Reducing Healthcare-Associated Infections using an Infection Control Network

描述（由申请人提供）：医疗保健相关感染（HAI）通常由多重耐药微生物（MDRO）引起。MDRO是一种日益严重的流行病，与显著的发病率、死亡率和成本相关。缓解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。这些措施只有在医疗保健提供者早期意识到患者已知有既往或新发MDRO感染时才能实施。目前，对MDRO的识别在每家医院独立进行：提供者手动审查患者记录中的MDRO历史。各设施之间很少分享信息，承认仅限于设施一级的监测;不存在区域人口监测。没有办法知道目前的患者是否在另一家机构诊断出MDRO。这导致感染控制预防措施的需求延迟或未被认识到，使MDRO的传播持续下去。需要进行人群监测，以提高对MDRO感染患者的识别，并促进人群水平的研究;需要区域临床决策支持（CDS），以更有效地预防医疗保健相关MDRO的传播。使用卫生信息交换的生物监测可以填补这些空白。我们的目标是通过建立一个区域性的电子感染控制网络来减少医疗保健相关的MDRO。该网络的目标是为HIE组织提供监测和CDS，并建立一个人群水平研究的平台。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感染和实施干预措施以预防传播的能力。以前的一个项目已经证明了MRSA特异性感染控制网络在减少HAI方面的有效性。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7种不同MDRO感染的患者，2）实施CDS。我们将评估该网络在减少医疗保健相关MDRO方面的准确性和效果，以及其促进MDRO感染人群水平研究的能力。我们相信这个项目是创新的，因为它利用HIE提供医疗相关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和提供CDS警报以确保及时订购感染控制干预措施，改善了对HAI的识别和控制。 公共卫生相关性：拟议的研究与公共卫生有关，因为它旨在提高对医疗保健相关感染的认识和预防，并提高所有美国人医疗保健的质量、安全性、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.