Generation of isolation notifications for patients with positive cultures of epidemiological significance

BACKGROUND: Notifying the unit of the need for patient isolation to be instituted has depended on manual review of reports and either microbiology or infection control personnel initiating a call to the unit to effect the activity. This is both time-consuming and can lead to potential exposures prior to the isolation for staff, visitors, and other patients. OBJECTIVES: To develop a more efficient, rapid notification system to notify patient care units of newly found pathogens of epidemiological significance. METHODS: A real-time program has been developed to survey current and historical lab information system data for cultures of epidemiological significance. It is designed to accommodate the environment of a health system where multiple institutions exchange patients and utilize common standards of care and share a common lab information system. The decision support directives are dictated by infection control and clinical management requirements, and an effort was made to enhance the synergy needed for improving timely, accurate clinical care. The program was written in Cache ObjectScript™ and utilizes results processed in the Misys Laboratory™ Information System. RESULTS: In order to optimize inpatient management, decision criteria can accommodate inpatient and outpatient incidents, resulting status, and time of last positive culture result. Cultures that are judged to be repeats are ignored for isolation notification if an alert has been issued during the current visit. Infection control establishes criteria for synonymous specimen types and assigns the severity and protocols used in the notifications for isolation activities. Any combination of four notification mechanisms can be deployed: fax, e-mail, printer reports, and text pager messaging. CONCLUSIONS: 1) Direct notification from the lab information system via e-mail, fax, printer reports, and text pager messaging provides a real-time data reporting system to the point of patient care eliminating delays in instituting isolation protocols. 2) Eliminating the need for phone calls to the unit is more efficient for infection control personnel. 3) Automatic generated reports provide instructions for isolation at the point of care. 4) Notifications are timely, and a significant number of reports are issued during weekend and evening time periods when infection control staff is not available.