Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria

Implementation and initial results

Marc Rosenman, Kinga A. Szucs, S. Maria Finnell, Shahid Khokhar, James Egg, Larry Lemmon, David C. Shepherd, Jeff Friedlin, Xiaochun Li, Abel N. Kho

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)S40-S47
JournalInfection Control and Hospital Epidemiology
Volume35
DOIs
StatePublished - Oct 1 2014

Fingerprint

Gram-Negative Bacteria
Microbiology
Infection
Enterobacteriaceae
Hospital Emergency Service
Inpatients
Health Level Seven
Acinetobacter baumannii
Carbapenems
Postal Service
Bronchoalveolar Lavage
Trachea
Sputum
Pseudomonas aeruginosa
Observational Studies
Retrospective Studies
Urine
Delivery of Health Care
Skin
Wounds and Injuries

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria : Implementation and initial results. / Rosenman, Marc; Szucs, Kinga A.; Finnell, S. Maria; Khokhar, Shahid; Egg, James; Lemmon, Larry; Shepherd, David C.; Friedlin, Jeff; Li, Xiaochun; Kho, Abel N.

In: Infection Control and Hospital Epidemiology, Vol. 35, 01.10.2014, p. S40-S47.

Research output: Contribution to journalArticle

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abstract = "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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T2 - Implementation and initial results

AU - Rosenman, Marc

AU - Szucs, Kinga A.

AU - Finnell, S. Maria

AU - Khokhar, Shahid

AU - Egg, James

AU - Lemmon, Larry

AU - Shepherd, David C.

AU - Friedlin, Jeff

AU - Li, Xiaochun

AU - Kho, Abel N.

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