Hospital Monitors Infectious Diseases Using Real-Time Surveillance

Cynthia Johnson, March 17, 2010

The responsibilities of an infection preventionist have never been more daunting. In addition to targeting interventions that protect patients from hospital-acquired infections, an increasing number of states have made reporting them mandatory.

With the Centers for Medicare and Medicaid Services (CMS) refusing to pay for treatment of hospital-acquired infections, it has never been more important to identify them and prevent them from impacting a hospital's bottom line.

If you add pandemic flu outbreaks, bioterrorism responsibilities, and The Joint Commission's National Patient Safety Goals (NPSG) onto the list of responsibilities, then you've got one overworked employee.

Susan Waguespack, RN, is the lone infection preventionist at St. Elizabeth Hospital in Gonzales, LA. She even doubles as the employee health coordinator for the 78-bed facility, which is the smallest of four hospitals in the Franciscan Missionaries of Our Lady of Health System (FMOLHS).

In May 2009, FMOLHS implemented a system manufactured by Milpitis, CA-based Quantros, Inc., to help improve quality, safety, and accreditation standards compliance. Waguespack, who had been requesting a surveillance system for more than a year, welcomed the opportunity to leverage the system's real-time infection surveillance and case management capabilities and abandon her time-consuming and cumbersome paper-based processes.

According to Donna Scott, RN, director of product management for Quantros, Waguespack's only viable option was to embrace the technology. The hospital was not going to provide her with additional staff beyond her part-time clerical assistant. Moreover, she knew her workload would become increasingly onerous as additional regulations came into play.

"I think out of all the facilities, I probably jumped into the system the quickest because I had to," says Waguespack. "I could not do the manual processes anymore."

From paper trail to real-time alerts

Prior to the system, Waguespack's processes were primarily paper-based. She used computerized charting, printouts, and her own custom-made Microsoft Excel spreadsheets. When incidents were found, they were documented on paper.

"Here I am at the end of the month with 50 or 60 individual sheets of paper that I have to compile into a line list to make it easier for me to see if there are any trends or if there's anything that I'm noticing that is out of the ordinary," Waguespack says.

Her processes are now computerized since she started managing them using the IC Insight tool within Quantros. At the end of the month, she now clicks on a spreadsheet to generate a custom report that takes approximately five to 10 minutes. The report contains data that would have taken her days to compile.

Real-time events are also easier to monitor using the system now that the hospital went through the process of developing parameters for prior admissions of patients, who have been in isolation before. For example, if a patient diagnosed with a multi-drug resistant organism (MDRO) re-enters the hospital six months after his or her initial visit, an alert displays on Waguespack's computer, which prompts her to take action.

The consequences of allowing a patient with an MDRO to re-enter a facility instead of being placed in isolation can be quite serious. If the infected patient were readmitted, the infection could spread throughout the hospital. If he or she were placed in a room with a very sick patient, that roommate's condition could be complicated to a point where it could be fatal.

"For me, infection control is definitely the place where we have the biggest opportunity now and we have some of the greatest risk," says Scott. "People getting infections in hospitals when they're already sick—not too good. They're already at a disadvantage."

There are also financial consequences tied to such an occurrence that are hard to quantify. Scott says she is unaware of any research that can put a dollar value on the impact of failing to identify a patient who has been admitted before with a previous resistant organism. As for St. Elizabeth's, Scott says identifying these patients using IC Insight is already saving them money by preventing more infections from occurring due to exposure.

According to Scott, some of Quantros' competitors batch information on MDRO patients once a day. She says that is helpful, but unless vendors can offer facilities real-time surveillance, they're not doing enough because infection preventionists need to respond to these events when they happen—not after.

"The exciting part is that Waguespack never knew about MDROs before and now she's finding every one," says Scott. "Her job is to find stuff before it breaks out, not after the fact."

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