title: Impact of electronic surveillance on isolation practices.
abstract: OBJECTIVE
  To assess the impact of an electronic surveillance system on isolation practices and rates of methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  A pre-post test intervention.
  
  
  METHODS
  Inpatient units (except psychiatry and labor and delivery) in 4 New York City hospitals.
  
  
  METHODS
  All patients for whom isolation precautions were indicated, May 2009-December 2011.
  
  
  METHODS
  Trained observers assessed isolation sign postings, availability of isolation carts, and staff use of personal protective equipment (PPE). Infection rates were obtained from the infection control department. Regression analyses were used to examine the association between the surveillance system, infection prevention practices, and MRSA infection rates.
  
  
  RESULTS
  A total of 54,159 isolation days and 7,628 staff opportunities for donning PPE were observed over a 31-month period. Odds of having an appropriate sign posted were significantly higher after intervention than before intervention (odds ratio [OR], 1.10 [95% confidence interval {CI}, 1.01-1.20]). Relative to baseline, postintervention sign posting improved significantly for airborne and droplet precautions but not for contact precautions. Sign posting improved for vancomycin-resistant enterococci (OR, 1.51 [95% CI, 1.23-1.86]; [Formula: see text]), Clostridium difficile (OR, 1.59 [95% CI, 1.27-2.02]; [Formula: see text]), and Acinetobacter baumannii (OR, 1.41 [95% CI, 1.21-1.64]; [Formula: see text]) precautions but not for MRSA precautions (OR, 1.11 [95% CI, 0.89-1.39]; [Formula: see text]). Staff and visitor adherence to PPE remained low throughout the study but improved from 29.1% to 37.0% after the intervention (OR, 1.14 [95% CI, 1.01-1.29]). MRSA infection rates were not significantly different after the intervention.
  
  
  CONCLUSIONS
  An electronic surveillance system resulted in small but statistically significant improvements in isolation practices but no reductions in infection rates over the short term. Such innovations likely require considerable uptake time.
authors.affiliation: Columbia University School of Nursing, New York, New York 10032, USA. ell23@columbia.edu
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
authors.forename: Maryam
authors.initials: M
authors.lastname: Behta
authors.forename: Bevin
authors.initials: B
authors.lastname: Cohen
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Barbara
authors.initials: B
authors.lastname: Ross
authors.forename: Rohit
authors.initials: R
authors.lastname: Chaudhry
authors.forename: David K
authors.initials: DK
authors.lastname: Vawdrey
authors.forename: Katherine
authors.initials: K
authors.lastname: Ellingson
mesh_terms: D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus; D009519:New York City / Q000453:epidemiology; D010356:Patient Isolation / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control