A Regional Informatics Platform for Coordinated Antibiotic-Resistant Infection Tracking, Alerting, and Prevention.

Clinical Infectious Diseases(2013)

Northwestern Univ | Regenstrief Inst Inc

Cited 19|Views28
Abstract
BACKGROUND We developed and assessed the impact of a patient registry and electronic admission notification system relating to regional antimicrobial resistance (AMR) on regional AMR infection rates over time. We conducted an observational cohort study of all patients identified as infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) on at least 1 occasion by any of 5 healthcare systems between 2003 and 2010. The 5 healthcare systems included 17 hospitals and associated clinics in the Indianapolis, Indiana, region. METHODS We developed and standardized a registry of MRSA and VRE patients and created Web forms that infection preventionists (IPs) used to maintain the lists. We sent e-mail alerts to IPs whenever a patient previously infected or colonized with MRSA or VRE registered for admission to a study hospital from June 2007 through June 2010. RESULTS Over a 3-year period, we delivered 12 748 e-mail alerts on 6270 unique patients to 24 IPs covering 17 hospitals. One in 5 (22%-23%) of all admission alerts was based on data from a healthcare system that was different from the admitting hospital; a few hospitals accounted for most of this crossover among facilities and systems. CONCLUSIONS Regional patient registries identify an important patient cohort with relevant prior antibiotic-resistant infection data from different healthcare institutions. Regional registries can identify trends and interinstitutional movement not otherwise apparent from single institution data. Importantly, electronic alerts can notify of the need to isolate early and to institute other measures to prevent transmission.
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MRSA,VRE,infection control,health information exchange,clinical decision support
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要点】:本文提出并评估了一个区域信息化平台,通过患者注册和电子入院通知系统跟踪、警报和预防抗生素耐药感染,有效降低了区域内的抗生素耐药感染率。

方法】:研究采用观察性队列研究方法,针对2003年至2010年间在印第安纳波利斯地区的5个卫生系统中被识别为至少一次感染或携带甲氧西林耐药金黄色葡萄球菌(MRSA)和/或万古霉素耐药肠球菌(VRE)的所有患者,建立并标准化了MRSA和VRE患者注册表,并使用Web表单由感染预防人员维护列表,同时通过电子邮件向感染预防人员发送警报。

实验】:在3年期间,向17家医院的24名感染预防人员发送了关于6270名独特患者的12,748次电子邮件警报,其中20%-23%的入院警报基于与入院医院不同的卫生系统的数据;少数医院在设施和系统之间的交叉中占主导地位。实验使用的数据集为2003年至2010年间印第安纳波利斯地区5个卫生系统中MRSA和VRE患者的观测数据,结果显示电子警报有效提高了对早期隔离和预防传播措施的认识。