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
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.
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| Bevin Cohen, Tim Landers, and Melissa Marine present at the 2010 APIC Annual Conference, New Orleans, LA |
Barbara Ross and Melissa Marine present
at the 2010 APIC Annual Conference, New Orleans, LA |
| Project Summary | Research Team | Advisory Board | Publications and Presentations |
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 Nursingand 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 Nursingand 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
|
| Elaine Larson, CIRAR Director and Bevin Cohen, CIRAR Project Coordinator
APIC Annual Conference, Ft. Lauderdale, FL, June 2009 |
Marine M, Chou M, Cohen B, Chaudhry R, Larson E, Behta M, Landers T, Ross B. Methods of measuring compliance with transmission-based isolation precautions: Comparison of paper-based and electronic data collection. In: Association for Professionals in Infection Control and Epidemiology Annual Conference, New Orleans, LA, July 2010 [Abstract 16-160].
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.