July 13, 2010 (New Orleans, Louisiana) — Rapid identification of healthcare-associated infections, using tools such as computerized monitoring systems and aggressive infection control measures, can help stop the spread of drug-resistant bacteria and provide cost savings to hospitals, according to research presented here at the 37th Annual Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).
Two studies presented highlighted the importance of rapid and effective infection monitoring and decontamination in hospitals and the measures necessary for putting "best practices" in infection control into action.
In one study, researchers detailed a successful campaign at Methodist Dallas Medical Center in Texas to stop the spread of drug-resistant Acinetobacter baumannii, which isbecoming increasingly prevalent in healthcare facilities, and can survive for months on wet and dry surfaces. Another study found that hospitals that adopt advanced computer technology for infection monitoring are more likely to implement evidence-based practices that can protect against infections, such as methicillin-resistant Staphylococcus aureus (MRSA) and ventilator-associated pneumonia (VAP).
"If we can identify cases of drug-resistant infection early, we can more easily use rapid response and introduce interventions that can prevent the spread of drug-resistant bacteria," APIC president Cathryn Murphy, PhD, told Medscape Medical News. Dr. Murphy is associate professor, faculty of health services and medicine, at Bond University, in Gold Coast, Australia. "As well as skilled and experienced staff who can recognize the signs and symptoms of infection, the use of integrated automated electronic systems can enable rapid identification of these bugs. Surveillance is a cornerstone of any infection control program, and measures such as automated infection monitoring systems enable infection preventionists to be very efficient," she added.
Drug-resistant A baumannii infection is particularly problematic for hospitals, Dr. Murphy said. Not only can the bacteria survive for extended periods, but the reported mortality from the infection is high — ranging from 8% to as high as 42% for patients in intensive care units (ICUs), she noted.
Infection with this particular drug-resistant bacteria is such a serious issue that APIC will be releasing a special guide on its prevention and control in the next few months, Dr. Murphy announced.
Although outbreaks of A baumannii have been reported to last as long as several months, the clinicians at Methodist were able to stop its spread in 7 weeks, according to the lead researcher, Elizabeth Wallace, MPH, infection preventionist at Methodists Dallas Medical Center.
In late 2009, 4 hospital-acquired cases of A baumannii were identified in a 1-week period at the 515-bed hospital. Three cases were identified in the cardiac care unit; the fourth was in the surgical ICU, Ms. Wallace said during a press conference before the APIC meeting. "It's unusual to see multiple patients with this bug. Based on the similarity in the cases we identified, we launched a full-fledged investigation," she said.
As well as using contact precautions for all patients in the surgical ICU and cardiac care unit, the hospital began to collect surveillance cultures on all patients in the 2 units twice each week and environmental cultures in patient rooms, medical equipment, computers, common areas, such as medication rooms, and ventilation air ducts. All rooms on the units were thoroughly cleaned, and ultraviolet fluorescent powder was used to demonstrate the effectiveness of cleaning before a room was deemed ready for the next patient, Ms. Wallace said.
"What was most important was our collaborative team approach — we had regular meetings with hospital staff, including people in labs, environmental services, and the physical plant department," she said, "so we were able to keep up continued surveillance and keep tabs on transmission."
In another study presented at APIC, researchers at the University of California, Berkeley, conducted a telephone survey of 241 general acute care hospitals about their use of automated infection control surveillance technologies and implementation of evidence-based infection control practices. Fully 80% of all hospitals in California responded to the survey.
One third of these hospitals were using automated surveillance technology to monitor hospital-acquired infections, according to lead researcher Helen Halpin, PhD, professor of health policy at the University of California, Berkeley.
The researchers found that hospitals that used automated surveillance technology were significantly more likely to implement best practices to prevent MRSA and VAP and to use better contact precautions and preventive surgical care infection practices than those that had manual surveillance with paper-based records.
"Automated systems can be a critical component in interpreting and disseminating information about hospital-acquired infections to doctors and nurses on a timely basis, and helping to estimate the scope of infection and its spread and location in a hospital. They also help staff monitor changes over time and determine what prevention control measures are necessary," Dr. Halpin said during a press conference.
Although the research does not conclusively prove that hospitals that use automated systems have lower infection rates, it does suggest that those that use computerized surveillance technology are able to put more prevention strategies in place, Dr. Halpin said.
"These should ultimately reduce the rate of infections," she asserted.
Although the cost of installing and operating an automated infection surveillance system is high, with startup costs ranging from $10,000 to $100,000 and ongoing costs ranging from $30,000 to $90,000 per year, these systems can help hospitals save millions of dollars over time, according to Dr. Halpin. "The return on investment is quite substantial," she said.
Dr. Murphy noted that 20% of APIC member hospitals have adopted automated infection surveillance systems; that number is likely to increase as the benefits of these systems become more widely recognized, she said. "Certainly, automated systems do give infection preventionists more data and let us take earlier and more effective prevention measures."
As well as cost, the staff learning curve associated with these systems may limit their adoption, she said.
Meanwhile, Peter J. Pronovost, MD, PhD, professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland, observes in a commentary in the July 14 issue of JAMA (2010;304:204-205) that the healthcare industry lacks "measurable, achievable, and routine ways to prevent patient harm." In fact, there are often barriers to achieving these ends.
One of these barriers is arrogance, Dr. Pronovost says; physicians can be overconfident about the quality of care they provide and hospital officials can fail to aggressively address problems like hospital-acquired infections.
"It's unconscionable that so many people are dying because of these arrogance barriers," Dr. Pronovost writes. "You can't have arrogance in a model for accountability."
Approximately 100,000 people die from healthcare-associated infections, another 44,000 to 98,000 die of other preventable mistakes, and tens of thousands more die from diagnostic errors or failure to receive recommended therapies, he writes.
"To be accountable for patient harms, healthcare needs valid and transparent measures, knowledge of how often harms are preventable, and interventions and incentives to improve performance," Dr. Pronovost writes. However, "Few patient harms can be accurately measured, or the extent of preventability even known," he acknowledges.
One major success story, he notes, is central-line-associated bloodstream infections, which are not only costly but kill 31,000 patients a year in the United States. Dr. Pronovost introduced a simple checklist for Johns Hopkins intensive care units, which has been adopted by Michigan's hospitals and has virtually eliminated central-line-associated bloodstream infections.
Input from patient care providers other than physicians is also encouraged by Dr. Pronovost, and he calls for public reporting of hospital infection rates.
There is a federal mandate to reduce central-line-associated bloodstream infections by 75% over 3 years, which is the "first quantifiable patient safety goal in the United States," Dr. Pronovost points out.
By holding hospital officials accountable for infection rates, by getting financial incentives from insurers for reducing infections and, when needed, by imposing regulatory sanctions, Dr. Pronovost says, "we can remedy this pandemic and move on to other types of preventable harm."
Ms. Wallace, Dr. Halpin, Dr. Murphy, and Dr. Pronovost have disclosed no relevant financial relationships.
37th Annual Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC): Abstracts 175 and 8-063. Presented July 13, 2010.
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Cite this: Computerized Infection Monitoring and Rapid Control Measures Benefit Patients and Hospitals - Medscape - Jul 13, 2010.
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