Emphasizing the need for speedy detection of a pattern of HAI, Scott D. Pope, PharmD, product director, SafetySurveillor, Premier Healthcare Alliance, Charlotte, NC, related an experience: "Early identification of clusters and trends can facilitate rapid resolution before a minor issue becomes major. For example: Using SafetySurveillor to complete mandatory state reporting, the director of infection prevention and control at O’Connor Hospital, San Jose, CA (Daughters of Charity Health System), identified a cluster of 8 patients over a 3-month period on 1 patient-care unit with hospital-onset Clostridium difficile. Without SafetySurveillor, it would have been almost impossible to identify cases manually. Most importantly, cluster recognition prompted immediate intervention to prevent further transmission of C difficile. Only 1 case of hospital-acquired C difficile has been reported on the unit since corrective measures were taken."

Stanley L. Pestotnik, MS, RPh, general manager, TheraDoc, Hospira, Salt Lake City, UT, offered another important observation by connecting the dots between tracking HAIs and drug resistance. "The need to track infections goes well beyond the problem of HAIs. It also is vital in the battle against drug-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA), influenza outbreaks such as H1N1, and other infectious diseases. With infection preventionists (IPs) on the front lines, infection-tracking technology such as the TheraDoc Infection Control Assistant is playing an increasingly important role."

The bottom line as to why it is so urgent to track infections was summed up neatly by Frédérique Segond, principal scientist and area manager, Parsing and Semantics, Xerox Research Centre Europe, Grenoble, France: "Monitoring HAIs is important to improve healthcare quality and security. Analyzing the causes helps IPs define corrective measures and preventive actions."

The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality recently released the "National Healthcare Quality Report,"¹ which stated unequivocally that U.S. healthcare quality is suboptimal, with some areas, such as patient safety and HAIs, meriting urgent attention. With all the new technology, techniques, and products, why are HAI rates still rising? One reason may be because there is better reporting now, but there may be other factors at work, too.

Jones, MedMined, said: "We would argue that infection rates may not necessarily be rising; there just has not been a consistent measure of collecting and analyzing clinical data to quantify poor outcomes in the past."

Stinchfield, Children’s Hospitals and Clinics of Minnesota, offered a similar opinion: "Better reporting is very likely part of the reason infection rates are alarmingly high. Better reporting is coming from awareness of the importance of infection prevention in hospitals and dedicating the important resources needed to track, measure, report, and prevent HAIs. Newer technology that allows staff to set computerized parameters around infection monitoring provides alerts earlier. This allows staff to evaluate more closely an infection that could be part of a system problem, whereas previously it may have been thought of as affecting an individual patient. Virtual surveillance systems get us to the same point of identifying and tracking organisms, but they save time from not tracking organisms manually, which allow staff to be out educating about better, safer patient-care processes such as central-line–bundle practices, appropriate antibiotic use, etc."

Segond, Xerox, added: "The variations in HAI rates need to be interpreted with caution regarding patient-safety trends. The characteristics of patients may change over time, eg, numbers of older patients and carriers of chronic diseases have been increasing. All these characteristics are associated with a higher risk of HAI. The monitoring system needs to take all these parameters into consideration." 
 

Premier Inc.’s SafetySurveillor offers online educational modules for physicians and nurses complete with Continuing Medical Education.

Segond explained briefly how tracking HAIs can work for patients’ safety and for staff’s efficiency: "IPs need quantitative indicators to evaluate trends and the emergence of new phenomena, eg, multidrug-resistant bacteria. Detecting these trends faster with this kind of system will allow a more timely response to them. These monitoring activities represent an important workload for IPs, and these tools could significantly reduce the resources required for HAI surveillance and give IPs more time for action plans and prevention measures. They can support the needs of mandatory reporting by standardizing detection methods and automating reports. Surveillance methods based on automatic HAI detection in electronic medical records will considerably reduce the IPs’ workload in data collection. This will allow them to concentrate on infection prevention."

Automated surveillance should have the capability of making IPs’ work more streamlined while improving patient safety, agreed Jones: "The goal of surveillance technology should be to minimize the time and clinical effort required to focus infection-prevention resources to the right place at the right time with the right information. A significant amount of the IP’s time is spent screening for likely cases of HAIs and surveying clinical data to identify relationships between emerging issues that may affect patient safety. These clerical efforts consume time that the IP could spend with the bedside caregivers, sharing valuable expertise on clinical process improvement and providing timely feedback to reinforce practice changes. To implement this approach, a surveillance solution must offer the capability to objectively recognize HAI reduction opportunities at the unit level, as well as housewide. The IP may then act as a facilitator, communicating performance data to the bedside staff and outcomes data to the executive team. Moreover, clinical interventions must be based on objective, timely, and accurate data that can be reliably compared across institutions in a meaningful and accurate way."

Reports generated from automated surveillance systems can help to pinpoint where IPs’ efforts should be focused, which could help administration to see why the infection control program may need more funding. Sometimes you really do need to spend money to make money. Pestotnik, TheraDoc, explained further: "Objective evidence is critical for creating effective infection control programs and gaining buy-in from clinicians, other staff, and executives. Armed with reports that show infection trends and tie specific interventions to reduced infection rates, for example, TheraDoc helps IPs gain acceptance for infection-control efforts. The ability to quantify and communicate the value of IP interventions to hospital executives also will be of enormous importance in helping IPs gain support and resources for infection-control efforts."

Frédérique Segond, principal scientist at the Xerox Research Centre Europe, is coordinator of the 3-year ALADIN project in which medical researchers will use an advanced text-mining tool developed by Xerox to analyze medical records, automatically identifying patients who could be at risk of contracting an HAI.

Some anecdotal evidence as to the practical usefulness of TheraDoc’s Infection Control Assistant was supplied by Pestotnik: "TheraDoc provides comprehensive, easy-to-use tools to help IPs achieve real results." Here are just a few examples:

• IPs at Rhode Island Hospital reduced the time spent at their desks reviewing microbiology and other reports by as much as 50%.

• Johns Hopkins Hospital reduced time spent on bloodstream infection surveillance by 80% and achieved HAI confirmation 50% faster with 98% accuracy.

• Johns Hopkins also improved identification of patients requiring isolation and timeliness of isolation for patients with 11 different multidrug-resistant bacteria and viruses by an average of 72 hours per patient.

• During the 2002 Winter Olympics, TheraDoc was used for rapid detection of disease clusters and agents of bioterrorism in the athletes’ village and surrounding population, helping identify and stem an influenza outbreak. The technology also has been instrumental during the H1N1 outbreak.

Surgical-site infection (SSI) was one of the HAI rates about which particular concern was expressed in the "National Healthcare Quality Report." According to Pope, Premier, SafetySurveillor can help. "Among other interfaces, SafetySurveillor accepts an interface from hospitals’ surgery information systems. This allows users to customize mobile alerts for postoperative patients with possible SSIs, effortlessly perform National Healthcare Safety Network (NHSN) risk stratification, and electronically capture and submit this information to NHSN."

Pope related an experience that illustrates how SafetySurveillor can be used for surgical-event monitoring. "St. Elizabeth Healthcare (KY) expanded its use of SafetySurveillor to include surgical-event monitoring. This incorporated special notification alerts (to e-mail and/or electronic work page) of post-procedure events if there is a readmission, an outpatient visit, a new culture order, or a positive microbiological culture result. This led to a decrease in surgical surveillance by IPs by an average of 3 hours per day and allowed IPs to focus on prevention, to develop new strategies to reduce SSIs, and to implement new screening protocols and other infection control projects. We have the ability to submit data electronically from SafetySurveillor to the NHSN. We can also offer outbound reporting of reportable diseases to public health departments."