2161. Pilot Implementation of a Nationwide Automated Multidrug-Resistant Organism Tracking and Alert System in Veterans Affairs
Session: Poster Abstract Session: Healthcare Epidemiology: HAI Surveillance
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek2018 Poster FINAL.pdf (750.4 kB)
  • Background:

    Regional spread of multidrug-resistant organisms (MDROs), including carbapenem-resistant Enterobacteriaceae (CRE), can occur when carriers present unbeknownst to healthcare facilities and thereby delay appropriate infection control interventions.  Herein, we describe pilot implementation of a novel national system that automatically alerts local facility staff to newly admitted patients with any history of CRE or methicillin-resistant Staphylococcus aureus (MRSA) in VA.

    Methods:

    From 12/2016-11/2017, we implemented the alert system in 10 VA medical centers.  The system continually monitors the VA Corporate Data Warehouse for new facility admissions nationwide among patients with archived CRE and MRSA data.  When such admissions occur, an alert is emailed to Infection Prevention personnel at the local facility.  During implementation, we upgraded to a faster, more accurate report, “MDRO Tracker”, that provided alerts within 4 hours of admission.  We evaluated system utility in three ways: 1) assessing user data and feedback; 2) comparing a dataset identifying all unique patients harboring CRE and MRSA to the subset of patients whose most recent positive result was identified at a different VA facility; and 3) enrolling a convenience sample of CRE and MRSA patients to validate system accuracy and assess whether the new system or existing infrastructure identified the MDRO first. IRB approval was obtained at each site.

    Results:  

    The number of users increased over time and are shown in Figure 1.  User feedback data are shown in Figure 2; 71/256 (28%) responses indicated that alert data were new and/or timely. Of all CRE- and MRSA- positive patients identified during the study period, 11/101 (11%) and 214/2390 (9%), respectively, had positive MDRO results originating from a different VA facility.  Of the 61 CRE and 1720 MRSA patients enrolled by research staff, 21% (n=13) of CRE and 7% (n=71) of MRSA cases were first identified by the automated system. 

    Conclusion:

    This pilot implementation of a novel automated MDRO alert system shows feasibility and potential for substantial utility of such a system.  Further refinement and expanded beta-testing of the system is underway.

    Christopher Pfeiffer, MD, MHS1,2, Makoto Jones, MD, MS3,4, J. Stacey Klutts, Md, PhD5,6, Rachael A. Lee, MD7,8, Holly B. Williams, BA9, Katelyn A. West, BS9, Judith M. Strymish, MD10,11, Nasia Safdar, MD, PhD12,13, Bryan D. Harris, MD, MPH14,15, Michael A. Gelman, MD, PhD16,17, Brooke K. Decker, MD, CIC18,19, Adrienne Murray, PharmD4,20, Nefi Aguilar, MS21 and Martin E. Evans, MD, FIDSA, FSHEA22,23,24, (1)Oregon Health & Science University, Portland, OR, (2)Veterans Affairs Portland Health Care System, Portland, OR, (3)University of Utah School of Medicine, Salt Lake City, UT, (4)VA Salt Lake City Health Care System, Salt Lake City, UT, (5)University of Iowa Carver College of Medicine, Iowa City, IA, (6)Iowa City VA Health Care System, Iowa City, IA, (7)Birmingham VA Medical Center, Birmingham, AL, (8)University of Alabama at Birmingham, Birmingham, AL, (9)VA Portland Health Care System, Portland, OR, (10)VA Boston Healthcare System, West Roxbury, MA, (11)Harvard Medical School, Boston, MA, (12)University of Wisconsin, Madison, WI, (13)William S Middleton Memorial Veterans Hospital, Madison, WI, (14)VA Tennessee Valley Healthcare System, Nashville, TN, (15)Vanderbilt University Medical Center, Nashville, TN, (16)Icahn Mount Sinai School of Medicine, New York, NY, (17)James J Peters Veteran Affairs Medical Center, Bronx, NY, (18)Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, (19)University of Pittsburgh, Pittsburg, PA, (20)University of Utah, Salt Lake City, UT, (21)Va Salt Lake City Health Care System, Salt Lake City, UT, (22)National Infectious Diseases Service, Department of Veterans Affairs, Washington, DC, (23)Lexington Veterans Affairs Medical Center, Lexington, KY, (24)University of Kentucky College of Medicine, Lexington, KY

    Disclosures:

    C. Pfeiffer, None

    M. Jones, None

    J. S. Klutts, None

    R. A. Lee, None

    H. B. Williams, None

    K. A. West, None

    J. M. Strymish, None

    N. Safdar, None

    B. D. Harris, None

    M. A. Gelman, Cepheid: Speaker , Speaking Fee .

    B. K. Decker, None

    A. Murray, None

    N. Aguilar, None

    M. E. Evans, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.