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Impact of Electronic Alerts on Isolation Precautions for Patients With Multidrug-Resistant Bacteria
Guillaume Kac, MD;
Patrick Grohs;
Pierre Durieux, MD, MPH;
Ludovic Trinquart;
Mathilde Gueneret;
Aurelia Rodi;
Pierre Boiron;
Romain Guillemain, MD;
Jacques Leglise;
Guy Meyer, MD
Arch Intern Med. 2007;167(19):2086-2090.
Background Health care workers' compliance with isolation precautions for patients colonized or infected with multidrug-resistant bacteria (MRB) is low.
Methods In a 750-bed, acute care university hospital with a patient information system covering the entire hospital, a database that included all patients with MRB was created and was merged daily with the admission-discharge-transfer application. An electronic alert was generated for all new cases of MRB and for all transfers between wards and all readmissions of patients with MRB. Two successive interventions were implemented based on this alert system. First, alerts were dispatched to medical and staff members in charge of infection control in each ward with requests to order isolation precautions for the patients. Second, alerts were dispatched to the infection control team, who directly ordered implementation of isolation precautions in electronic nursing records. Five audits during a 3-year period were performed to evaluate their effect on health care workers' compliance with isolation precautions.
Results Awareness of the MRB status for the nurses in charge of the patients statistically significantly increased from 24.0% at baseline to 59.4% at 1 year after the first intervention. This proportion improved to 93.1% at 1 year after the second intervention. Similarly, the implementation of isolation precautions statistically significantly increased from 15.0% at baseline to 50.5% at 1 year after the first intervention and then to 90.2% at 1 year after the second intervention.
Conclusion A computer alert system can lead to effective and lasting improvement in the implementation of isolation precautions for patients with MRB in health care institutions.
Author Affiliations: Hygiène Hospitalière (Drs Kac and Mss Gueneret and Rodi), Microbiologie (Mr Grohs), Santé Publique et Evaluation Médicale (Dr Durieux), Unité d’Épidémiologie et de Recherche Clinique (Mr Trinquart), Informatique Hospitalière (Mr Boiron), Anesthésie-Réanimation (Dr Guillemain), Direction (Mr Leglise), and Pneumologie (Dr Meyer), Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris; Centre d’Investigations Épidémiologiques 4, Institut National de la Santé et de la Récherche Médicale (Mr Trinquart); and Respiratory Department, Université Paris Descartes (Dr Meyer), Paris, France.
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