Computer surveillance of hospital-acquired infections: a 25 year update.

Hospital-acquired infections (HAIs) are a significant cause of patient harm and increased healthcare cost. Many states have instituted mandatory hospital-wide reporting of HAIs which will increase the workload of infection preventionists and the Center for Medicare and Medicaid Services is no longer paying hospitals to treat certain HAIs. These competing priorities for increased reporting and prevention have many hospitals worried. Manual surveillance of HAIs cannot provide the speed, accuracy and consistency of computerized surveillance. Computer tools can also improve the speed and accuracy of HAI analysis and reporting. Computerized surveillance for HAIs was implemented at LDS Hospital in 1984, but that system required manual entry of data for analysis and reporting. This paper reports on the current functionality and status of the updated computer system for HAI surveillance, analysis and reporting used at LDS Hospital and the 21 other Intermountain Healthcare hospitals.

Rapid identification of hospitalized patients at high risk for MRSA carriage.

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study, nasal swabs from 153 high-risk patients were tested for MRSA carriage using polymerase chain reaction (PCR) of which 31 (20.3%) were positive compared to 12 of 293 (4.1%, p < 0.001) low-risk patients. The mean interval from admission to availability of PCR test results was 19.2 hours. Computer alerts for patients at high-risk of MRSA carriage were found to be reliable, timely and offer the potential to replace testing all patients. Previous MRSA colonization was the best predictor but other risk factors were needed to increase the sensitivity of the algorithm.

System-wide surveillance for clinical encounters by patients previously identified with MRSA and VRE.

Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have emerged as major infection control problems worldwide. Patients previously infected or colonized with MRSA or VRE need to be identified and often isolated as soon as they visit a health care facility. Infection control personnel usually are not aware when these patients enter their facilities. We developed a system-wide surveillance system to alert infection control personnel when patients with previous MRSA or VRE cultures from LDS Hospital have subsequent clinical encounters at any inpatient or outpatient facility at Intermountain Health Care (IHC). This paper describes this system and includes the results from an initial study on the potential epidemiological benefits provided to help improve patient care. The study found that patients with previous MRSA and VRE had subsequent encounters at 62 different IHC facilities up to 304 miles away from 1 day to over 5 years later. In addition, the new surveillance system was able to alert infection control personnel when ever these patients visited any IHC inpatient or outpatient facility.