Experience with the two-stage (electronic detection and internal validation) health-care-associated infection tracking system in hospital infection control and prevention program

Abstract

Background: Surveillance of health-care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. Objectives: To study the benefits and limitations of an innovative, two-stage surveillance method of HAIs and effectiveness of infection control measures. Design: It is a retrospective 5-year study of electronic surveillance system to capture HAI cases with high index of suspicion and confirmation with the manual methods of HAI tracking. Methods: The tertiary care hospital, New Delhi, India, adopted an electronic two-stage HAI surveillance system in April 2015. This system automatically detects all microbiology culture-positive cases for patients on central line, ventilator or urinary catheter for more than 48 h in the hospital along with relevant clinical information, which was further validated by infection control team. These all are suspected HAI cases. Hence, the system is screening the cases which can be potential HAI further. Daily clinical assessment to look for initial warning signs related to HAI was done in every individual case irrespective of culture results. Results: HAI incidence rates in pre-period (before implementation of electronic detection system April 2013 to March 2015) of CLABSI, CAUTI, VAP and SSI were 1.36%, 1.41%, 2.65% and 0.16% and post-period (after implementation of electronic detection system April 2015 to March 2018) were 1.25%, 1.30%, 1.16% and 0.09%, respectively. The pre- and post-analysis depicted that rates of CLABSI, CAUTI and VAP declined significantly; however, SSI rate in post-implementation declined but not significantly. Conclusion: The electronic tracking system acts as an early warning system for identification of suspected HAI cases and triggers an early preventive response by both clinician and hospital infection control team. Moreover, the use of electronic monitoring system also led to implementation of many additional infection control measures.