Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T20:22:35.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System

Published online by Cambridge University Press:  02 January 2015

Didier Pittet ,
Edith Safran ,
Stephan Harbarth ,
François Borst ,
Pascale Copin ,
Peter Rohner ,
Jean-Raoul Scherrer  and
Raymond Auckenthaler
Didier Pittet*
Affiliation:
Infection Control Program, University Hospital of Geneva, Geneva, Switzerland
Edith Safran
Affiliation:
Hospital Information System, University Hospital of Geneva, Geneva, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program, University Hospital of Geneva, Geneva, Switzerland
François Borst
Affiliation:
Hospital Information System, University Hospital of Geneva, Geneva, Switzerland
Pascale Copin
Affiliation:
Infection Control Program, University Hospital of Geneva, Geneva, Switzerland
Peter Rohner
Affiliation:
Clinical Microbiology Laboratory, University Hospital of Geneva, Geneva, Switzerland
Jean-Raoul Scherrer
Affiliation:
Hospital Information System, University Hospital of Geneva, Geneva, Switzerland
Raymond Auckenthaler
Affiliation:
Clinical Microbiology Laboratory, University Hospital of Geneva, Geneva, Switzerland
*
Infection Control Program, Division of Infectious Diseases, Department of Internal Medicine, 24, rue Micheli-du-Crest, University Hospital of Geneva (HCUG), 1211 Geneva 14, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir.

Objective: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates.

Methods: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the “readmission alert,” detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room.

Results: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P<.001).

Conclusions: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission.

Type
From the Fourth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 8 , August 1996 , pp. 496 - 502
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, M. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91:221S–227S.CrossRefGoogle ScholarPubMed
2. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639–642.Google Scholar
3. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.Google ScholarPubMed
4. Voss, A, Milatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.Google Scholar
5. CMJE, Vandenbroucke-Grauls. Control of MRSA in The Netherlands. Proceedings of the fourth CIPI. Nice, France. 1996;S1703. Abstract 70.Google Scholar
6. Struelens, MJ, Mertens, R, le Groupement pour le Dépistage de MRSA. National survey of methicillin-resistant Staphylococcus aureus in Belgian hospitals: detection methods, prevalence trends, and infection control measures. Eur J Clin Microbiol Infect Dis 1994;13:56–63.Google Scholar
7. Comité de rédaction. Staphylocoques dorés résistants à la méti-cilline: situation et enjeux. Swiss Noso 1995;2:25–29.Google Scholar
8. Pittet, D, Francioli, P, von Overbeck, J, Raeber, PA, Ruef, C, Widmer, AF. Infection control in Switzerland. Infect Control Hosp Epidemiol 1995;16:49–56.Google Scholar
9. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.CrossRefGoogle ScholarPubMed
10. Stamm, AM, Long, MN, Belcher, B. Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus . Am J Infect Control 1993;21:70–74.Google Scholar
11. Layton, MC, Hierholzer, WJ, Patterson, JE. The evolving epidemiology of MRSA at a university hospital. Infect Control Hosp Epidemiol 1995;16:12–17.CrossRefGoogle ScholarPubMed
12. Shortliffe, EH. The adolescence of AI in medicine: will the field come of age in the '90s? Art Intelligence Med 1993;5:93–106.Google Scholar
13. Pryor, TA, Gardner, RM, Clayton, PD, Warner, HR. The HELP system. J Med Syst 1983;7:87–102.CrossRefGoogle ScholarPubMed
14. Evans, RS, Larsen, RA, Burke, JP, et al. Computer surveillance of hospital-acquired infections and antibiotic use. JAMA 1986;256:1007–1011.CrossRefGoogle ScholarPubMed
15. Burke, JP, Classen, DC, Pestotnik, SL, Evans, RS, Stevens, LE. The HELP system and its application to infection control. J Hosp Infect 1991;18(suppl):424–431.Google Scholar
16. Evans, RS, Burke, JP, Classen, DC, et al. Computerized identification of patients at high risk for hospital-acquired infection. Am J Infect Control 1992;20:4–10.Google Scholar
17. Haley, RW, Gaynes, RP, Aber, RC, Bennett, JV. Surveillance of nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown and Co; 1992:79–108.Google Scholar
18. Garner, JS, Jarvis, WR, Emori, TG, Toran, TC, Hughes, JM. CDC definition for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
19. Centers for Disease Control. Guidelines for isolation precautions in hospitals. Infect Control 1983;4(suppl):245–325.Google Scholar
20. Harbarth, S, Pittet, D, Copin, P, Alexiou, A, Henry, N, Auckenthaler, R. MRSA carriage and infections after one year of institutionalized infection control without use of systemic antimicrobials for eradication of MRSA colonization. Proceedings of the fourth CIPI. Nice, France. 1996:16. Abstract ICN-AMR.Google Scholar
21. Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar
22. Kloos, WE, Lambe, DW. Staphylococcus. In: Balows, A, Hausler, WJ, Hermann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. Washington, DC: American Society of Microbiology; 1991:222–237.Google Scholar
23. National Committee on Clinical Laboratory Standards. (NCCLS document M2A5). Performance Standard for Antimicrobial Disk Susceptibility Tests. Villanova, PA: NCCLS;1993:14.Google Scholar
24. National Committee on Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Villanova, PA: NCCLS; 1993.Google Scholar
25. Baker, CN, Huang, MB, Tenover, FC. Optimizing testing of methicillin-resistant Staphylococcus species. Diagn Microbiol Infect Dis 1994;19:167–170.Google Scholar
26. Scherrer, JR, Baud, R, Brisebarre, A, et al. A hospital information system in continuous operation and expansion. In: Orthner, HF, Blum, BI, eds. Implementing Healthcare Information Systems. Proceedings of the 10th Symposium on Computer Applications in Medical Care. 1986;100–122. Abstract.Google Scholar
27. Scherrer, JR, Baud, R, de Roulet, D. Moving towards the future design of HIS: a view from the seventies to the end of the nineties, the DIOGENE paradigm. In: Proksch, HU, Dudeck, J, eds. Hospital Information Systems. Amsterdam, The Netherlands: Elsevier Science BV; 1995:347–375.Google Scholar
28. Safran, E, Pittet, D, Borst, F, et al. Alerts as starting point for hospital infection surveillance and control. In: Barahona, P, Stefanelli, M, Wyatt, J, eds. Artificial Intelligence in Medicine. Proceedings of the fifth Conference on Artificial Intelligence in Medicine-Europe, AIME 95. Pavia, Italy; June 25-28, 1995. Berlin, Germany: Springer-Verlag; 1995:165–172.Google Scholar
29. Pittet, D, Wenzel, RP. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177–1184.Google Scholar
30. Boyce, JM. Incidence of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in the United States. Infect Control Hosp Epidemiol 1995;16:19. Abstract.Google Scholar
31. Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
32. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981;71:53–58.CrossRefGoogle ScholarPubMed
33. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.CrossRefGoogle ScholarPubMed
34. Reboli, AC, John, JF Jr, Platt, CG, Cantey, J. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans' Affairs medical center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol 1990;11:291–296.CrossRefGoogle Scholar
35. Cohen, SH, Morita, MM, Bradford, M. A seven-year experience with methicillin-resistant Staphylococcus aureus . Am J Med 1991;91:233S–237S.Google Scholar
36. Jernigan, JA, Titus, MG, Gröschel, DHM, Getchell-White, SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus . Am J Epidemiol 1996;143:496–504.Google Scholar
37. Walsh, TJ, Vlahov, D, Hansen, SL, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus . Infect Control 1987;8:7–14.Google Scholar
38. Rao, N, Jacobs, S, Joyce, L. Cost effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol 1988;9:255–260.CrossRefGoogle Scholar
39. Lugeon, C, Blanc, D, Wenger, A, Francioli, P. Molecular epidemiology of methicillin-resistant Staphylococcus aureus at a low-incidence hospital over a 4-year period. Infect Control Hosp Epidemiol 1995;16:260–267.Google Scholar
40. McDonald, CJ, Hui, SL, Smith, DM, et al. Reminders to physicians from an introspective computer medical record. A two year randomized trial. Ann Intern Med 1984;100:130–138.CrossRefGoogle ScholarPubMed
41. McDonald, CJ, Tierney, WM. Computer-stored medical records. Their future role in medical practice. JAMA 1988;259:3433–3440.Google Scholar
42. Tate, KE, Gardner, RM, Waever, LK. A computerized laboratory alerting system. MD Computing 1990;7:296–301.Google Scholar
43. McDonald, CJ, Tierney, WM, Overhage, JM, Martin, DK, Wilson, GA. The Regenstrief medical record system: 20 years of experience in hospitals, clinics and neighborhood health canters. MD Computing 1992;9:206–17.Google Scholar
44. Evans, RS, Pestotnik, SL, Classen, DC, Burke, JP. Development of an automated antibiotic consultant. MD Computing 1993;10:17–22.Google ScholarPubMed
45. Rind, DM, Safran, C, Philips, RS, et al. Effects of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med 1994;154:1511–1517.Google Scholar
46. Classen, DC, Burke, JP. The computer-based patient record: the role of the hospital epidemiologist. Infect Control Hosp Epidemiol 1995:729–736.Google Scholar
47. Hill, RLR, Duckworth, GL, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988;22:377–384.CrossRefGoogle ScholarPubMed
48. Weems, JJ. A plea from the sole: let's keep the ‘shoe leather’ in healthcare epidemiology. Infect Control Hosp Epidemiol 1996;17:42–43.CrossRefGoogle ScholarPubMed