IT in Infection Prevention

This presentation was presented at Apollo International Forum on Infection Control (AIFIC’ 2013), Chennai

The presentation is solely meant for Academic purpose

INFORMATION TECHNOLOGY

IN INFECTION CONTROL

© 2010. All rights reserved.

A New world. New Occurrences. New Interventions.


Infections: Heeding the call

At any time, over 1.4 million people are suffering from HAI worldwide (WHO figures, 2006).

One third of healthcare acquired infections are preventable1

One in 10 patients in an acute healthcare setting have HAI’s. (15-50% in ICUs*).

ALOS of a patient who acquired infection in the hospital is 2.5 times more than those who have not

Patients with Hospital acquired infections cost 6 time more to treat than those who have not

1 - http://www.cdc.gov/ncidod/eid/vol4no3/weinstein.htm

http://www.cdc.gov/ncidod/eid/vol4no3/weinstein.htm


32 percent of all healthcare-associated infection are urinary tract infections

22 percent are surgical site infections

15 percent are pneumonia

14 percent are bloodstream infections

Infections: Heeding the call


Prevalence of HAI

Developed countries

Developing countries

Almost twice as high as in developed countries


13 Million people die across the

globe every year due to

environment-related causes.


In US, HAI is one of the top 10 causes of death.

INDIA?


Infections- The Outcomes

Delayed patient discharge/ blocked beds

Increased ALOS Patient mortality and morbidity Increased treatment cost Increased infection control cost Subject to litigation

Socio economic costs


Overuse of antibiotics leads to development of resistant strains.

On date more than 70% of bacteria have developed resistance.

Such is the speed of mutation that a drug needs to be in prescription for just 12 months for resistant strains to develop.

Infections- The Urgency of the Call


It takes 6 years to develop a new antibiotic.

The only hope is………

PREVENTION & CONTROL OF INFECTIONS


A call for the nation

Nation wide surveillance

Robust infection prevention & control training/ certification programs

Sharing best practices across


Program Leadership & Coordination Focus of the Program Education of the staff Integration of the program with Quality Improvement & Patient Safety Unlocking the value of Clinical Information Technology

Identifying the big Challenges


Program Leadership & Coordination

Infection Prevention & Control Committee

Infection Control Team based on size

and complexity of the organization Program based on current scientific

guidelines like WHO, CDC Adequate resources provided by the

leaders


Focus of the Program

Infection Control Plan which includes all the departments

Systems to track & investigate outbreaks of infectious diseases Risk reduction goals & measurable

objectives are established Isolation Procedures Barrier Techniques & Hand Hygiene Surveillance

Respiratory tract infections Urinary tract infections Intravascular invasive device related infections Surgical site infections Highly virulent infections Emerging or re-emerging infections with the community


Infection Prevention at Apollo

Focused Program, Committee, Team, Manual (SOP’s)

Regular Newsletter

Hand wash facilities at a minimum distance to encourage hand washing

Alcohol rub dispensers at every bed side Well identified processes to prevent infections and

surveillance of these processes done regularly (Kitchen/ Laundry/ Ward/ICU)

Clean and Dirty Utility in each patient care area,

Negative pressure room for communicable disease patients

Continuous training and daily rounds by Infection

Control Team

Infection Control during renovation

Waste management

Infection control tracers


Education about the Program

Periodic staff education in response to significant trends in infection data

Staff Vaccinations

Education to patient, families and visitors

Performance

Potential

Skill & Will

Appraisal Management

Competency Matrix Corporate Database

Employee Database Referral Doctor’s

Database

Operations and Ancillary Functions –

Registration, Admissions, transfers,

Housekeeping, F&B, CSSD

Clinical Support Systems

Radiology, Laboratory, PACS,

Wards, OT

Doctor’s Module

EMR

CRM

Patient Relationship Mgmt

Disease Management

Patient Retention

Calls / Query Management

Credentialing

& Privileging

Customer Cycle Employee Cycle

Patient Relationship Management Sales Management

Marketing Management Call Management Claims Processing Quotation Management Web Interface

Recruitment Management Appraisal Management

Payroll & Benefits Time attendance & Leave Training Organization Management

Exit Management Employee Self Services

Duty Roasters

Scheduler

Apollo’s Clinical Information Technology – Integrated Enterprise

Monitoring and Tracking of

Infections in the Hospital

Audit & Surveillance Activities for

Infection prevention

Monitoring and Analyzing the

Usage of Restricted

Antibiotics/Drugs

Hospital Hygiene Monitoring

Formulation Of Policies and guidelines

Outbreak Management

MedMantra’s Infection Control Solution


Surveillance

Significant manual data assessment and entry

Assess preventative actions such as isolation of patients

Formic Fusion

PATIENT SAFETY

FOLLOW UP

CORRECTIVE MEASURES

IN TIME

DATA SHARING FORMAT

SSURVEILLANCE DATA

• UNIT DOCTOR

ICN

• SISTER IN CHARGE

BEDSIDE SISTER • ANCILLARY

SERVICES

FOR ACTION

Sample Tool used for analysis

• For identified projects as per risk assessments and data, we use tools like Fish Bone embedded into our systems. We enter the data and the causes and they are prioritized. This helps us to get a better picture of the causes.


Sample Dashboard for data collection – Ward/ ICU level

Infection Prevention & Control, Surveillance & reporting Ventilator Associated Pneumonia - Sample

VAP- Pneumonia that occurs in a patient who was intubated and ventilated at the time of or within48 hours before the onset of

the pneumonia. Or If the Pneumonia develops in a patient within 48 hours of discharge from a location, indicate the

discharging location on the infection report, not the current location of the patient. It is calculated as (Total no. of VAP cases/

No. of ventilator days) x 1000

Long term cases especially ESRD [End Stage Renal Diseases] , oncology patients were

admitted in the month of Apr11, Jul 11, Jan & Feb12. Education of Nurses for care of

Neutropenic patients, craniotomy cases and patients of ESRD on ventilator was done. Rise in

VAP was attributed to the Profile of cases in MICU, SICU, and NICU . We follow a Green Star

Program for VAP which is a visual dashboard to see the infections. We are also following

bundles to ensure that we take maximum precautions for reduction of infections. Infection

rates also depend on the type and mix of patients.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

De

vis

ed

Da

ys

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12

Ventilator Associated Pneumonias 0.00 2.90 2.68 4.12 0.00 0.00 2.49 0.00 0.00 0.00 0.00 0.00 2.33 4.98

Benchmark 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16 4.16

Mean 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39 1.39

UCL 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9

LCL 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VAP/1000 DD

Benchmark : 4.16 DD Reference: National Healthcare Safety Network Desirable: <4.99 DD Acceptable : 5.00 - 6.99 DD


Integration of the program with Quality Improvement & Patient Safety

Tracking infection risks, rates, and trends in healthcare associated infections

Focus on infection related issues that

are epidemiologically important Comparison of the rates with other

organizations through comparative databases

Communication of the results to the

staff including clinicians

Reporting to public health agencies


Improved Clinical Outcomes

Follow VAP, Central Line Bundle CAUTI

and Sepsis Bundle in the hospital which has shown good results

Hand washing stressed upon and continuous data monitoring

Reduction in duration of hospital stay (The average length of stay For Acute Stroke reduced from 11 days to 4.5 days)

Stroke ALOS

2009

2012

11 days

4.5 days

Stroke ALOS reduced by 4.2%


Hand Washing Compliance (%)

2009 2010

20

40

60

80

77 81

Increased in 2012 by 5.9%

VAP Rate (%)

2011

1.0

1.5

2.0

2.5

1.83

2.21

Increased in 2012 by 21%

2012

2011

1.0

1.5

2.0

1.5 1.47

2012

Mortality (%)

Decreased in 2012 by 2%

2011 2012

100

86 91

SAMPLE ANALYTICAL REPORTS PROVIDED BY IT

Operational workflows @ Work


Upon admission of an infectious patient, necessary flagging and data capture occurs in the eco-system

Flagging…


In case a patient acquires infection during the stay, the same gets registered

Registering HAI occurrences


VENTILATOR ASSOCIATED PNEUMONIA

- Plum Infiltrate on X-ray Chest - Purulent Tracheal secretion - Early Onset VAP - Late Onset of VAP - Temp. of >38.5 or < 36.5 F - TLC > 1100 or < 4000 - Reduction in PaO2 / FIO2 over the last 48 hours

CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION

Fever Central Line pus formation Positive culture of Peripheral And Central Blood culture Count less than 1100 or more than 4000 Redness

CATHETER ASSOCIATED URINARY TRACT INFECTION

Fever Gross turbid Urine Positive Culture Isolates TLC increase

SURGICAL SITE INFECTION

Purulent drainage Positive Culture Isolates Pain / tenderness Swelling Redness / Heat

OTHER HAI

Bed sores Cellulitis IV Extra Vasation Peg Site Open case of TB MDRO


Granularity of capture


Dashboard…


Alerts

Interactions

Warnings

Dosages

Drug Database @ Work

HIPaR Drug Knowledge

base

HIPaR Knowledgebase Administration

Console

MedMantra

Cloud

Request API (I/P) Response API (O/P)

Drug Interactions Functional

Layer

API/Web Service Layer

Apollo Health City, Hyderabad

HIPaR Patient SafetyShield™ Cloud System

Patients Profiles DB

Hospital Staff

Doctor

Patient

Person

Pharmacist

Users

API/Web Service

Layer

DB Interface

Layer

Network

Jubilee Hills

Apollo Central Region – AP – 1,279 IP Beds

DRDO Hyderguda Karimnagar Kakinada


Transactions When Deployed Across The Group

Coverage : Apollo Group - IP Date Range : As Per Med-Mantra Deployment Schedule Scope : Final Phase – 26 HIPaR Patient Safety Services

IP Beds 10,000

Assumed Occupancy 80%

Assumed Daily IP Prescriptions Per Bed 2

Total Daily Prescriptions Count 16K

Average Drugs Per Prescription 5*

Patient Safety Validations Generated Per Prescription by Med Mantra

165

HIPaR Patient Safety Validation Transactions Per Day 2.64M


Proposed IT framework

Standard Operating Procedures - Protocols

Information Aggregation

and Integration

Infection Information Collection

HIS

/M

ed

Ma

ntr

a

Patient Profiles and

Medical History

Various Cluster Diseases Occurrences Info

Data Sources

Re

po

rtin

g a

nd

D

isse

min

ati

on

Data Validation

Protocol Qualification

Possible Occurrences

Detection

Online

Periodic

Email

SMS

Doctors’ Diagnosis –

IP/OP

Microbiology Reports

Molecular Biology Reports

Prevalent Infections

Drugs used/ Requisitioned

Infection Occurren

ce Inferenc

e

HIS

/M

ed

Ma

ntr

a

Care Guidelines Operational Workflows

Clinical Knowledgebase

Drug Knowledgebase


Unlocking the Value of Clinical Information Technology

Data collection

Get alerts on multi-drug resistance Develop statistical studies and link the data for

research through patient information access Monitor antibiotic use Detect and monitor outbreaks Investigate infection source and reservoir

Perform patient screening tests

Implement environmental controls


Accurate Timely Information Creating Standard Operating Procedures

Protocolization of Control Activities

Assessing the impact - staff activity Feedback to Clinical Staff Defining Strategic Objectives, Day-to-day

Operations Information Management for Surveillance

Collection – Smart Phones, Tabs Integration with HIS SOPs and Analysis– Data Analytics Reporting and Dissemination – Online and

period Alerts – SMS and Email

Unlocking the Value of Clinical Information Technology


Best Practices to unlock the IT potential

Designing the IT system for clinician utility

Producing user friendly workflows Perfecting critical processes Ensuring an enhanced clinical product Establish metrics for success

Ensuring maximum utilization

Building positive momentum Growing the user base Pursuing universal adoption

Enabling continuous value generation

Hardwiring a philosophy of change Managing a wealth of data Triaging high risk patients

Prevent.. Intervene.. Control and…

Stay Disinfected…

IT in Infection Prevention

Health & Medicine

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