For infection preventionists, clinical pharmacists and others charged with managing healthcare associated infections (HAIs), the new legislation poses two challenges: increased reporting requirements and new Medicare financial penalties for hospital readmissions prompted by infections.

How can hospitals meet these challenges? One step is the adoption of computerized infection surveillance systems. They have demonstrated their value in reducing infection rates and improving the workflow of IPs, pharmacists and other clinicians in numerous studies. The effectiveness of the systems prompted the Association for Professionals in Infection Control and Epidemiology (APIC) in 2009 to formally recommend adoption of them.

In a position paper, APIC noted that surveillance of HAIs is a "cornerstone of effective prevention programs," but without automation it consumes large amounts of time and reduces resources available for other patient safety activity. The APIC report found that the software can reduce time spent on surveillance activities (e.g. checking paper records) by up to 65%.

Although various forms of infection surveillance software have been available for at least a decade, only about 25-30% of U.S. hospitals currently have a system in place. As more and more hospitals acquire electronic medical records, this number is expected to increase. While purchasing an EMR is a major capital expense and often requires major workflow changes, adding infection surveillance software is a logical next step that is much less expensive and can significantly ease the workflow of infection control professionals.

Many types of automatic surveillance software programs are available today. Basic versions simply integrate portions of the medical record with laboratory, admission, discharge, transfer (ADT) and treatment information. This integrated record greatly reduced the need for "shoe leather" epidemiology.

More advanced systems now available include query-based data management and/or data mining capabilities. In the former, an IP queries the system usually through standardized menus, to identify certain patients or trends. With data mining, surveillance becomes automatic, as the software uses algorithms to instantly identify emerging patterns, trends or specific patients.

For example, automatic surveillance software can identify new patients who may have influenza or other infectious diseases. It can also enable better antimicrobial stewardship programs (ASPs) by monitoring appropriate drug-bug therapies and potentially inappropriate utilization of antimicrobials within susceptible patient populations.

The software can be programmed to provide event alerts, rate and trending analysis, threshold notification and reports for state public health departments. For example, hospital management can monitor facility infection rates vs. national benchmarks.

Advanced surveillance programs can be used for automated cluster detection, using statistical tools such as analysis of variance. Detailed infection reports can also be generated. For example, the software could be programmed to generate a report listing urinary tract infections caused by e. Coli per 1,000 patient days for certain facilities or floors.

The software also facilitates patient hand-off and helps IPs provide appropriate therapies for key indicators such as creatinine/INR abnormalities, IV/PO use and duplicate medication therapy.

One key advantage of moving to an automated system is the ability to apply IP resources more effectively. In many cases, a hospital’s infection control efforts are focused on an intensive care unit (ICU) or on surgical floors. However, central venous catheters (CVCs) may be in use on other floors as well. Some studies have shown that central line-associated bloodstream infection (CLABSI) rates outside the ICU are as high as the rates inside the ICU. Adoption of surveillance software can enable hospital management to provide effective monitoring of the non-ICU population, resulting in lower overall infection rates.

From a cost standpoint, while it is difficult to break-out the value of surveillance software alone, the benefits of an effective ASP have been widely documented. For example, a 2008 study in Clinical Infectious Diseases found that an effective ASP achieves cost savings by decreased use of inappropriate antibiotics, reduced length-of-stay and reduced antibiotic resistance. It cited a program at a 174-bed community hospital that achieved some $250,000 in overall savings annually.

Drug costs alone represent a substantial opportunity for savings. By one rule of thumb, antibiotic use accounts for approximately 30 percent of an organization’s pharmacy budget and that 50 percent of antibiotics given to patients are being used inappropriately.

The potential savings in drug costs alone was highlighted in a study reported to the Infectious Disease Association of California earlier this year. It found that an ASP started in 2006 at the 280-bed Kaiser Vallejo Hospital, saved $150,000-$300,000 per year in reduced antimicrobial drug costs.

The Kaiser program was a team effort involving pharmacists, physicians and infection preventionists. Initially, infectious disease pharmacists reviewed line listings of patients on antibiotics. In 2008, the team implemented Medici, a clinical pharmacy system developed by our company, Asolva Inc., to scale the success to 20 more hospitals within the healthcare system. Medici’s automated surveillance improved the review process, and facilitated additional reports on outcomes measures.

Hospital leadership may hesitate to add another software program based on fears of taxing an already overloaded IT staff. However, a number of automated surveillance programs are available as SAAS (software as a service). These systems are available over the Internet on a subscription basis, avoiding large upfront costs and the need to reconfigure existing hardware.