Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
| Autor: | Rosenman MB; Indiana University School of Medicine, Indianapolis, Indiana., Szucs KA, Finnell SM, Khokhar S, Egg J, Lemmon L, Shepherd DC, Friedlin J, Li X, Kho AN |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2014 Oct; Vol. 35 Suppl 3, pp. S40-7. |
| DOI: | 10.1086/677833 |
| Abstrakt: | 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. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|