title: MiBAlert-a new information tool to fight multidrug-resistant bacteria in the hospital setting.
abstract: Although the timely isolation of patients is an essential intervention to limit spread of drug-resistant bacteria, information about the colonization status is often unavailable or lost when patients are readmitted or transferred between hospitals. Therefore, carriers of drug resistant bacteria are not recognized sufficiently early, and proper and timely isolation precautions are not taken. Consequently, resistant bacteria of public health concerns including vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) can spread epidemically. To ensure timely identification and proper isolation of such patients we developed an automatic real-time alert of carriers of drug resistant bacteria.
  
  
  
  The aim of this paper is to describe the system, called MiBAlert, and share the initial experiences in connection with an outbreak of VRE in the greater Copenhagen area (the Capital region), Denmark.
  
  
  
  We obtained data on cases of VRE from hospitals in Copenhagen during the period when the first version of MiBAlert was implemented and log-data on the use of MiBAlert. Furthermore, a survey was conducted among 88 staff members to investigate their experiences of MiBAlert.
  
  
  
  The alert is a tool directed toward healthcare personnel accessing the electronic health record (EHR) and those further involved in the care and treatment of the patient. It is based on a web service using data from the national microbiological database, MiBa. MiBAlert is a real-time electronic non-intrusive alert generated automatically in the header of the EHR each time record is accessed. On February 15, 2015 a pilot version of MiBAlert was launched. All positive tests for VRE throughout 1year were shown with alert status by MiBAlert visible to all medical staff with access to EHR. The alert system was automatically updated directly in the EHR across the five hospitals in the Capital region. We found that the system performed satisfactorily, being operational 24/7 all 135 trial days, apart from 72min, for all the hospitals. Of the staff who responded to the survey, 82% considered that MiBAlert overall improved compliance with isolation precautions regarding VRE-positive patients. We found a marked decline of new patients infected or colonized with VRE concomitant with the implementation of MiBAlert and the survey results.
  
  
  
  We found that MiBAlert was a valuable tool in a bundle approach to counter a multiple hospital outbreak of VRE, and that it has a great potential to improve the control of other drug-resistant bacteria.
authors.affiliation: Herlev and Gentofte Hospital, Department of Clinical, Microbiology, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark. Electronic address: bente.ruth.scharvik.olesen@regionh.dk.
authors.forename: Bente
authors.initials: B
authors.lastname: Olesen
authors.affiliation: Rigshospitalet, University of Copenhagen and Task Force for Prevention of Hospital Infections, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Anhøj
authors.affiliation: The Capital Region of Denmark, CIMT, Centre for IT, Medical Technology and Telephony Services, Denmark.
authors.forename: Kenneth Palle
authors.initials: KP
authors.lastname: Rasmussen
authors.affiliation: Statens Serum Institut, Department of Infectious Disease Epidemiology, Denmark.
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.affiliation: Statens Serum Institut, Department of Infectious Disease Epidemiology, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Voldstedlund
mesh_terms: D056902:Clinical Alarms / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000517:prevention & control*; D003718:Denmark; D018432:Drug Resistance, Multiple; D057286:Electronic Health Records; D016983:Enterococcus / Q000502:physiology; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D020713:Vancomycin Resistance
keywords: Automatic electronic alert EHR; Electronic alert; Electronic alert EHR; MiBAlert; Outbreak VRE; Real-time electronic alert; VRE