Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system

Article Article scientifique Article Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system eng 1996 author Pittet Didier 117792 author Safran Edith 28730 author Harbarth Stéphan Juergen 0000-0002-3551-1025 93885 author Borst François 52752 author Copin P. author Rohner Peter 129742 author Scherrer Jean-Raoul 25226 author Auckenthaler Raymond 23033 496-502 8875292 0899-823X http://www.jstor.org/stable/30141281 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir. OBJECTIVE: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates. METHODS: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the "readmission alert," detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room. RESULTS: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implantation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P <.001). CONCLUSIONS: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission. Cross Infection/ drug therapy/epidemiology/prevention & control Hospital Information Systems Humans Infection Control Methicillin Resistance Staphylococcal Infections/ drug therapy/epidemiology/prevention & control Staphylococcus aureus/drug effects Dewey 616 56 Département de médecine 221 false 526 Epidémiologie et contrôle de la résistance aux antibiotiques 866 251 Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière 330 Infection control and hospital epidemiology 17 8 3dc35caa-9c23-48a7-8786-39351ab447e8 Article Restricted file1.pdf 1689265 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine

Title	Published in	Year	Views	Downloads

Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system	Infection control and hospital epidemiology	1996	562	0
ExPASy: un système expert pour l'analyse de séquences protéiques	Technologie et Santé	1993	354	58
From biopsy to automatic diagnosis	Schweizerische medizinische Wochenschrift	1990	509	0

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Scherrer, Jean-Raoul