title: Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
abstract: OBJECTIVE
  To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.
  
  
  METHODS
  Observational, retrospective study.
  
  
  METHODS
  Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).
  
  
  METHODS
  During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO. METHODS/INTERVENTION: A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).
  
  
  RESULTS
  The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn).
  
  
  CONCLUSIONS
  It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
authors.forename: Kinga A
authors.initials: KA
authors.lastname: Szucs
authors.forename: S Maria E
authors.initials: SM
authors.lastname: Finnell
authors.forename: Shahid
authors.initials: S
authors.lastname: Khokhar
authors.forename: James
authors.initials: J
authors.lastname: Egg
authors.forename: Larry
authors.initials: L
authors.lastname: Lemmon
authors.forename: David C
authors.initials: DC
authors.lastname: Shepherd
authors.forename: Jeff
authors.initials: J
authors.lastname: Friedlin
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Li
authors.forename: Abel N
authors.initials: AN
authors.lastname: Kho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D066275:Health Information Exchange; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult