Simulated interventions show EMR data can help improve infection prevention
Key takeaways:
- Simulated pathogen transmission and interventions suggest EMR data can improve infection prevention.
- Better HCW hand hygiene compliance and efficacy and room disinfection efficacy could reduce infections.
Intervention models checked against electronic medical record data show ways to help improve infection control practices and reduce infections, according to a recent study.
“Clinical trials for assessing the effects of infection prevention and control (IPC) interventions are expensive and have shown mixed results,” Fardad Haghpanah, PhD, postdoctoral fellow at One HealthTrust, told Healio.
“The primary pathways of transmission are presumed to include lapses in infection control practices by health care workers (HCWs) and contamination of medical equipment and the hospital environment. However, the complexity and heterogeneity of HCW-patient contact patterns and frequent contacts with surfaces and devices, many of which are untraceable, make it difficult to measure and evaluate the relative role of each pathway,” he said.
Haghpanah explained that a “valuable, yet underutilized” source of data to reduce uncertainties in the understanding of transmission pathways is EMRs because they contain time-stamped information on patient movements, as well as interactions with HCWs. “These challenges and insights motivated our team to develop an agent-based simulation of the ICUs in a tertiary hospital, coupled to the hospital’s EMR data to simulate transmission of two [hospital-acquired infection]-causative pathogens: MRSA and [vancomycin-resistant enterococci],” he said.
Using the model and data from the EMRs, the researchers simulated pathogen transmission between patients, HCWs and the environment. They also simulated several IPC interventions and estimated their impacts on reducing infections.
Overall, the researchers found that the randomness of ICU infections was mainly due to three sources — uncertainties in admission prevalence, hand hygiene compliance and environmental disinfection efficacy.
Because of this, simulated interventions included improving the average hand hygiene compliance and efficacy among HCWs to 95%. The authors noted that there was no way to reduce admission prevalence through a simulation, so they excluded this as an intervention.
Using the simulated interventions, the researchers found that improving HCW hand hygiene compliance from 70% to 95%, room disinfection efficacy from 50% to 95% and reducing post-handwashing residual contamination down from 50% to 1%, could reduce infections by 36%, 31% and 26%, respectively.
“For more effective intervention assessment through modeling, future research must prioritize areas with the greatest uncertainty,” Haghpanah said. “For example, the role of environmental contamination along with HCW-mediated transmission (ie, patient-to-HCW-to-patient) is critical to be understood as each requires different intervention strategies to mitigate transmission.”
Haghpanah added, “Collecting measures of pathogen absolute abundance (ie, pathogen load) on patient room surfaces, combined with HCW visit and patient movement data from EMR, could provide a rich tapestry describing the patient-environment-HCW network and the role of patient and HCW shedding in transmission.”
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