Bar Code Technology for Device Associated Infection Surveillance: Usability Study and Preliminary Data

Background: Monitoring of indwelling device days facilitates prompt device removal and accurate calculation of infection incidence density. Currently device day data are captured manually by nursing staff , and data are aggregated by Infection Preventionists. The computerized patient records system (CPRS) developed by the Department of Veterans Affairs utilizes bar code technology for inpatient medication management. We hypothesized that a bar code reader system with device monitoring software would provide an accurate, automated method to fully capture device days, with the potential to be used to create device removal reminders and to analyze device-specific data.

Objective: To test usability of a bar code reader system for invasive device monitoring, and collect pilot data.

Methods: We conducted a usability study with a free-standing commercial bar code reader system with nurse volunteers. A pilot study of the system was conducted in the intensive care units. Nursing staff volunteered their time to participate in the bar code activities. A nurse applied a unique bar code to each indwelling urinary catheter and central venous catheter (CVC) shortly after insertion.  If a patient had more than one CVC, a bar code was applied to only one device. Each day the charge nurse scanned the bar code on each indwelling device.  We compared daily CVC counts collected manually to those collected with the bar code scanner for two months.

Results: 16 nurses participated in an initial usability study. All nurses reported that the device was simple to use and bar codes were captured easily. During the pilot phase of the study we discovered that the initial bar code labels did not adhere well to urinary catheters and had to be redesigned. The newly designed bar codes were easily secured to both central and urinary catheters, and were easier to read. The manual system counted 348 CVC days; the bar code system counted 364 CVC days, a 4.6% increase. The barcode system generated printouts of device days and types of devices for any requested date range. However, we were unable to link the system to the existing CPRS, due to VA information technology security concerns.  This prevented identification of the patient and thus the use of the dashboards and reminders for device removal and CVC dressing changes which the package is designed to provide.

Conclusions: Bar code technology holds promise for device day surveillance. In order to fulfill the potential of this technology, device data must be linked to patient identifiers and incorporated into daily patient care activities.