TECHNOLOGY
‘The solution to ineffective isolation management could be the deployment of automated electronic infection surveillance systems that can provide real-time updates of information to assist the decision-making process.’
isolation or precautions required throughout the facility. When automated with electronic
surveillance and reporting systems, isolation management strategies can result in fewer empty beds, fewer instances of diverting prospective patients to other hospitals, and shortened LOS for patients. Indeed, isolation management is a good candidate for automation due to the need to gather rapidly changing data from multiple systems, including clinical documentation, laboratory, radiology, pharmacy and admissions. When this information is aggregated in
real-time in a useful way for infection surveillance personnel, communication gaps are closed and real-time information equates to optimal efficiency. Infection preventionists and others are able to make informed decisions using up-to-date status reports that provide information on new and existing patients, as well as those at-risk for needing isolation. Automation can also alert clinicians to
clinical markers indicating that a patient may be developing sepsis or other high- risk condition, allowing for earlier intervention. A prime example of this can be seen
with the intense scrutiny placed on prevention of Clostridium difficile infection. When automated infection surveillance systems are deployed, infection preventionists can spend more time in the day-to-day work of preventing infections in real-time instead of reacting after an infection has already developed. With manual processes, the only way
to identify C. difficile would be to locate at-risk patients by manually identifying and analysing paper-based data. Once a potential patient is identified, a test would need to be ordered and the results later communicated to nursing staff before an isolation determination can be made. Without a method of recognising the need for C. difficile testing in real-time, this process often results in patients being identified after they have already had the potential to pass on the infection. In contrast, a clinical rule can be built
into automated infection surveillance systems to locate patients at risk as soon as they are admitted by flagging medications often prescribed for treatment of C. difficile. Infection surveillance has a proven
track record with C. difficile in a number of facilities in the United States. In a 205-bed community hospital in Bethpage, New York, for example, after deploying infection surveillance technology alongside a solid C. difficile reduction strategy, the hospital realised a 56% decrease in occurrences within six months. An acute care regional referral system
in northeast Alabama demonstrated similar success with this approach, reducing C. difficile to its lowest level since 2004 – 4.1 cases per 10,000 patient days. The data continues to point to a downward trend. Another benefit to automation is that
it can open the door for smaller hospitals, which may lack resources for staff infection preventionists to ramp up
infection surveillance initiatives. By providing comprehensive, real-time information on the status of all isolation patients, automated systems can make it possible for the appropriate staff to accurately and efficiently direct the flow of patients into, and out of, isolation.
Choosing an effective system When it comes to evaluating automated surveillance solutions, a key criterion should be the ability to interface securely with existing systems. This is most commonly found in newer solutions that make use of the latest web-based technologies, which also eliminates the need for the upfront investment into, and installation of, expensive hardware or software. Professionals tasked with choosing an
electronic surveillance system should consider the fact that web-based solutions will reduce the need for IT support, while still allowing easy access to necessary information on all isolated patients, including diagnosis and type of precaution. The most effective systems can be
programmed to monitor clinician orders and test results and automatically alert users to activities that could signal the need to intervene. In tandem with the C. difficile example, clinical rules can be built that allow systems to monitor free text input in association with a chest X-ray and alert the infection prevention specialist whenever the key CDC-defined terms for pneumonia such as infiltrate, consolidation, or cavitation appears, signaling a possible case of pneumonia or tuberculosis. These alerts allow for faster intervention
and isolation, reducing the risk of transmission. The system also allows for more efficient bed flow by accurately identifying cohorting opportunities and reducing instances where beds are needlessly taken out of commission.
Conclusion Automation has the potential to be a powerful tool for proactive infection surveillance. Real-time surveillance to automate isolation management improves patient flow and facilitates rapid interventions. As a result, hospitals can reap the benefits of increased revenues, decreased LOS and improved patient outcomes.
Tom Jordan, RN, BS, is director of Infection Prevention for Sentri7 from Pharmacy OneSource, part of Wolters Kluwer Health. He can be contacted at
tom.jordan@
pharmacyonesource.com
About the author 56 THE CLINICAL SERVICES JOURNAL MARCH 2012
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