Registry Flags Patients Harboring Drug-Resistant Bacteria

Nancy A. Melville

August 31, 2015

ATLANTA — Healthcare workers have a new tool to help them stop the spread of carbapenem-resistant enterobacteriaceae (CRE).

In Illinois, authorized personnel at healthcare facilities can now access the state's mandated online registry to identify patients who have screened positive for the bacteria. And soon, they will be automatically alerted when a positive patient is being admitted.

The registry will allow personnel to enact appropriate precautions when an infected patient comes in, and will create "a community where people are engaged in the process with a shared objective of preventing the spread of infectious disease," William Trick, MD, from the Cook County Health and Hospitals System in Chicago, told Medscape Medical News.

The research was presented by one of Dr Trick's coauthors, Robert Weinstein, MD, lead principal investigator for the Chicago Centers for Disease Control and Prevention (CDC) Epicenter, here at the International Conference on Emerging Infectious Diseases.

"CRE is a global epidemic of an almost bullet-proof bacteria," Dr Weinstein explained. "It is spread regionally in any area, and in our area, it is amplified by many long-term acute-care hospitals."

 
CRE is a global epidemic of an almost bullet-proof bacteria.
 

The communication of a patient's enterobacteriaceae status is typically made during patient transfers or between healthcare providers. However, patients going home before being admitted to another hospital often slip through the cracks, which can lead to the spread of the dangerous bacteria to a different healthcare setting.

The web-based Extensively Drug-Resistant Organisms registry — launched in November 2013 by the Illinois Department of Public Health and the Chicago CDC Epicenter — is unique. It is believed to be the first such registry in the United States with a bidirectional aspect; it allows authorized infection preventionists at healthcare facilities to make patient-specific queries when a patient is admitted.

Dr Weinstein reported results from the first 17 months of the registry.

Each month, about 60 to 120 patients — from 115 of the state's 182 acute-care hospitals and from long-term acute hospitals, skilled nursing facilities, reference laboratories, and clinics — were entered into the registry.

And each month, the registry received an average of 30 unique facility inquiries about the status of a patient's enterobacteriaceae colonization.

Currently, such queries are generated by the healthcare facility, but a system is being beta-tested at two pilot facilities that will automate notification. At hospital admission, patients will be automatically entered in the registry. If there is a record of a positive screen, the facility will be alerted so that proper precautions can be taken, such as making sure the patient does not share a room or a bathroom and that proper gown and gloves are used by healthcare personnel.

No Hospital Room Sharing, Gowns and Gloves Added

During the first month of the beta test, one hospital reportedly received two notifications that patients being admitted were in the registry. The infection control department was unaware of the colonization status of either patient.

Dr Weinstein shared some early feedback on the automated system. One user reported, "I got a CRE alert on a patient we'd never seen before from a nursing home, and I went to check his transfer notes and nothing is in there — I don't even think the nursing home knows he has CRE."

The user added, "It was very exciting to get this because it was a case we didn't know about."

 
I got a CRE alert on a patient we'd never seen before from a nursing home, and I went to check his transfer notes and nothing is in there.
 

The registry is the result of a collaboration between state and local public health agencies and a nonprofit informatics group called the Medical Research Analytics and Informatics Alliance.

In the future, Dr Trick pointed out, the registry could be used to track other high-risk resistant bacteria, and cluster analysis or whole-genome sequencing could be implemented.

"We don't currently have any initial targets, but certainly as other high-risk bacteria develop and start to spread, we could add them to the list," he said.

Because of the threat of hacking with any healthcare database, security is a top priority.

Security and Privacy Protections

"The registry is restricted to individuals who have gone through security with the Department of Public Health, and all of the data are encrypted," Dr Trick explained. "In addition, we closely monitor all activity on the site, and we don't store social security numbers."

Tennessee is one of the states considering a system similar to the Illinois registry, reported Marion Kainer, MD, MPH, from the Tennessee Department of Health in Nashville.

"In exploring this option for Tennessee," she told Medscape Medical News, the state will likely "take full advantage of the infrastructure that is already in place."

The communicable disease surveillance system that clinicians already use, along with electronic medical records, "would likely be used to populate the registry. Then it would be used in a bidirectional way," she explained.

Although such registries can play an important role, they represent just one part of a bigger challenge.

"I think the Illinois system is a nice add-on in prevention efforts," Dr Kainer said. "But at the moment, the most important thing is to understand what is going on in the community, and communication among facilities is very important."

This registry "is certainly not the only thing we need, but as a communication tool, I do think there may be an important role for this," she added.

Dr Trick reports that he is an uncompensated board member of Medical Research Analytics and Informatics Alliance. Dr Kainer has disclosed no relevant financial relationships.

International Conference of Emerging Infectious Diseases (ICEID). Presented August 25, 2015.

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