitorPro (IMPro) software from rL Solutions, is for hospital infection control practitioners (ICPs) who need or want real-time infection surveillance and control. IMPro is a fully web-based solution that generates reports and infection risk alerts based on automated surveillance of hospital subsystems. IMPro has been refined over 5 years in a clinical setting, with input from experienced infection control experts. It integrates with existing hospital sub-systems. It also offers real-time surveillance of microbiology results. IMPro is designed to help reduce the overall cost of HAIs by helping identify and track patients at risk early.

How it contributes to reduced infections: With IMPro, ICPs spend less time on non-value-add administrative tasks like report creation as well as paper file management and more time on hospital infection prevention and containment. In addition, it can help minimize the impact of infections by responding more rapidly through real-time surveillance; invoke precautions earlier through real-time alerts based on admission data; accelerate infection prevention initiatives by pinpointing problem areas through control charts; answer any infection-related question with just a few clicks – reducing the time needed for investigation and review.

Anecdotal evidence: With the advent of more community-acquired VRE, the Repatriation General Hospital in South Australia relies heavily on IMPro. For example, IMPro alerts the ICP regarding incoming patients with known organisms so that isolation can occur; however, if the VRE microbiology result is returned as a positive while the patient is in the hospital, there may already have been significant prior contact with other patients. What IMPro does is to provide details of where the infected patient has been, and lists all other patients that could have been in contact, so that precautions can be taken. This contact tracing report takes just a few minutes, and is just one way that IMPro helps prevent infection by interpreting existing hospital data sources. IMPro also helps to improve the hospital’s overall efficiency by providing run-sheets to simplify daily follow-ups, and online reporting to allow instant ad-hoc drill-down to answer questions during infection control committee meetings. These have helped the Repatriation General Hospital to achieve zero MRSA HAI for months, compared with almost daily occurrences prior.

Description: Premier Inc.’s SafetySurveillor web-based infection tracking tool is designed to reduce HAIs and optimize antibiotic use to increase patient safety, improve quality of care, and reduce costs. SafetySurveillor protects patients by continuously tracking HAIs and antibiotic use to monitor prevention and control activities. The system helps hospitals meet state-mandated public reporting of certain HAIs, including screening for MRSA and Clostridium difficile, some of the most common and harmful infections found in hospitals today. SafetySurveillor also helps reduce costs in the system through avoiding conditions and additional associated care.

How it contributes to reduced infections: With SafetySurveillor, hospitals can automatically detect HAIs and alert staff, facilitating timely intervention to reduce and prevent infections. The system provides baseline data for trending, reporting, and analysis to learn from experience and improve care. It reduces administrative burden for IPs, allowing them to be more efficient and productive, thus improving care.

Anecdotal evidence: More than 200 hospitals nationwide have chosen the system. SafetySurveillor is one of the HAI surveillance system software vendors participating in a CDC project to develop a standards-based solution for transmission of HAI data from hospitals using existing commercial software systems to the agency’s National Healthcare Safety network.