Entering a New Era of Surveillance Feedback: An Open Trial of a Web-based Two-dimensional Color-coded Carrier Mapping System (2DCM-web) by National Surveillance Participants

Background:  Intra-hospital dissemination of pathogenic bacteria and opportunistic pathogens, including highly drug-resistant strains, remains a threat despite current infection control practices.  We have developed a system generating 2-D (time-place) carrier maps color-coded by antibiogram groups (2DCM).  The system generates a concise snapshot of bacterial isolates within the hospital, visualizing bacterial dissemination.  The Japanese Nosocomial Infections Surveillance System (JANIS) Clinical Laboratory Subdivision (JCLS) is a Japanese National Surveillance System involving approximately 600 hospitals (20% of all hospitals with >200 beds) nationwide and collects all bacterial test results with background of a specimen and a patient.  JCLS data is generated automatically by clinical laboratory equipments or data management systems connected to laboratory equipments sold in Japan.  The Japanese Ministry of Health, Labour and Welfare (MHLW) collects data automatically and releases the individual results through the Web.

Objective: Evaluate a web based system that enables visualization of bacterial dissemination to participants in the National Surveillance System. 

Methods: 2DCM has been adapted for a web-based application using “ClickOnce®” technology and is available to all JCLS participants (600 facilities).  Participants use the system online using Internet Explorer®.  The program is downloaded through the Web, temporarily installed onto the local computer and automatically un-installed when the user quits the program.  Data feeds based on data submitted from individual participants are also delivered through the Web.

Results: 187 hospitals submitted an average (av.) of 10.3 months of surveillance data for the trial and ran the 2DCM-web program on average 3.1 times / month.  No major problems were experienced during this large scale trial.  In a survey to determine the benefits of the system, 41% of participants answered “Yes” to the effectiveness of the system in proving intra-hospital bacterial dissemination, whereas 53% answered “Can’t tell” and 4% “No” (2% NA).  The survey also showed that the major (64%) reason for not participating in the trial was not knowing how to use the system or the system itself.

Conclusions: The open trial proved the feasibility of the 2DCM-web system as a part of the National Surveillance System.  Assessment of the benefits of the system in identifying intra-hospital bacterial dissemination is still incomplete. The participants are unfamiliar with the 2DCM charts and have difficulty assessing charts showing too much or too little dissemination.  Use of the 2DCM charts may become easier once actual cases of bacterial dissemination have been experienced.  Development of more concise charts will improve their acceptability. MHLW will implement the system into the JANIS system in 2011.