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The Power of Surveillance

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State mandates and HHS' new five-year infection control initiative could prompt more hospitals to use electronic tools for tracking HAIs.

For decades electronic surveillance has been used to track and capture all types of nefarious characters. From terrorists to Wall Street fund managers, electronic surveillance has proven to be a favorite tool among the various government agencies charged with keeping us safe. What does that have to do with healthcare? Plenty, say those who have begun using the technology to track healthcare-associated infections.

To date only about one-third of U.S. hospitals use an electronic infection control tool, says Scott Pope, PharmD, national director of SafetySurveillor, one such tool, at Premier Inc., in Charlotte, NC. That number will grow, however, as more states implement infection reporting mandates and the Department of Health and Human Services' five-year plan to reduce HAIs gets under way, Pope says.

"It's very exciting that HHS is going to take on this initiative, and technology will certainly play a large role. This is all leading to a point where hospitals are going to see that their existing manual systems of doing infection control surveillance are just not going to be scalable for the future and for what this broader initiative is looking to accomplish," says Pope.

HHS' goal is to gather more complete infection data and provide for more comprehensive dissemination of reporting data as a way to reduce (or eliminate) HAIs in the next five years. While most experts agree elimination may not ever happen, the plan is getting plenty of attention from hospitals looking to reduce their HAI rates. The department also intends to create standard definitions for HAIs to promote interoperability and inter-agency cooperation in the sharing of HAI data.

As it stands, various agencies across HHS house systems and databases containing HAI-related information, each operating as its own silo of information. HHS is proposing that these agencies collaborate to find system integration solutions that will allow them to more reliably gauge national estimates of HAIs.

Marcia Patrick, infection control director for MultiCare Health System in Tacoma, WA, and a board member of the Association for Professionals in Infection Control and Epidemiology Inc. has been using an electronic surveillance/data mining program at three of the system's four hospitals for going on three years and is in the process of bringing the fourth hospital online with the program. She says the results have been astonishing.

"When you are manually trying to track this data," Patrick says, "it's virtually impossible to get a whole-house picture. You have to target high-volume, high-risk areas. For many hospitals, including us, that's usually in the ICU. With MedMined we are able to get data on every nursing unit, which has allowed us to do intervention tailored specifically to those units to reach their infections," she says.

For example, she says when one of the hospitals' large med-surg floors was identified as having a higher than expected urinary tract infection rate, hospital administrators were able to target that area for additional training in the proper administration and care of a catheter line. The program also let her know what those UTIs were costing the hospital, which helped make the $30,000 in start-up costs (total for three hospitals) and $15,000 per month subscription fee much more palatable to the organization's financial department. "What we've been able to realize in savings has paid for all our salaries each year since we started this," she says.

That's not to say that these data mining programs are not without their problems. A big one, says Patrick, is the ability of all of the programs to "talk" to each agency requesting HAI data. "We report to the National Healthcare Safety Network and the Centers for Disease Control. But because of the way each agency has their data set up, our program can't speak directly to NHSN and transfer that same data to the CDC," she says.

The HHS' Centers for Disease Control and Prevention estimates that approximately 1.7 million HAIs occurred in U.S. hospitals in 2002 and were associated with 99,000 deaths. CDC also estimates that HAIs add as much as $20 billion to healthcare costs each year. With numbers like that, it's somewhat surprising that if electronic surveillance of HAIs does what its proponents say it can do, that its use hasn't caught on much more quickly. Even Patrick, who says she wouldn't do her job without it, says she had to lobby for nearly three years to get their current program. If you can spend in the range of $10,000 per hospital to get the program going and $15,000 a month to reduce HAIs by even half, what's the delay?

Kathryn Mackenzie

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