Pharmacy OneSource Blog

Lessons Learned from the Largest Fungal Meningitis Outbreak in United States History

Posted on 01/14/15

Infection_Prevention_and_Antimicrobial_Stewardship_–_A_Natural_FitIn 2012, contaminated steroid injections caused the largest fungal meningitis outbreak in United States history, affecting 20 states and resulting in 751 infections and 64 deaths. The management of this healthcare-associated infection (HAI) outbreak required ongoing communication and collaboration with healthcare providers, healthcare facilities and public health departments.

One lesson learned following the outbreak response was the challenge faced by health department officials (HDOs) to readily access patient health information from the electronic health records (EHRs) at these facilities, which prevented the rapid and efficient identification of potential fungal meningitis cases. In the December 2, 2014 issue of the Federal Register¹, the CDC posted a Proposed Data Collections project for public comment and recommendations. One of the project’s goals is to improve HDOs access to EHRs in healthcare facilities during an HAI outbreak investigation. In addition to the study project, the insights from healthcare facility staff will be used to build a toolkit to help state HDOs understand the perspectives and needs of these facilities around issues such as data security and privacy.

This situation raises the question of whether automated surveillance (AS) technology systems could play a supportive role in facilitating the access of HDOs to patient data to aid case finding. Many hospitals have already implemented AS systems to streamline the identification, analysis and reporting of HAIs as well as for data importation to the CDC National Healthcare Safety Network (NHSN) using a clinical document architecture (CDA) format. Allowing HDOs access to AS technology systems that are prospectively aggregating patient data from disparate data sources may offer a solution for rapid and efficient identification of cases during an outbreak event. These systems allow for the design of detection algorithms to alert healthcare professionals regarding patients meeting the trigger criteria. Some AS system vendors offer their customers the ability to easily and rapidly customize the algorithm criteria; a huge benefit when outbreak case definitions are being refined.

In my opinion, AS technology is more agile and adaptable than the EHR for responding to evolving case definitions during an outbreak investigation with the added advantage of electronic alerts, which can be sent over a variety of mediums the moment a new patient qualifies for the case-finding algorithm. This approach would require collaboration with the industry vendor as well as support from the facility information technology (IT) personnel. The CDC could develop a detection algorithm and disseminate it to HDOs with access to AS technology to ensure standardized case-finding during an HAI outbreak situation. I look forward to ongoing discussions on the many opportunities for information technology to promote patient safety and save lives during future outbreak situations.

Keith H. St. John, MT(ASCP), MS, CIC


¹Federal Register, vol.79, No. 231, Tuesday, December 2, 2014, Proposed Data Collections Submitted for Public Comment and Recommendations, pp. 71429-30.

Topics: Sterile Compounding

About the Author

Keith H. St. John, MT(ASCP), MS, CIC has served as an Infection Preventionist for the past 30 years, including over 17 years of managing Infection Prevention and Control programs and personnel at major tertiary teaching institutions that include pediatric as well as adult hospital settings. Keith is a clinical microbiologist by training and is certified in Infection Control & Epidemiology (CIC). Keith’s rich professional experience includes: Past President of the Certification board of Infection Control & Epidemiology (CBIC); publications in medical and infection control journals; presentation at national and regional conferences; and former faculty associate at Temple Dental and Medical School. Mr. St. John is also a former member of APIC’s Governmental Affairs Committee, Education Committee, Practice Guidance Council and Research Foundation. He has served APIC as Chapter President & Board member, Editorial Board and reviewer for AJIC, APIC Text Revision Task Force (x2) and Pharmacy chapter co-author. Keith has been a volunteer member of the United States Pharmacopeia Convention Expert Compounding Committee since 2005, sharing his expertise on the revision of USP Chapter <797>, Pharmaceutical Compounding – Sterile Preparations. In addition to APIC, he is an active member of the Healthcare Infection Society (UK) and the Society for Health Epidemiology of America (SHEA). Keith received his Master’s of Science degree in Clinical Microbiology from Thomas Jefferson University in Philadelphia and his Bachelor of Science degree in Medical Technology from the University of Delaware.