Computer assisted reporting and monitoring of microbiology/infectious disease data and antibiotic therapy.

At the Salt Lake Latter-Day Saints (LDS) Hospital, we developed an interface between the microbiology laboratory computer system and a central hospital computer system (HELP). This system contains an integrated data base including information from most medical areas. A translation program was created to transform the microbiology data from the laboratory file structure to a hierarchical data structure on the HELP system. The translated microbiology data could then be reviewed from any Nursing; division or ICU in the hospital within seconds after it was entered in the laboratory computer. We next developed a knowledge base, with the help of infectious disease experts, and linked it to a computer Infectious Disease monitoring system. The knowledge base is automatically activated when specific microbiology data are entered into the patient’s computer file (Data-driven). The Computer Infectious Disease Monitor (CIDM) was designed to detect patients with the following condition: 1) a hospital-acquired infection 2) and infection at a sterile body site, 3) an infection by antibiotic resistant organisms, 4) not receiving appropriate antibiotics, 5) could be receiving a less expensive antibiotic, 6a) a “reportable†disease and 7) receiving prophylactic antibiotics longer than necessary. A study comparing the nosocomial infections identified by the CIDM with the nosocomial infections identified by the Infection Control Practitioners (ICPs) at LDS Hospital during a 2 month period was conducted. A physician retrospective chart review (PRCR) was performed on 217 patients identified as having a nosocomial infection by either the CIDM or the ICPs. The CIDM identified 88% of the patients with nosocomial infections and the ICPs 74% (p<0.0002). The CIDM identified 78% of the total nosocomial infections and the ICPs 68% (p<0.032). By combining the infections found by the CIDM with those found by the ICPs, 88% of the infections were identified. The CIDM identified 84% of the infections with positive microbiology cultures and the ICPs 74%. By combining the infections identified by the CIDM with the ICPs, 95% of the infections with positive cultures were identified. Thus, the ICPs augmented by the CIDM identified. Thus, the ICPs augmented by the CIDM identified significantly more nosocomial infections (p<0.001). During the same 2 month period the CIDM also identified 37 different instances where the patient was not receiving an appropriate antibiotic and 31 other instance where the patient could have been receiving less expensive antibiotic as confirmed by PRCR. During a 3 week period, 506 patients received a cephalosporin antibiotic for the first time. These drugs were being used for phrophylaxis 87% of the time. Thirty-five percent of the patients were receiving the cephalosporins longer than necessary and the CIDM identified 91% of them. The CIDM was found to incrase the efficiency, timeliness and completeness of nosocomial infection surveillance while at the same time reduced cost and time. The CIDM can identify patients who are receiving inappropriate and/or more expensive antibiotic therapy. The CIDM an also identify patients who are receiving prophylactic antibiotic longer than necessary.