Study finds correlation between electronic surveillance systems and IP satisfaction

A survey study published in this month's American Journal of Infection Control looked at the impact of electronic surveillance systems (ESS) on infection preventionists' (IPs) jobs. IPs from over 200 hospitals in California participated in the survey. One very interesting finding from the study is that IPs with ESS have more organizational support and that organizational support is highly correlated with IPs' satisfaction level.

The study also provides an informative look at the changing role of today's IPs. The table below summarizes how today's IPs spend their time:

The chart below summarizes where IPs are spending their time:

Although the study finds that IPs with ESS don't necessarily spend less time on surveillance, they do allow the IPs to spend less time on data collection and more time on decision making and implementing preventative interventions.

Abstract and link to full text here

Predicting Epidemics using Social Network Analysis

We posted a few months ago on the book Connected and how social network analysis is relevant to the fields of epidemiology and infection control. In the journal PLoS One, the authors Christakis and Fowler published specifics on the study briefly mentioned in Connected about a social network experiment performed on the campus of Harvard University.

Long story short, by mapping out the network of friends in a group of over 300 students, they were able to predict the onset of a flu epidemic two weeks earlier than through random sampling or by other means. In the case of SARS or swine flu, those two weeks could be the difference between a local epidemic and a global pandemic if public health officials had access to this data. There are many potential applications for social network analysis in the study of disease, but real-time public health applications may require private health data that individuals are as yet unwilling to make available outside of a controlled study on a college campus.

Big Think: A Better Way to Predict Epidemics
http://bigthink.com/ideas/24058

PLoS ONE: Social Network Sensors for Early Detection of Contagious Outbreaks
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0012948

Big Think: Nicholas Christakis Interview
http://bigthink.com/nicholaschristakis

New York State releases HAI report

Earlier this month, the New York State Department of Health released its 3rd annual report on hospital-acquired infections (HAIs). Some good news from the report:

1. Surgical site infection (SSI) rate in New York was 5.3 per 100 procedures, lower than the national average of 5.6 per 100 procedures and has been declining since 2007, when New York first started reporting HAIs.

2. Central line associated blood stream infection (CLABSI) rate has fallen 18% in the last two years.

3. The dollar savings associated with reduction in CLABSI rates in adults, pediatrics, and neonatal ICUs in New York was estimated to be between ~$2.5M and $10M.

One of the report's recommendations was that hospitals need to integrate health information technology systems to enhance infection prevention and reporting efforts.

Full Report Here

Using EMR data to determine origin of HAI

It's known that certain settings like healthcare, long-term care, and prison facilities increase the risk for certain infections. A prime example is MRSA. The challenge has been to determine where the patient acquired the infection, either from the community at large or from a healthcare facility. The distinction between the two is important for the monitoring, treatment, and prevention of infections.

A study by JS Wilson developed a process that identifies healthcare facilitiese from patients' addresses in the EMR database, automatically categorizes the address as either a healthcare facility or a residential address, and finally decides whether or not the infection is likely to be community or healthcare acquired.

This is an interesting attempt to use EMR data in assessing infection risk and opens the door to further investigating the effects of social networking on infections.

Full research paper here

Book Review: Best Care Anywhere

Philip Longman’s second edition of Best Care Anywhere is a valuable, high level summary of the history of the Department of Veterans Affairs, the story of the VistA EHR system, and how incentives can be aligned within this huge health care system to achieve some of the highest scores on quality metrics, including HAI rates.

Of particular interest to me was the story of how the VistA EHR system was originally created. VistA was the brainchild of a community of computer-savvy VA physicians, and was developed in occasional opposition to the wishes of senior leadership. A virtual “Underground Railroad” emerged to enable the continued development of the system through the 1970’s and 1980’s. VistA has become legitimate during that time, with support from several presidential administrations, and adoption beyond the VA. It's interesting that earlier this week, an RFI has been released seeking assistance in maintaining the open source nature of VistA to continue this legacy.

Longman proposes a controversial strategy of extending the VA’s model of health care delivery beyond the VA, asserting that such an approach would improve care quality and reduce health care costs. He proposes not only extending VA's reach by opening access to non-veteran beneficiaries, but also implementations of VistA well beyond the VA into community and rural hospitals.

I'm very curious to see the response of policy makers, providers, and patients towards this controversial new strategy of health care quality transformation.

NDM-1 found in Massachusetts

Back in August, NDM-1 bacteria made national news when it was discovered in Europe and many predicted that it will spread to the rest of the world. Yesterday, I read on Boston Globe's online portal that a case of NDM-1 had been found in Massachusetts General Hospital (MGH).

NDM-1 is a gene that makes bacteria highly resistant to many classes of antibiotics. The bacteria originated in India, where unregulated use of antibiotics is common. The MGH patient had recently traveled to India, had spent time in a hospital there, and was undergoing cancer treatment at MGH when the bug was discovered. Two other cases have also been identified in California and in Illinois.

The most worrisome aspect of this bug is the lack of antibiotics to treat it. Currently, only two antibiotics are some what effective against NDM-1 bacteria: colistin and tigecycline, and doctors don't foresee any new antibiotics being developed in the near future. To quote the author of the article, "The paucity of drugs reflects not only the strength of the superbug but also the long-neglected development of new antibiotics."

Full text of the Boston Globe article

Twenty-First Century Plague: The Story of SARS

During a recent visit to Toronto hospitals, I learned firsthand how the SARS outbreak affected infection prevention departments specifically and health care workers in general. I decided to do some background research on the outbreak and picked up Thomas Abraham’s Twenty-First Century Plague: The Story of SARS. It’s a quick read at 176 pages and takes the reader from SARS’ origins in southern China, tracking the disease step-by-step as it emerges in major cities, spreads internationally, and is eventually thwarted by the efforts of the global health community led by the World Health Organization. Some highlights include: the unusual transmission of SARS via bathroom drains and apartment building plumbing, how health care workers risked and lost their lives to control infections, and how network-enabled collaboration helped spread successful prevention strategies just in time.

It’s a must read for anybody curious about this recent global outbreak, and it serves as a harrowing reminder of how chaotic, confusing, and destructive a modern pandemic can be.

What's better for your health, "long ties" or "dense cluster?

Lately, there has been a lot of buzz on using social networks to change
health behavior.  Ron blogged earlier about Nicholas Christakis' book
Connected, this week a new research study came of out of MIT that shows that when it
comes to changing health behavior, having fewer friends that one knows
really well is better than having many friends whom one doesn't know well.

Professor Damon Centola from the MIT Sloan School of Management tracked
the number of people who registered for a health forum from two distinct
social networks.  In one social network, participants had "long ties" with
each other, meaning each participant knew many different people but didn't
know them well.  In the other social network, participants formed "dense
clusters," meaning each of them knew fewer people but knew them very well.

The study result showed 54% of the people from the dense clusters network
registered for the health forum and 38% from long ties network did.  This
study suggests that policies may be more effective when aimed at
communities and groups that act as clustered networks.

More about Professor Centola's study

Benefits and harms of patient isolation

There was a great essay written by Dr. Abigail Zugar on the topic of patient isolation in the New York Times.

Full text