Healthcare-associated infections (HAIs) are the bane of patients, nurses, infection preventionists, administrators, and everyone involved in the chain of care. With Medicare exerting penalties against facilities for patient readmissions due to HAIs, it's imperative for both the health of patients and the financial health of hospitals that definitive actions are taken.
Every day, nurses work their hardest to lower the occurrences of HAIs such as catheter-associated urinary tract infections (CAUTIs), central line-associated blood stream infections, ventilator-associated events, and surgical site infections. Sometimes they need a little extra help. That's where real-time clinical surveillance technology comes into the picture.
These tools add an extra layer to a hospital's existing electronic health records by providing clinicians with clinical data and predictive analytics. Nurses know in real time what is happening with their patients and who is at risk for an infection-and then act to prevent it.
"Our ability and scope was so much narrower when we were dependent on manual ways of identifying infections," said Beth Goodall, RN, BSN, CIC, epidemiology director for DCH Health System in Tuscaloosa, Ala. "The technology transformed how we're able to do surveillance."
Real-time clinical surveillance tools take algorithms out of clinicians' hands in order to provide more guaranteed accuracy. The systems analyze cultures and when the software spots a trend, it alerts hospital staff to potential patterns. "Healthcare technology for tracking and analyzing potential infections helps provide the clinical evidence or supporting data to justify a process or procedure change," Goodall explained.
In addition to HAIs, the systems track potential outbreaks of communicable diseases. Clinicians can be notified in a timely manner about diseases and conditions the hospital is required to report to the health department and/or the Centers for Disease Control and Prevention.
Craig H. Gilliam, BSMT, CIC, FAPIC, is director of infection prevention and control at St. Jude Children's Research Hospital in Memphis, which also uses real-time monitoring tools. In the past, when isolation precautions were indicated for a particular patient, nurses or infection preventionists had to wait for paper reports. Now they receive alerts for diseases and intervene quicker to set contact precautions. In Tennessee, the health department has noticed that hospitals using this technology are more accurate in their reports, Gilliam said.
Right Drug for the Right Patient
Real-time systems also help with antibiotic stewardship. They can notify clinicians when they are dealing with a drug-resistant organism, prompting the use of different, more effective medications. Healthcare providers are also alerted to bug-drug mismatches, in which a certain antibiotic is not optimal for a certain patient.
Antibiotics can be expensive, and prescribers may be unaware of lower-priced options. The software monitors for high-cost drugs that are used inappropriately and suggests less expensive options that work equally well.
Nurses can also take control and plug in criteria and parameters to find patterns of possible infection in the hospital. They don't have to wait on someone in the laboratory for results. Infection prevention becomes the responsibility of the entire hospital. At St. Jude's, for example, nursing, lab, pharmacy and infection prevention use the software to communicate with each other and interact with patients. "I think it makes us more effective at our jobs," Gilliam commented.
Real-time technology offers data on nursing care quality that can be shared with clinicians. "It allows us to engage the frontline staff," Goodall said. Nurses on the units can be proactive with their patient care when they see patterns of potential infections in the reports.
It's All in the Data
Real-time reporting is crucial because time is of the essence when finding and curbing HAIs. The systems find patterns in microbiological results and instantly provide that information to staff members. Goodall explained, "When healthcare-associated infections are identified early, even slight trends can be utilized in patient safety interventions."
Instant clinical feedback means nurses have necessary data even before they see patients. Infection preventionists have easier access to information on specific HAIs or patient populations that need to be tracked, and can quickly share that knowledge with the frontline nursing staff.
"It has allowed the DCH Epidemiology Department nurses to provide a level of detail with a few clicks on the computer that had not previously been so readily available," Goodall explained.
Goodall and Gilliam acknowledged that some staff members needed a little nudge to trust the systems when they were first introduced. "We were used to doing it one particular way," said Gilliam. "There was reluctance to let go of the thought, 'Well, if it's on paper, it has to be correct'."
St. Jude's tested the software for longer than was probably necessary, to ease staff hesitations. Eventually, earlier detection of infectious diseases, which led to earlier treatments, helped convince staff members.
At DCH Healthcare, some nurses initially did not trust the data provided by the infection surveillance system. "They soon realized it was another performance improvement tool that could improve patient outcomes," Goodall said.
Value to Patient Care
Another advantage of real-time technology is time management. "The documentation is quicker so nurses spend more time with patients," Gilliam explained. Infection preventionists can spend their time and energy actually doing their jobs, rather than being bogged down in paperwork. Nurses did not go into the profession to sit in front of a computer; they chose it for patient care. A key value of these systems is that they improve patient care by allowing nurses to spend more time at the bedside. For example, they can pull data from tablets right in the patient's room, tracking key trends.
Most real-time technology systems set up alerts during the discharge process. Clinicians know what red flags to look for and can avoid potential readmissions by preventing complications. Many of the patients at St. Jude return for outpatient treatments after their hospital stay. Infection preventionists can use the software to continually monitor patients throughout their entire care experience.
Real-time technology can also provide data on the average length of stay for certain diagnoses. Nursing staff can then be notified of ideal times to switch from IV to oral medications and ideal removal times for central lines and catheters, better preparing patients for discharge.
Decreasing HAI rates is the primary purpose of the software. Hospital administrators are well aware of the cost of HAIs. Any available tool to reduce infection rates ultimately saves money and therefore is a solid investment.
Benefits of Proactive Approach
The potential impact of real-time systems can be seen in the data from DCH Health System. When mandatory reporting of HAIs began, the facility had CAUTI rates higher than the national average. After implementing clinical surveillance tools and developing interventions in response to the data, these rates showed significant improvement. Since 2015, the health system's CAUTI rate has been lower than the national average. Its C difficile rate is significantly better than other hospitals, on average, Goodall said.
"DCH was one of the first hospitals in Alabama to utilize this electronic surveillance system, so I have seen the infection prevention advance to a more data-driven program, with expanding scopes and participation in the patient safety arena," Goodall noted.
Gilliam, Goodall and countless other healthcare workers in epidemiology and infection prevention see their fields continually growing and changing. One constant remains. "Prevention is key, and having the ability to be proactive rather than reactive is rewarding," Goodall said.
Danielle Bullen Love is a staff writer. Email her at firstname.lastname@example.org.