Posted on June 24, 2019
The infection prevention (IP) and control staff is on the front lines of some of the most life-threatening conditions in the hospital. They must simultaneously monitor the patient population, minimize risks for healthcare workers, patients, and visitors, and investigate and prevent infection and potential outbreaks. In addition, they ensure hospital staff is compliant with Antimicrobial Stewardship standards, guidelines, and the hospital’s own protocols.
It’s a high-pressure job that’s only getting harder given the prevalence of healthcare-acquired infections (HAIs), which continue to put a strain on IPs who are spending less time with patients and more time gathering and analyzing data. Consider that each day, one out of 25 hospital patients in the U.S. contracts an HAI, resulting in billions of wasted dollars and an alarming 90,000 deaths annually.
Given the heightened transparency of HAI rates through mandated public reporting, continuing emergence of multi-drug resistant organisms (MDROs), and the trajectory of the patient safety movement, hospitals need high-performing IP programs.
So how do IPs advance programs that deliver outcomes and support quality initiatives, while limiting the time spent collecting, analyzing, and reporting surveillance data?
Wolters Kluwer spoke with 3 infection prevention leaders to better understand the current environment, their pain points, priorities for the future, and how they are navigating increasing clinical demands through surveillance solution Sentri7® combined with their EHRs.
Our expert panel includes:
Question: How has your use of Sentri7 with your EHR evolved since you first implemented the solution?
Answer: Superczynski: “Currently we don’t have anything in our EHR that alerts us to a patient history of multi-drug resistant organisms (MDROs). So Sentri7 is really my go-to system. I have it set up to email me so I can quickly identify someone who needs to be on isolation soon after a patient is admitted.I remember when we first implemented Sentri7 a few years’ back. I was down in the ED and I was getting alerts from Sentri7 and our staff was asking me. ‘How do you know this?’ Since I’m the only IP person at the hospital, it has really helped me stay one step ahead. I’m able to work in different systems, including the EHR, but still get real-time alerts from Sentri7 when there’s something I need to know.”
Answer: Sturgill: “I’ve been with Carilion for 20 years and I’ve seen the evolution of how we use our EHR and Sentri7. When I first started, everything was manual. We would receive a stack of positive culture results and then have to categorize them. We would then visit the units to find the patient’s chart and then decipher a provider’s handwriting. We decided we really needed to automate. So, we made an early investment in an infection control module. That really started our journey electronically. At some point, we needed to replace that module. The timing was right. Pharmacy was looking at Sentri7 for Antimicrobial Stewardship and they knew that there was also an IP capability. It was the right choice and now both departments use the product.”
Answer: Youngs: “We really have come a long way since implementing Sentri7 several years’ back. I am the only IP. At the time, all I had was paper. I would get cultures and lab reports and sensitivity data every day. If I fell behind, I would get a days’ or a week’s worth of results to go through to determine if a patient had an HAI or not. It was just way too much for one person. For our medium-sized hospital, that was 50-60 cultures every day. In addition to reviewing the results, I’d have to look in on patients to determine whether the infection was an HAI, whether it was significant, or whether a cluster was going on.
We have a different EHR now, but at the time we made our selection, that system only allowed me to only pull lists. It was not a simple process to get what I needed from IT and then I still had mountains of paper to get through. I wanted autonomy. When I’m in the middle of a project or it’s 4 in the afternoon and I need to get something done, I don’t want to have to call somebody to write a rule and then wait three days for it to be done. That was one of the primary drivers for purchasing Sentri7. Once we implemented, the systems really worked well together. The EHR provides the culture results, patients’ surgical information, and other health data, and Sentri7 aggregates it and delivers the alerts.”
Question: How is Sentri7’s analytics helping make an impact?
Answer: Superczynski: “Sentri7 really does have so much in the way of data and analytics. We’re now able to report on Days of Therapy and other key metrics that help us effect change and decrease antibiotic usage. Our Antimicrobial Stewardship Committee is now looking at the data to see how we’re tracking over time. And we’re even able to impact individual provider behavior so they can see how they’re prescribing relative to their peers. It’s really powerful when you can compare one provider against another. It makes the data more personal, which can be much more effective in trying to positively impact change.”
Question: Studies show that IPs spend an average of more than 5 hours per day completing NHSN reporting tasks. That means less time with patients. How does Sentri7 change that dynamic for you as an IP?
Answer: Superczynski: “Sentri7 streamlines my work and really frees my time to tackle problems as opposed to spending time going through charts and looking for information. It’s helping me make the right decisions – identifying patients at risk, knowing who should be on isolation, even determining a patient who is not on the proper treatment based on culture results. There have been multiple times when the system has alerted me that a patient has a history of MDRO. Even when I don’t have final culture results, I’m able to determine whether a patient should be on isolation based on history or whether the antibiotic is going to cover the type of infection the patient has. That’s a powerful capability.”
Answer: Sturgill: “The Wolters Kluwer team has been really responsive to our needs and has developed some of the things we were requesting that were manual and time consuming. For example, in the state of Virginia – like all states – we must submit reportable diseases to our state health authority. We were filling out a form manually and submitting to the state via fax. The product team helped us build a reportable diseases list in Sentri7 so we could pull the list of positive results electronically. Now, we don’t have to rely on the lab to give us the list of positive results. We can also catch more reportable diseases and report to our local health department in a more-timely manner.”
Question: How do keep pace with changes in evidence and incorporating those into your rules?
Answer: Sturgill: “Actually, it’s been quite a few years since we’ve updated our rules. It’s even harder for us to standardize across the facilities in our health system so everyone is getting and acting on the same information. We’re now implementing the standardized rules set up in Sentr7 so we have that consistency. We’re expecting to see more in our dashboard once we implement, but moving forward, we’ll know we’re all standardized and that the rules will automatically update as evidence changes.”