Reducing Healthcare-Associated Infections using an Infection Control Network

描述(申请人提供)：医疗保健相关感染(HAI)通常由多药耐药生物(MDRO)引起。MDRO是一种与日俱增的流行病，与显著的发病率、死亡率和成本有关。减轻这一流行病的一项基本战略是通过感染控制预防措施防止MDRO的传播。这些措施只有在卫生保健提供者很早就知道患者已知有以前或新的MDRO感染时才能实施。目前，对MDRO的识别是在每家医院独立进行的：提供者手动审查患者记录以了解MDRO的历史。设施之间很少共享信息，识别仅限于设施一级的监测；不存在区域人口监测。没有办法知道呈现病例的患者是否在另一家机构诊断为MDRO。这导致对感染控制预防措施的延迟或未被认识到的需要，使MDRO的传播永久化。需要人口监测以提高对MDRO感染患者的认识，并促进人口水平的研究；需要区域临床决策支持(CDS)以更有效地防止与医疗保健相关的MDRO的传播。使用卫生信息交换(HIE)的生物监测可以填补这些空白。我们的目标是通过创建一个区域电子感染控制网络来减少与医疗保健相关的MDRO。该网络的目标是为HIE中的组织提供监测和CDS，并为人口层面的研究建立一个平台。中心假设是，区域感染控制网络将提高每个机构快速识别MDRO感染和实施预防传播的干预措施的能力。以前的一个项目已经证明了针对MRSA的感染控制网络对减少人类免疫缺陷病毒感染的有效性。我们将在这一成功的基础上开发软件来处理进入我们HIE的微生物学报告，以便1)识别患有7种不同MDRO感染的患者，以及2)实施CDS。我们将评估该网络在减少与医疗保健相关的MDRO方面的准确性和效果，以及它促进人群水平的MDRO感染研究的能力。我们相信这个项目是创新的，因为它利用HIE提供与医疗保健相关的MDRO感染的自动监测，并在多个机构提供CDS。该项目意义重大，因为它通过自动识别与医疗保健相关的MDRO并通过提供CDS警报来确保及时安排感染控制干预措施，从而改进了对HAIS的识别和控制。 公共卫生相关性：拟议的研究与公共卫生相关，因为它寻求改善对医疗保健相关感染的认识和预防，并提高所有美国人的医疗保健的质量、安全、效率和有效性。

DESCRIPTION (provided by applicant): Healthcare-associated infections (HAI) are often caused by multidrug-resistant organisms (MDROs). MDROs are a growing epidemic associated with significant morbidity, mortality, and cost. An essential strategy for mitigating this epidemic is to prevent transmission of MDROs through infection control precautions. These measures can be implemented only if healthcare providers are aware - early on - that a patient is known to have a previous or new MDRO infection. Currently, recognition of MDROs occurs independently at each hospital: providers manually review patient records for a history of MDROs. Information is rarely shared between facilities, and recognition is limited to facility-level surveillance; regional population surveillance does not exist. There is no way to know if a presenting patient had an MDRO diagnosed at another institution. This leads to a delayed or unrecognized need for infection control precautions, perpetuating transmission of MDROs. Population surveillance is needed to improve recognition of patients with MDRO infections and to facilitate population-level studies; regional clinical decision support (CDS) is needed to more effectively prevent transmission of healthcare-associated MDROs. Biosurveillance using a health information exchange (HIE) can fill these gaps. Our goal is to reduce healthcare- associated MDROs by creating a regional electronic infection control network. The objective of this network is to provide surveillance and CDS for organizations in an HIE and establish a platform for population-level studies. The central hypothesis is that a regional infection control network will improve the ability of each institution to quickly identify MDRO infections and to implement interventions to prevent transmission. A previous project has proven the effectiveness of a MRSA-specific infection control network to reduce HAIs. We will build upon this success to develop software to process microbiology reports coming into our HIE in order to 1) identify patients with seven different MDRO infections, and 2) implement CDS. We will evaluate the accuracy and effect of the network in reducing healthcare-associated MDROs, and its ability to facilitate population-level studies of MDRO infections. We believe that this project is innovative because it leverages an HIE to provide automated surveillance of healthcare-associated MDRO infections and deliver CDS across multiple institutions. The project is significant because it improves recognition and control of HAIs by automating identification of healthcare-associated MDROs and by providing CDS alerts to ensure timely ordering of infection control interventions. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it seeks to improve the recognition and prevention of healthcare-associated infections and to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.