944. Automated Alerts Generated from Illinois’ Extensively Drug Resistant Organism (XDRO) Registry Can Improve Awareness of Carbapenem-Resistant Enterobacteriaceae (CRE) Carriage at the Time of Hospital Admission
Session: Oral Abstract Session: HAI: Surveillance and Reporting
Friday, October 28, 2016: 11:00 AM
Room: 388-390

Background: Healthcare facilities need to know whether a patient is a CRE carrier at the time of admission, to implement timely contact precautions. Illinois’ XDRO registry (xdro.org) is a database of all CRE-colonized patients reported, as required by law, to Illinois Department of Public Health. In this pilot study, we assessed the ability of the registry to send an automated “CRE alert” to infection preventionists (IPs) at healthcare facilities anytime a CRE-reported patient was admitted to their facility.

Methods: We activated CRE alerts in 9 hospitals in the Chicago area during 2015; we assessed outcomes through 4/2016. Hospitals automatically sent name + date of birth (DOB) of all admitted patients to the XDRO registry using an electronic interface. A computer then searched the registry for a “full match” (complete first name + last name + DOB) or “partial match” (first name initial + last name + DOB). Any full or partial match generated an email to designated hospital IPs alerting them of a CRE patient admission. IPs recorded whether the alert identified the correct patient (based on additional information such as address), whether the patient was already known to the IP as CRE-positive, and whether contact precautions were in place for any reason at the time that the IP viewed the alert.

Results: Nine hospitals received CRE alerts for 204 patient admissions (102 unique patients) during 61 total hospital-months, for a mean of 3.3 alerts/month (range 0.0 to 6.6 alerts/mo., Table). Alerts identified the correct person 99% (201/204) of the time; 3 incorrect alerts were partial matches (a single patient), easily recognized as a non-match by the IP. Patients were not known by the IP to be CRE positive in 28% (56/201) of alerts (Figure). The rate of contact precautions at the time of CRE alert was 74% versus only 39% for known versus unknown CRE status, P<0.001.

Conclusion: Hospitals are unaware of the CRE status for 3 of 10 admissions involving a previously reported CRE-positive patient, precluding timely use of contact precautions and highlighting a gap in inter-facility communication. Automated CRE alerts using a public health registry are feasible and accurate, providing actionable information for IPs to apply infection control precautions at the time of admission.

Michael Y. Lin, MD, MPH1, Angela Tang, MPH2, Wei Gao, BS3, Shawn Xiang, MS3, Erica Runningdeer, MSN, MPH, RN2, Onofre Donceras, MS, RN3, Jayne M. Haake, MT(ASCP), CIC4, Jorge P. Parada, MD, MPH5, Deborah B. Pavlak, RN, BSN, CIC6, Barbara Schmitt, RN, BSN1, Elaine Trulis, MS, BSN, RN7, Michael O. Vernon, DrPH8, Sharon F. Welbel, MD1,3, Shane Zelencik, MPH, CIC8, Robert A. Weinstein, MD1,3, William E. Trick, MD1,3 and For the CDC Prevention Epicenter Program, (1)Rush University Medical Center, Chicago, IL, (2)Illinois Department of Public Health, Chicago, IL, (3)Cook County Health and Hospitals System, Chicago, IL, (4)Presence Saint Joseph Medical Center, Joliet, IL, (5)Loyola University Health System, Maywood, IL, (6)Rush Oak Park Hospital, Oak Park, IL, (7)Nursing, Loyola University Medical Center, Maywood, IL, (8)NorthShore University HealthSystem, Evanston, IL

Disclosures:

M. Y. Lin, None

A. Tang, None

W. Gao, None

S. Xiang, None

E. Runningdeer, None

O. Donceras, None

J. M. Haake, None

J. P. Parada, None

D. B. Pavlak, None

B. Schmitt, None

E. Trulis, None

M. O. Vernon, None

S. F. Welbel, None

S. Zelencik, None

R. A. Weinstein, None

W. E. Trick, None

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