Applied Research in Antimicrobial Resistance: Studies of Susceptibility Impact of Automated Surveillance on MRSA Isolation, PI: E. Larson

Grant # TS-1431 (5 U50 CD3000-860-21)
Title: IMPACT OF AUTOMATED SURVEILLANCE ON MRSA ISOLATION
Co-PIs: Maryam Behta, PharmD, Director, Quality Research and Technology Utilization, Department of Information Services, NewYork-Presbyterian Healthcare Medical Centers, and Elaine Larson, RN, PhD, Professor of Therapeutic and Pharmaceutical Research, Columbia University School of Nursing and Professor of Epidemiology, Mailman School of Public Health, Columbia University
Funder: Association for Prevention Teaching and Research (APTR) - Centers for Disease Control and Prevention (CDC) Cooperative Agreement
Dates: 9/30/08 - 9/29/10
Funding: $595,990

Elaine Larson, CIRAR Director and Bevin Cohen, CIRAR Project Coordinator
APIC Annual Conference, Ft. Lauderdale, FL, June 2009

PROJECT SUMMARY

Despite the fact that CDC publishes recommendations to prevent transmission of multiply-drug resistant organisms, the extent to which these are actually practiced is unclear. This project will test the impact of an automated surveillance system on the monitoring of and compliance with isolation precautions to prevent the spread of a major healthcare-associated pathogen, methicillin-resistant Staphylococcus aureus (MRSA). Specific aims are, for patients infected or colonized with MRSA, to (1) assess the sensitivity and specificity of electronically-accessible data elements (e.g. providers’ orders, nursing notes) for monitoring initiation of isolation precautions; (2)assess the impact of an automated surveillance system on timeliness of initiation and discontinuation of isolation precautions; (3) compare incidence density and proportion of MRSA patient days of colonization or infection with MRSA before and after implementation of an automated surveillance system; and (4) determine the rate of recurrence of MRSA-positive cultures among patients whose isolation precautions are discontinued following serial negative cultures.

This is a quasi-experimental, pre-post intervention trial with study outcomes being measured before and after implementation of the isolation module of an automated surveillance system (EpiPortal). It will be conducted at five sites within a major health system in New York City which includes >1,900 acute adult and pediatric beds. At these sites in 2007, ~1,700 MRSA unique cases were identified, requiring 33,000 isolation days. The current standard surveillance method (baseline) for MRSA in all study sites is similar to that practiced in many U.S. healthcare settings. EpiPortal is an electronic decision support system designed to improve the workflow and decision making process of the infection control team, and will be introduced following baseline data collection, in the first 3 months of the project, followed by a phase-in period before post-intervention data are collected. The system has been developed and extensively tested by a team of bioinformaticians, epidemiologists, and clinicians. Data to assess the impact of the automated system will be collected from a number of available electronic clinical and administrative sources, as well as direct prospective observation of isolation practices at all five study sites. Multilevel logistic regression models will be used for the comparison of the proportion of positive outcome measures before and after the implementation of the automated surveillance system with the adjustment of characteristics of units and sites and potential confounders.

CORE RESEARCH TEAM
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Name	Role	Institution / Department
Maryam Behta, PharmD Director, Quality Research and Technology Utilization	Co-Principal Investigator	Department of Information Services, NewYork-Presbyterian Healthcare Medical Centers
Elaine L. Larson, RN, PhD Professor of Pharmaceutical and Therapeutic Research and Professor of Epidemiology	Co-Principal Investigator	Columbia University School of Nursing and Department of Epidemiology, Mailman School of Public Health, Columbia University
Rohit Chaudhry, MS Senior Systems Analyst	Co-Investigator	Department of Biomedical Informatics, College of Physicians & Surgeons of Columbia University
E. Yoko Furuya, MD, MS Instructor in Clinical Medicine and Assistant Director of Hospital Epidemiology	Co-Investigator	Department of Medicine, Division of Infectious Diseases, Columbia University, and NewYork-Presbyterian Hospital, Columbia University Medical Center
Haomiao Jia, PhD Assistant Professor of Clinical Biostatistics (in Nursing)	Biostatistician	Columbia University School of Nursing and Department of Biostatistics, Mailman School of Public Health, Columbia University
Barbara Ross, RN, BSN, CIC Lead Nurse Epidemiologist, EpiPortal System	Co-Investigator	Department of Epidemiology, NewYork-Presbyterian Healthcare Medical Centers
Lisa Saiman, MD, MPH Professor of Clinical Pediatrics and Hospital Epidemiologist	Collaborator	Department of Pediatrics, Division of Infectious Diseases, Columbia University, and Morgan Stanley Children's Hospital of NewYork-Presbyterian
David Vawdrey, PhD Associate Research Scientist	Co-Investigator	Department of Biomedical Informatics, College of Physicians & Surgeons of Columbia University
Bevin Cohen, BA	Project Coordinator	Columbia University School of Nursing
Mei Chou, MS	Programmer	Columbia University School of Nursing
Melissa Marine, BS	Research Coordinator	Columbia University School of Nursing

ADVISORY BOARD

Name	Institution / Department / Affiliation
Bruce H. Forman, MD	Associate Clinical Professor, Department of Biomedical Informatics College of Physicians & Surgeons of Columbia University
Eliot J. Lazar, MD	Associate Clinical Professor, Department of Medicine, Division of Cardiology College of Physicians & Surgeons of Columbia University
Frank Lowy, MD	Professor of Medicine and Pathology, Department of Medicine, Division of Infectious Diseases College of Physicians & Surgeons of Columbia University

PUBLICATIONS AND PRESENTATIONS

NEW! Cohen BA, Clock SA, Behta M, Larson EL, Saddul R, Vawdrey, D. Provider Orders and Nursing Documentation of Contact Precautions for Patients with Multidrug-Resistant Organisms (MDROs). In: Association for Professionals in Infection Control and Epidemiology Annual Conference, Ft. Lauderdale, FL, June 2009 [Abstract 18-207].

Larson EL, Cohen B, Ross B, Behta M. Isolation Precautions for Methicillin-Resistant Staphylococcus aureus: Electronic Surveillance to Monitor Adherence. Am J Crit Care first published on February 20, 2009 as doi:10.4037/ajcc2009467.

Behta M, Ross B, Chaudhry R. A Comprehensive Decision Support System for the Identification, Monitoring and Management of Patients with Multi-Drug Resistant Organisms (MDRO). AMIA Annu Symp Proc. 2008 Nov 6;:1218.