886 A Web-based Two-Dimensional Color-coded Carrier Mapping System (2DCM-web) That Can Be Accessed Freely By Surveillance Participants: A New Era of Surveillance Data Feedback

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Shuhei Fujimoto, MD., Ph.D. , Department of Bacteriology and Bacterial Infection, Division of Host Defence Mechanism, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
Misao Honma, CLS , Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, 113-8677, Japan
Kentaro Dote, MD., Ph.D. , Intensive Care Division, Ehime University Hospital, Toon, Ehime, 791-0295, Japan
Yoshichika Arakawa, MD., Ph.D. , Department of Bacteriology II, National Institute of Infectious Diseases, Musashi-Murayama, Tokyo 208-0011, Japan
Background:  Intra-hospital dissemination of pathogenic bacteria and opportunistic pathogens, including highly drug resistant strains, remains a threat despite current infection control practices.  Improved surveillance methods could help prevent nosocomial outbreaks caused by these bacteria.  We have developed a web-based system generating 2-D (time-place) carrier maps color-coded by antibiogram groups that automatically produces a concise snapshot of bacterial isolates within the hospital.  The web-based system has been designed to be used as a part of a nationwide automated bacterial surveillance system (JCLS: Japanese Nosocomial Infections Surveillance System (JANIS) Clinical Laboratory Subdivision) that involves approximately 600 hospitals (20% of all hospitals with >200 beds ) nationwide. 
Objective: Provide a handy tool to find, analyze and evaluate intra-hospital dissemination of bacteria, open to the participants of the national surveillance system. 
Methods: A two-dimensional antibiogram-based, color-coded carrier mapping system (2DCM) has been adapted for a web-based application using “ClickOnce®” technology.  Participants can use the system online using Internet Explorer® after logging into the system with an ID and password.  The program is downloaded through the Web and temporarily installed onto the local computer and is automatically un-installed from the computer when the user quits the program.  Data feeds, which are based on the submitted data from individual participants, are also delivered through the Web.
Results:  Although the level of response of the program depends on the performance of the local computers, the system worked on a practical level when we tested the system with conventional (ex. 1GHz CPU clock, 512MB main memory) desktop and laptop computers.  Program download and installation required just a click on a button and took less than a few seconds.  It took up to ten seconds for data feeds.  The typical data processing time was between two and ten seconds.  The system, with its user-friendly interface, provided 2-D graphical feedback color-coded by antibiogram groups as a concise view of bacterial carriage, and enabled distinction between intra-hospital dissemination and strains acquired prior to hospital admission.
Conclusions: 2DCM-web is a useful tool available to the surveillance participants that gives a unique visualization of bacterial carriage within hospitals and provides the capability to identify unreported intra-hospital bacterial disseminations.  We are currently providing the web-based service to the research participants, and will make the service available to the JCLS system consisting of 600 participants nationwide within two years.