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● Infection Tracking Reducing HAIs by

harnessing data How clinical decision support can eff ectively manage antimicrobial stewardship.

By Fauzia Khan, M.D.

and maintaining the highest quality of care. Despite the growing need, antimicrobial management can be both a com- plicated and costly undertaking for hospitals and caregivers. Many antimicrobial stewardship programs in a hospital


setting rely on manual methods to monitor and then manage hospital-acquired infections (HAIs). As healthcare becomes digitalized and electronic health records (EHRs) are now the standard, implementing clinical decision support (CDS) for antimicrobial stewardship is quickly becoming an essential component to alleviate clinicians’ pain points in managing infectious diseases. By automating the process of infection control, evidence- based CDS can help clinicians make informed treatment deci- sions at the point of care by providing real-time recommenda- tions through a single dashboard view of all patients’ current conditions and medications. T is helps clinicians to prioritize and treat the most critical patients fi rst to better manage, slow and stop the progression of infections. T e following are CDS technology considerations that hospitals and caregivers should examine to help reduce costly HAIs, which can result from improper treatment of highly resistant bacteria.

Antibiotic de-escalation De-escalation is a key element within antimicrobial steward-

ship programs. Physicians may prescribe antibiotics based on hospital antibiograms. (According to the U.S. National Library of Medicine, an antibiogram is “a summary of antimicrobial susceptibilities of local bacterial isolates.”) However, these an- tibiotics need to be de-escalated to either mono therapy or narrow-spectrum antibiotics once the results of the culture and sensitivity are available. De-escalation of antibiotic therapy is associated with a decreased incidence of multiple drug-resistant

20 September 2013

ntimicrobial resistance is a rising concern in the healthcare industry, and eff ectively managing clinical surveillance in any hospital or intensive- care unit (ICU) is vital to ensuring patient safety

Fauzia Khan, M.D., FCAP, is chief medical officer and co-founder, Alere Analytics. For more on Alere Analytics: www.

organisms (MDROs). T e intended outcome is to stop the progression of infectious disease, save lives and reduce length of stay at a hospital, all while optimizing cost eff ectiveness resulting in potential signifi cant savings.

IV to PO conversion In order to optimize treatment, improve outcomes and reduce associated costs, data needs to be managed more eff ectively to improve awareness of the number of days that a patient has been on IV therapy for possible conversion to an appropriate PO (oral) medication. T e criteria used to determine whether or not the patient is eligible for PO therapy vary from facility to facility, but they generally encompass the following three key areas: 1. Conversion eligibility criteria: Patients on IV therapy for 48-72 hours, with a functioning GI tract, or showing signs and symptoms of clinical improvement (decrease in temperature, white blood cell count [WBC] <15,000/ mm3), with the exception of those on steroids.

2. Exclusion/caution criteria: Examples include patients with serious infections, such as meningitis and sepsis, NPO status (nothing by mouth) or NG (nasogastric) tube with continuous suction.

3. Medication class criteria: Specifi c medications, such as antiepileptic and cardiovascular medications; patients on those medications could be at higher risk when converted to PO therapy.

What’s next? Leveraging clinical data So how do hospitals and physician groups address these complexities of treatment of highly resistant and other bacteria? T e answer remains in harnessing the power of technology that already exists in many hospitals and physician offi ces today. By implementing CDS technology, clinicians can view patient information from a wide range of sources – HIEs, EHRs and portals – through the hospital information system (HIS), thus automating this process and alleviating much of the resource burden from the clinical staff .


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