Abstract
SummaryBackgroundIt is important to ensure that the timely administration of appropriate antimicrobial decolonization therapy occurs when patients are identified as meticillin-resistant Staphylococcus aureus (MRSA)-colonized. Computerized Provider Order Entry (CPOE) with embedded Clinical Decision Support (CDS) may help to facilitate this.AimTo investigate changes in the average time from patient admission to administration of MRSA decolonization antimicrobial therapy in the context of various national and local infection control interventions, including the use of CPOE.MethodsData concerning the time of admission and of administration of patients' first MRSA decolonization antimicrobials were extracted from a locally developed CPOE system (Prescribing Investigation and Communications System: PICS) which was introduced at a large university teaching hospital in the UK in 1998. Data were extracted retrospectively from January 2006 to March 2012.FindingsA variety of relevant local and national interventions occurred from 2006 to 2012. Notably, the automatic charting of MRSA decolonization antimicrobial therapy was introduced in December 2007. There was a significant decline of 15.0% per year (95% confidence interval: 11.1–18.7%; P < 0.001) in the time taken from admission to administration of MRSA decolonization antimicrobial therapy during the study period.ConclusionsNumerous factors may have contributed to the observed reductions in the time from admission to administration of MRSA decolonization antimicrobials, including the implementation of specific features within a CPOE system. By rapidly attending to positive MRSA colonizations there is decreased potential for MRSA to spread, which may help to reduce the prevalence of MRSA colonizations within hospitals and improve patient outcomes.
Highlights
Healthcare-associated infections (HCAIs) such as those due to meticillin-resistant Staphylococcus aureus (MRSA) are problematic in hospitals worldwide.[1]
MRSA bacteraemias may be attributed to a number of factors, including routine screening for MRSA colonization, transmission-based precautions, antimicrobial stewardship and patient isolation.2e6 It is important to promote the timely detection of MRSA colonization in patients and administration of appropriate antimicrobial drugs for decolonization, which may help to reduce the opportunity for MRSA to spread within hospitals
The use of Computerized Provider Order Entry (CPOE) systems with embedded Clinical Decision Support (CDS) may help to ensure that appropriate treatment responses rapidly follow the detection of HCAIs such as MRSA, by improving workflow and efficiency
Summary
Healthcare-associated infections (HCAIs) such as those due to meticillin-resistant Staphylococcus aureus (MRSA) are problematic in hospitals worldwide.[1]. Following the implementation of a CPOE system, Chapman et al observed a non-significant reduction from 131 to 125 min in the time from admission to administration of antibiotics in a neonatal intensive care unit (ICU).[7] Panosh et al found a significant reduction from 3.18 to 2.00 h in the time from ordering to administration of antimicrobial drugs after CPOE had been introduced into their university teaching hospital.[8] Other studies have suggested that CPOE has helped to decrease both staff work time and rates of MRSA in hospitals following the implementation of the automatic ordering of MRSA surveillance cultures by the CPOE system and improved rates of patient isolation following the provision of electronic alerts upon the identification of multidrug-resistant bacteria.[6,9] CPOE systems with embedded CDS may eliminate the need to manually complete certain stages in the process from patient admission to monitoring for and treating antimicrobial infection. We investigated the time taken from patient admission to administration of MRSA decolonization antimicrobial therapy in the context of various local and national policy changes and in relation to relevant changes to our CPOE system
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