Surveillance is not a word regularly used in healthcare facilities. Even many experienced healthcare professionals are not aware that it is a long-established practice and critical daily task in the prevention and control of infectious diseases. Infection prevention and control professionals gather, sort and analyze patient reports to determine which have infections to order to control their spread to others.
However the prevention of these infections in the first place is the desired goal. Extensive "sleuthing" has been required to find the cause of the disease (microbe), how it infects a patient, how it is spread to others, what needs to be done to eliminate it and prevent its return. This is accomplished by painstaking review of laboratory results, patient charts and other medical records.
How do they get this information? Not quickly. They start with a core requirement of microbiology lab results from all admitted patients. In a typical 300 bed hospital, this could easily be several hundred pages of paper daily. Given significant labor constraints, these reports, in various phases of completion, are reviewed for obvious problems first.
Examples include any patients growing a pathogen — a microbe which is known to cause an infection, e.g. the cause of tuberculosis or influenza. Or, more typically seen in a healthcare acquired infection, a patient with a microbe growing where there should be none, e.g. in the blood or in a surgical site. Or, worse case scenario, an infectious disease outbreak. i.e. multiple patients infected with the same organism over a brief time.
The infection control specialist doing this review may have an unusual skill to notice something out of the ordinary, a pattern or trend in the results. And unusual microbes or patterns of test results may be noticed by the laboratory staff, or patient's nurses and MDs. But there is much more in-depth analysis required to find proof of patterns of infections, and their origin.
First, It must be determined if the patient truly has an infection. A documented prescription of antibiotics is not evidence of infection. Charts must be scrutinized for patient history, exposure to others, diagnostic and invasive procedures, treatments and clinical status. Once it's determined that a patient has an infection, the next question must be answered. Did they acquire it as a result of this admission or a previous one? What about during an outpatient visit? If yes, it's now a healthcare associated infection (HAI). Its source must be found, transmission eliminated and preventative measures established.
The advent of lab information systems (LIS) catapulted infectious disease surveillance forward. Personal computers, database, spreadsheet and statistical software packages allowed manual reports to be entered into systems and truly analyzed as data. Even though the analysis was often long after events occurred, patterns and trends could be seen, reports generated and procedures changed to prevent their reoccurrence. And yet, while information technology revolutionized patient and resource flow throughout health systems, infection control was, and still is, being left behind.
Why is it taking so long to catch up? Good question. To start with, infection control and prevention department staff have an extraordinary scope of responsibilities. Every healthcare organization has an infection control program. In the largest medical centers, there may be a staff of six to eight, including a Ph.D. epidemiologist and or an infectious disease physician. In a smaller hospital, this essential mission may be addressed by one person, investigating the infections of 300 occupied beds. But most often, there are far too few to be proactive in their efforts and sadly, there is important work which goes undone.
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Those who find time to read the literature or attend conferences began to hear about the innovators in infection control informatics at WashingtonUniversity, St. Louis or the University of Utah over 10 years ago. But most didn't know how or wouldn't dare ask their IT department to create a complex database and analysis system. But for about four years now, they are hearing from system developers and vendors. (see table)
They've seen demonstrations of infection surveillance technology, and while some have just been too overwhelmed to investigate the variety of products and services available, hundreds of hospitals have now signed up and are automating surveillance. While the opportunities to become informed are many and the desire to acquire surveillance technology is strong, the financial justification is difficult. Infection prevention and control is not a revenue generator. Without this leg to stand on, highly experienced professionals will not make the request for thousands to hundreds of thousands of dollars for these services.
But this technology is here and it is proving to provide an outstanding return on investment because labor savings brought about by automating surveillance are huge. The efficiency of any infection prevention team can be radically improved. But these systems present tremendous opportunities to improve the effectiveness and substantially impact patient outcomes.