Alerts as starting point for hospital infection surveillance and control
Expert systems methodology investigated within the GAMES-II European Union research project was applied in the Hôpital Cantonal Universitaire of Geneva to infection control, and in particular to the control of methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
For detecting MRSA patients, alerts were implemented by periodic queries to the databases of the hospital information system (HIS). Two mechanisms of alerts were established. The ‘lab alert’ is based on recent laboratory results and detects all patients with a positive result for MRSA found the day before. The ‘readmission alert’ identifies patients previously known to have been colonized by or infected with MRSA if and when they are readmitted to the hospital. When useful, alert outputs include guidelines about infection control measures to be taken. Receipt of the alert is the initial step for additional patient data collection by the infection control nurses. These data are being recorded in a patient chart structured to be linked to HIS data.
The ‘lab alert’ detected, in the period from March till end of October 1994, 1415 lab results positive for MRSA corresponding to 307 infected or colonized patients in the hospital, other medical institutions or ambulatory care. The main advantage of this alert lies in improved work organization and efficacy for the infection control nurses.
The ‘readmission alert’ detected 150 admissions of patients previously known to have been colonized by or infected with MRSA over a period from June 9 till October 31, 1994. The 150 admissions corresponded to 107 different patients. Main task of this alert was found in the field of prevention.
Computer alerts using data routinely stored in the HIS were found very useful for several medical tasks, in particular for prevention and work organisation, and as starting point to create an extended computerized patient record. Alerts represent an application of telematic computer technology to improve quality of care and reduce health care costs at low additional computer efforts, and their use should be promoted as starting point for a medical action.
KeywordsInfection Control Nosocomial Infection Hospital Information System Reduce Health Care Cost Nosocomial Bloodstream Infection
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