Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System

Abstract

BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir.OBJECTIVE: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates. METHODS:The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the "readmission alert," detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room.RESULTS: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P<.001).CONCLUSIONS: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission (Infect Control Hosp Epidemiol 1996;17:496-502).

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

“…Infection control then followed-up with the treating clinicians directly. This intervention reduced the average time to obtaining follow-up cultures from 25 days to 3 days and increased the proportion of MRSA patients recognized at the time of admission from 13% to 40% [9]. Our study had a stronger effect due we believe to the fact that the computer delivered its information about MDRO cases directly to the physician -leaving out the middle step that required infection control to reach the physician manually.…”

“…Computerized alerts notifying infection control of the MRSA status of admitted patients effectively reduced the average time to obtaining follow-up cultures from 25 days to 3 days and increased the proportion of MRSA patients recognized at the time of admission from 13% to 40% [9]. This system computer printed paper alerts to the infection control providers, who could then follow-up with the treating clinicians.…”

Effect of Screening for Methicillin-Resistant Staphylococcus aureus Carriage by Polymerase Chain Reaction on the Duration of Unnecessary Preemptive Contact Isolation

“…3 " 5 Therefore, it is common practice to screen for previous carriers and to place them in preemptive isolation at hospital readmission while awaiting the results of screening. 4 Because of logistical problems, the cost of isolation, patient discomfort, and the potential loss of care, it is desirable to shorten the latency period between screening and reporting of the results. In hospitals where there are insufficient rooms for the isolation or cohorting of MRSA-positive patients, a lower prevalence of presumed MRSA colonization reduces the need to house MRSA carriers with noncarriers in rooms with multiple beds, and thus reduces the risk of transmission.…”

“…Previous MRSA carriers are flagged by a computerized rapid alert system. 4 Our study was conducted in the general internal medicine service, which has 246 acute care beds, 9,249 annual admissions, and an average length of stay of 9.4 days. According to an audit in December 2006,25% of MRSA-positive patients were isolated in single rooms, 24% were in rooms with noncarriers, and 51% were cohorted in rooms with either 2 or 6 beds.…”

Clinical Data Reuse or Secondary Use: Current Status and Potential Future Progress

“…To improve healthcare management and quality, clinical data has already been reused to measure and improve quality [23,24], predict patients length of stay, discharge, readmission, and death [25][26][27][28], and improve infection control [29][30][31]. Data has also been reused for early detection of diseases, pharmacovigilance, and post-market and public health surveillance [32].…”