Posted on October 1, 2015
A call comes into the infection prevention and control office from one of the pulmonologists. The doctor states that she and her colleagues are seeing more fungal isolates from their patients’ bronchoscopy specimens over the last several months. You tell her that you will look into it and keep her up to date with your findings.
Where do you start? First, you want to confirm the diagnosis by verifying that there truly is an increased incidence of fungal isolates from patients undergoing bronchoscopy. Before electronic surveillance technology (EST) systems you had several options, most of which were not optimal. If you kept hard copies of lab results, you could go through all of those slips but you probably did not keep outpatient lab results, so your case finding would be incomplete. Maybe you kept a line list of all patients and isolates – was it handwritten, in a spreadsheet or in a word processor? Another process option was to ask the microbiology department if they could run a report for you from their automated system, if they had one. If not, the case finding was extremely tedious. These methods are cumbersome for data analysis.
With an automated electronic surveillance system, you can do a search request based on organism, organism class, type of specimen, patient location, date ranges, and other selected parameters. Automated surveillance can help obtain useful information from infection control data through a systematic application of medical informatics and technology.1 An EST system should be able to integrate laboratory, pharmacy, electronic health record, and admission/discharge/transfer information and offer the ability to provide automated data collection, event alerts?, data analysis, threshold notification, and a real-time antibiogram.
Back to the fungal isolates. An EST can be used to find inpatients and outpatients who had a bronchoscopy specimen which grew a fungus, including all genus and species. You would need to develop a time frame, including dates before the physician became suspicious. If you have a baseline of cultured fungal isolates and that threshold was not exceeded, you are probably not dealing with an increase. However, utilizing your EST and finding a substantial increase in your fungal isolates, regardless whether they are the same species, should warrant an investigation. What could be different? You could check where the scopes are reprocessed and investigate the processes, including: if the same person is reprocessing the scopes, if there is new equipment, where the scopes are hung, if the workload has increased, and if the inner lumens are kept dry after reprocessing.
This example just one way of how EST can be used to investigate an outbreak and determine if it is real or a pseudo-outbreak. Infection preventionists (IPs) should be able to participate in the evaluation and purchase of this technology. Not only does such a system benefit the IP, but it is also a powerful component of a comprehensive infection prevention program.2
Do you have an EST and are you utilizing it to its fullest potential? What would you like to see in your system that is not currently available?