Enhanced Isolation Practices To Improve Patient Safety: Preventing Nosocomial Transmission in a Hospital

Abstract

ISSUE: Healthcare associated infections (HAI) are transmitted by predictable routes. Reservoirs and susceptible hosts contribute significantly. Transmission occurs via the indirect spread of pathogens from these identified reservoirs to susceptible hosts. In 2006, the Joint Commission National Patient Safety Goals propose reducing HAI. PROJECT: Isolation precautions (IP) at the Johns Hopkins Hospital (JHH, 1026 bed capacity) are designed to prevent transmission of microorganisms. In an effort to provide quicker and more efficient use of our infection control resources, we developed a new computer program with TheraDoc^® that generated a log that provides real-time data on patients with 11 epidemiologically significant microorganisms/drug resistance patterns. These logs were transmitted to the units listing patients that required isolation. Patients having more than one organism requiring isolation were triaged "hierarchally" to facilitate appropriate isolation. RESULTS: The isolation rate throughout JHH was compared on January 11, 2005 and 2006. A search of the old database revealed 148 patients (14.4%) were isolated for drug-resistant microorganisms (MRSA or methicillin-resistant S. aureus, VRE or vancomycin-resistant Enterococcus, and extended spectrum beta-lactamases or ESBLs). Using the new expanded database, a query of all 11 microorganisms/tests reported (MRSA-also differentiating respiratory source or non-respiratory source), VRE, ESBL, multiply-drug resistant Acinetobacter or MDRAC, multiply-drug resistant Gram-negative rods or MDRGNR, Varicella zoster, Influenza, respiratory syncytial virus or RSV, Clostridium difficile, and acid-fast bacilli), 199 patients (19.4%) were isolated within 1 day of admission. The new system provided isolation precaution requirements an average of 72 hours sooner. LESSONS LEARNED: Automated computer systems that provide fundamental functions and distribute information house-wide automatically reduce the time an infection control epidemiologist spends doing surveillance. Tools such as this new isolation system allows the ICE to truly prevent and control the spread of infection within their facility.