Do you need Isolation? Decreasing time to isolation by improving the notification process efficiency and its association with reductions of methicillin-resistant Staphylococcus aureus (MRSA) acquisition

Background: On average, our facility admits 33,000 patients per year. Many of these patients had been previously hospitalized and identified as being MRSA colonized and therefore had ongoing needs for isolation precautions (IP). Additionally, patients can acquire new MDROs during their current visit that would necessitate isolation. It was noted that isolation implementation was often delayed because of communication delays to the point of care (POC) healthcare workers (HCWs). To decrease time to isolation (TTI), real-time (RT) alerts were generated.  Initially this was done using RT paper alerts (PAs). Although the PA was generated in RT, verbal communications were done manually, relied on availability of the receiver of the information, and were very labor intense. Faxed communications were delivered to nondedicated fax machines and so often not seen or acted on in RT. This methodology fostered delays in communication and thus isolation implementation.  Over time, RT electronic alerts (EAs) were utilized. RT alerts also triggers long-term isolator coding so that patients will be placed in isolation on subsequent health-care visits. 

Objective: To determine if RTEAs generated after a detection of MRSA, was associated with a decreased TTI and decreased MRSA converter rate as compared to RTPA.

Methods:

Prior to 1/10 a RTPA was used to communicate isolation needs. In 4/09 (period 1) TTI was measured for 15 MRSA alerts. In 1/10 a new RTEA was implemented that more globally distributed the communication via text pager and email. In 4/10 (period 2) TTI was again measured in 10 MRSA alerts. TTI was defined as the time from positivity/alert to the time isolation was documented in the electronic medical record. A conversion was defined as a newly documented Hospital Acquired (HA) MRSA acquisition. The MRSA conversion rate was defined as the # of HA MRSA acquisitions/the # of admits not known to be MRSA colonized/infected X 100. MRSA conversion rate from 1/08- 12/09 was considered the preintervention rate and the MRSA converter rate from 1/10 – 9/10 was defined as post intervention rate.

Results:

Average TTI in Period 1 was 75 minutes versus 60 minutes in Period 2. The MRSA converter rate decreased by 25% (p= 0.49, OR= 1.33, CI 1.0 – 1.77).

Conclusions: RTEA are more reliable and can more rapidly alert multiple HCWs simultaneously. Rapid notification can lead to decreased TTI and although not statistically significant, this intervention was associated with a decreased MRSA conversion rates.