Using electronic medical records to increase the efficiency of catheter-associated urinary tract infection surveillance for National Health and Safety Network reporting.

BACKGROUND: Streamlining health care-associated infection surveillance is essential for health care facilities owing to the continuing increases in reporting requirements. METHODS: Stanford Hospital, a 583-bed adult tertiary care center, used their electronic medical record (EMR) to develop an electronic algorithm to reduce the time required to conduct catheter-associated urinary tract infection (CAUTI) surveillance in adults. The algorithm provides inclusion and exclusion criteria, using the National Healthcare Safety Network definitions, for patients with a CAUTI. The algorithm was validated by trained infection preventionists through complete chart review for a random sample of cultures collected during the study period, September 1, 2012, to February 28, 2013. RESULTS: During the study period, a total of 6,379 positive urine cultures were identified. The Stanford Hospital electronic CAUTI algorithm identified 6,101 of these positive cultures (95.64%) as not a CAUTI, 191 (2.99%) as a possible CAUTI requiring further validation, and 87 (1.36%) as a definite CAUTI. Overall, use of the algorithm reduced CAUTI surveillance requirements at Stanford Hospital by 97.01%. CONCLUSIONS: The electronic algorithm proved effective in increasing the efficiency of CAUTI surveillance. The data suggest that CAUTI surveillance using the National Healthcare Safety Network definitions can be fully automated.

The Animal Welfare Act: from enactment to enforcement.

Originally enacted in 1966, the Laboratory Animal Welfare Act has been amended several times and renamed the Animal Welfare Act. Responsibility for administering the Animal Welfare Act was delegated within the United States Department of Agriculture to the Administrator of the Animal and Plant Health Inspection Service, and regulations and standards have been developed to implement the intent of Congress conveyed in the language of the Act. In our opinion, the key to compliance with the Animal Welfare Act and its regulations and standards is to have in place a proactive, progressive Animal Care and Use Program that uses the semiannual inspection and programmatic review process to improve the day-to-day management of the program. Successfully managing the inspection process has taken on new meaning in what has recently become known as the 'Age of Enforcement.' As part of this approach, the Animal and Plant Health Inspection Service made changes to the inspection process and issued an Enhanced Animal Welfare Enforcement Plan, which included the development of an Inspection Requirements Handbook. The Inspection Requirements Handbook provides inspectors with information on conducting inspections and includes as an attachment a flow chart for Enforcement Action Guidance. The chart describes 4 types of actions that may occur as part of the enforcement process and the steps that will be followed if noncompliant items are documented during an inspection.

The effect of public disclosure laws on biomedical research.

The Freedom of Information Act (FOIA) and state 'open-records' laws govern access to records in the possession of federal agencies and state entities, such as public universities. Although these laws are intended to promote 'open government' and to assure the existence of an informed citizenry capable of holding government officials accountable for their decisions, an inherent tension exists between the public's access to information and biomedical research institutions' need to ensure the confidentiality of proprietary records and to protect the personal safety of employees. Recognizing these and other conflicts, the federal FOIA and state public-disclosure laws contain express exemptions to protect sensitive information from disclosure. Although some state open-records laws are modeled after the federal FOIA, important differences exist based on the language used by the state law, court interpretations, and exemptions. Two specific types of exemptions are particularly relevant to research facilities: exemptions for research information and exemptions for personal information. Responding to FOIA and state open-records requests requires knowledge of relevant laws and the involvement of all interested parties to facilitate a coordinated and orderly response.