The public reporting of healthcare-associated infection (HAI) data and quality improvement collaboratives with focus on HAI reduction and changes in reimbursement schemes have heightened awareness of the importance of infection prevention in preserving hospital revenues and reputation. With increased responsibility for avoiding readmission penalties and non-payment for HAI “never” events, infection prevention (IP) directors/managers must be able to quickly analyze and interpret a huge range of complex data and consistently promote evidence-based behaviors and interventions.
Clinical surveillance programs that combine automated data capture and analysis with unit-specific feedback and partnership with infection control liaison nurses address five operational components critical to meeting the goals of any IP leader. A comprehensive clinical surveillance system:
1. Reduces the time spent gathering data and increases time available to address problems.
Automated surveillance systems can monitor a variety of data feeds, including admission/discharge/transfer, lab, pharmacy, radiology and surgery to identify patients at risk for HAIs or in need of isolation management, and track locations where these infections may have occurred. With much of the time-consuming data aggregation performed in real-time in conjunction with electronic notification of sentinel events, IP leaders can focus their energies on activities that prevent and control HAIs.
2. Eliminates delays in identification of critical issues.
If a patient has a methicillin-resistant Staphylococcus aureus (MRSA) infection, a delay of 24- or 48-hours in identification could have serious consequences for that patient’s health and the well-being of other patients, staff members and visitors. Clinical surveillance programs that utilize automated real-time alerts for patients with multi-drug resistant organisms can initiate prompt isolation and prevent cross-transmission of these pathogens.
3. Allows partnership engagements with infection control liaison nurses to support program initiatives and advance training of clinicians, staff and patients.
The only interventions worth measuring are the ones that are performed consistently and effectively. Without ongoing training, reiteration and reinforcement for clinicians, staff and patients, evidence-based infection prevention initiatives practices may not be adopted and sustained. Many successful programs utilize unit-based infection control liaison nurses to model best practices, reinforce policies and identify areas for additional education. Infection prevention liaison nurses may also educate patients infected with multi-drug resistant organisms (MDRO) such as Clostridium difficile and MRSA or communicable diseases on their role in preventing transmission to others.
4. Assists with the aggregation and reporting of data to support the antimicrobial stewardship (AMS) program.
Many hospitals have initiated an AMS program that monitors antimicrobial agent selection across the institution, patterns of antimicrobial overuse, emerging resistance, bug/drug mismatching and use of best practices for dosing and administration. The IP leader is now perceived as a collaborative partner in the AMS program and can utilize the automated data capture for developing MDRO reports, for creating antibiograms to display susceptibility profiles for specific organisms by specimen source and patient location, and for sharing real-time microbiology data. In addition, a comprehensive clinical surveillance program may report this data to the CDC’s National Healthcare Safety Network as part of the antibiotic utilization and resistance module.
5. Automatically evaluates the impact of interventions on HAI outcome and MDRO data over defined time periods.
Clinical surveillance systems provide the IP leader with standardized and customizable reports to trend HAI outcome and MDRO data against internal or external benchmarks on a monthly, quarterly or annual basis. This automated trending allows for prospective evaluation of deployed infection prevention interventions and early detection of outbreaks.
How are you using clinical surveillance to enhance your infection prevention programs? We’d love to hear your thoughts in the comments below.
1 Thom KA, Li S, Custer M, Preas MA, Rew CD, et al. Successful Implementation of a unit-based quality nurse to reduce central line-associated bloodstream infections. Am J Infect Control. 2014 Feb;42(2):139-43. doi: 10.1016/j.ajic.2013.08.006. Epub 2013 Dec 17.