A RepayoR ElyseeM PaoneE ZigaP WengerJ SmithS LopezSt. Michael’s Medical Center, Newark, New Jersey

University Hospital, Newark, New Jersey

St. James Hospital, Newark, New Jersey

Newark Beth Israel Medical Center, Newark, New Jersey

Columbus Hospital, Bloomfield, New Jersey

Department of Health, Newark, New Jersey

ISSUE: New Jersey hospitals historically reported communicable diseases to the local health department (LHD)

via paper (facsimile or mail). These reports were then forwarded to the state health department (SHD) after

investigation and follow-up. There was a considerable delay in receiving and responding to reports with this

process. This resulted in significant constraints on the LHDs ability to plan and execute initiatives in a timely

manner to reduce morbidity and mortality in the event of adverse health situations.

PROJECT: Implementation of the Communicable Disease Reporting System (CDRS), a Web-based electronic

reporting system was piloted in five Newark hospitals by the New Jersey State Health Department to enhance the

reporting of diseases between the hospitals and both LHD and SHD, and to immediately receive simultaneous

reports. This allows timely monitoring of disease patterns as well as timely feedback to the hospitals for quality

improvement or remediation of any problems.

RESULTS: A recent study of reports sent to the LHD, particularly for Salmonellosis and Shigellosis, showed that

prior to the deployment of CDRS, the lag time for receipt of reports by the LHD averaged 24 hours for both

diseases. However, the average time lag for receiving and posting the records in the SHD database was 47 days

for Salmonellosis and 193 days for Shigellosis.

LESSONS LEARNED: CDRS has a promising future and could be used for early identification and abatement of

communicable diseases, thus improving quality of life.

E122 Vol. 32 No. 3

Computer-Assisted Surveillance: Does It Work?

S Wright*M PeningerL TaylorA PutneyP PearsonL. Ostrosky-ZeichnerMemorial Hermann Hospital, Houston, Texas

ISSUE: Traditional surveillance for nosocomial infections is labor-intensive and time-consuming. In today’s

healthcare setting, infection control professionals (ICPs) must be continuously searching for time-efficient

May 2004 E123

alternative ways to collect reliable data. We sought to determine whether electronic review of our clinical-financial

database could identify post–cesarean section (C-section) endometritis with sufficient accuracy to provide sound

data to the obstetrics (OB) service.

PROJECT: Our Labor and Delivery Department was asked to provide a monthly list of C-section patients, ASA

scores, wound classifications, and durations of surgery. A Performance Improvement Specialist used DRGs to

identify C-section patients and then ICD9 codes to identify cases of endometritis. Validity of the electronic data was

confirmed by chart for the first 2 months.

RESULTS: During the early phases, we found that chorioamnionitis was also captured. This was eliminated by

changing the ICD9 screening codes. Other infections being captured under this code which were discounted were

urinary tract infections and were due to coding errors. Electronic versus traditional surveillance initially showed

only a 79% match. After changing our method of collecting the ICD9 codes, the match was 88%. The OB service

now receives data they can benchmark against National Nosocomial Infection Surveillance (NNIS) rates. Providing

them with this information has allowed them to evaluate their service and identify tools to improve the quality of

patient care in our facility.

LESSONS LEARNED: With a little effort up front, surveillance time can be greatly reduced without compromising

the quality of the data received. Computer-assisted surveillance can be a valuable tool for today’s ICP, but the

success of this method is dependent on the accuracy of chart documentation and the experience of the coders.

Cluster of Serratia marcescens Associated with Tap Water Utilization inHigh-Flow Nasal Cannula: Identification, Investigation, and Correction

N Church*S ThorntonK MetsgerV GowanV HillburgerS AdamsM RiceProvidence St. Vincent Medical Center, Portland, Oregon

BACKGROUND: Providence St. Vincent Hospital (PROVSTV), a 450-bed acute-care facility in Portland, was alerted

to a significant increase in hospital-associated Serratia marcescens isolates from respiratory sources during

March–May 2003.

OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for

future prevention with other clinical staff.

METHODS: Data-mining services are provided to PROVSTV. Monthly reports are generated to detect unsuspected

patterns of infection within the hospital and community. In June 2003, Infection Control (IC) received an alert

describing a 310% increase (p¼0.041) in patients with non-duplicate hospital-associated Serratia marcescens

isolates from upper respiratory sources among post cardiac surgery and critical care patients. Upon IC

investigation it was discovered that respiratory care staff on the units involved were utilizing tap water in the

humidifiers on the ventilators. Cost was given as the reason sterile water was not being used. Respiratory

Therapy investigated the cost impact of utilizing sterile water for this purpose. A pre-packaged humidifier with

sterile water was discovered which would be cheaper than the old system. This system was implemented.

RESULTS: Continuing electronic surveillance for hospital-associated Serratia marcescens respiratory isolates

revealed only five isolates in the subsequent 6 months following the implementation of corrective measures.

Compared with the 3-month period in which the alert was generated, this was a 58% reduction.