Electronic Public Health Registry of Drug-Resistance
Electronic Public Health Registry of Drug-Resistance
In response to clusters of carbapenem-resistant Enterobacteriaceae (CRE) in Illinois, USA, the Illinois Department of Public Health and the Centers for Disease Control and Prevention Chicago Prevention Epicenter launched a statewide Web-based registry designed for bidirectional data exchange among health care facilities. CRE occurrences are entered and searchable in the system, enabling interfacility communication of patient information. For rapid notification of facilities, admission feeds are automated. During the first 12 months of implementation (November 1, 2013–October 31, 2014), 1,557 CRE reports (≈4.3/day) were submitted from 115 acute care hospitals, 5 long-term acute care hospitals, 46 long-term care facilities, and 7 reference laboratories. Guided by a state and local public health task force of infection prevention specialists and microbiologists and a nonprofit informatics entity, Illinois Department of Public Health deployed a statewide registry of extensively drug-resistant organisms. The legal, technical, and collaborative underpinnings of the system enable rapid incorporation of other emerging organisms.
The emergence of extensively drug-resistant organisms (XDROs) is a major public health problem because few or no effective antimicrobial drugs are available to treat infections caused by these bacteria. In the United States, carbapenem-resistant Enterobacteriaceae (CRE) are XDROs considered high priority for control, and regional clusters have been detected in Illinois and elsewhere. Control of drug-resistant bacteria is possible but requires a coordinated regional effort across the spectrum of health care facilities. Failure to control spread of antimicrobial drug–resistant bacteria hinders medical care at a growing number of facilities by creating hazardous opportunities for untreatable infections during aggressive medical interventions, such as immunosuppressive therapies and device insertions, or during common endoscopic procedures.
To combat CRE, the Centers for Disease Control and Prevention (CDC) recommends a "Detect and Protect" strategy: detect CRE patients through systematic surveillance and protect patients by preventing transmission of CRE through application of appropriate infection control precautions when such patients enter a health care facility. Because a patient is often cared for at multiple health care facilities, ensuring that information follows a patient is challenging: survivors of prolonged intensive care unit (ICU) treatment go through a median of 4 facility care transitions, including non–acute care facilities, within 1 year. To improve the effectiveness of the Detect and Protect strategy, information needs to be shared routinely among facilities, but information sharing often is suboptimal. Innovative tools to automate information sharing have been developed but have focused on hospitals; comprehensive systems are needed that extend beyond acute care hospitals and encompass large geographic regions.
Before 2013, the Illinois Department of Public Health (IDPH) had limited information about the epidemiology of CRE. A CDC-funded surveillance activity (REALM project), consisting of point prevalence studies of CRE carriage among ICU patients in Chicago acute care hospitals and all patients in long-term acute care hospitals (LTACHs) was ongoing; however, prevalence data were limited to Chicago and did not include patients outside the ICU or in long-term care facilities (LTCFs). The first function of the XDRO registry was to provide a mechanism for standardized reporting of CRE carrier patients from all health care facilities throughout the state.
In November 2013, IDPH launched a public health informatics tool called the XDRO registry (http://www.xdro.org), designed to facilitate information exchange throughout health care facilities in Illinois. The first function of the registry was to provide a mechanism for standardized reporting of patients in whom CRE was detected. The registry, an electronic platform for CRE information exchange, receives reports (Figure 1) of CRE in accordance with a state-enacted surveillance rule (Table 1) and centrally stores patient-specific CRE information (Figure 2). The registry was developed through collaboration among public health agencies (federal, state, city, and local), informatics specialists, infection control professionals, microbiologists, and academic researchers. We report our experience designing and implementing the Illinois XDRO registry.
(Enlarge Image)
Figure 1.
Display of Illinois XDRO registry's submission page. Completion of 1 report is contained within this single page. Asterisk indicates required fields. Field names in gray font (i.e., Escherichia coli and Klebsiella spp. criterion and mechanism of resistance) are conditioned on prior responses, organism name and XDRO criteria, respectively. The field "For laboratories and IDPH only" is not visible for other users; this field enables public health and reference laboratories to input isolates for facilities that have not submitted a report. XDRO, extensively drug-resistant organism.
(Enlarge Image)
Figure 2.
Conceptual framework of the XDRO registry, Illinois, USA. XDRO, extensively drug-resistant organism
Abstract and Introduction
Abstract
In response to clusters of carbapenem-resistant Enterobacteriaceae (CRE) in Illinois, USA, the Illinois Department of Public Health and the Centers for Disease Control and Prevention Chicago Prevention Epicenter launched a statewide Web-based registry designed for bidirectional data exchange among health care facilities. CRE occurrences are entered and searchable in the system, enabling interfacility communication of patient information. For rapid notification of facilities, admission feeds are automated. During the first 12 months of implementation (November 1, 2013–October 31, 2014), 1,557 CRE reports (≈4.3/day) were submitted from 115 acute care hospitals, 5 long-term acute care hospitals, 46 long-term care facilities, and 7 reference laboratories. Guided by a state and local public health task force of infection prevention specialists and microbiologists and a nonprofit informatics entity, Illinois Department of Public Health deployed a statewide registry of extensively drug-resistant organisms. The legal, technical, and collaborative underpinnings of the system enable rapid incorporation of other emerging organisms.
Introduction
The emergence of extensively drug-resistant organisms (XDROs) is a major public health problem because few or no effective antimicrobial drugs are available to treat infections caused by these bacteria. In the United States, carbapenem-resistant Enterobacteriaceae (CRE) are XDROs considered high priority for control, and regional clusters have been detected in Illinois and elsewhere. Control of drug-resistant bacteria is possible but requires a coordinated regional effort across the spectrum of health care facilities. Failure to control spread of antimicrobial drug–resistant bacteria hinders medical care at a growing number of facilities by creating hazardous opportunities for untreatable infections during aggressive medical interventions, such as immunosuppressive therapies and device insertions, or during common endoscopic procedures.
To combat CRE, the Centers for Disease Control and Prevention (CDC) recommends a "Detect and Protect" strategy: detect CRE patients through systematic surveillance and protect patients by preventing transmission of CRE through application of appropriate infection control precautions when such patients enter a health care facility. Because a patient is often cared for at multiple health care facilities, ensuring that information follows a patient is challenging: survivors of prolonged intensive care unit (ICU) treatment go through a median of 4 facility care transitions, including non–acute care facilities, within 1 year. To improve the effectiveness of the Detect and Protect strategy, information needs to be shared routinely among facilities, but information sharing often is suboptimal. Innovative tools to automate information sharing have been developed but have focused on hospitals; comprehensive systems are needed that extend beyond acute care hospitals and encompass large geographic regions.
Before 2013, the Illinois Department of Public Health (IDPH) had limited information about the epidemiology of CRE. A CDC-funded surveillance activity (REALM project), consisting of point prevalence studies of CRE carriage among ICU patients in Chicago acute care hospitals and all patients in long-term acute care hospitals (LTACHs) was ongoing; however, prevalence data were limited to Chicago and did not include patients outside the ICU or in long-term care facilities (LTCFs). The first function of the XDRO registry was to provide a mechanism for standardized reporting of CRE carrier patients from all health care facilities throughout the state.
In November 2013, IDPH launched a public health informatics tool called the XDRO registry (http://www.xdro.org), designed to facilitate information exchange throughout health care facilities in Illinois. The first function of the registry was to provide a mechanism for standardized reporting of patients in whom CRE was detected. The registry, an electronic platform for CRE information exchange, receives reports (Figure 1) of CRE in accordance with a state-enacted surveillance rule (Table 1) and centrally stores patient-specific CRE information (Figure 2). The registry was developed through collaboration among public health agencies (federal, state, city, and local), informatics specialists, infection control professionals, microbiologists, and academic researchers. We report our experience designing and implementing the Illinois XDRO registry.
(Enlarge Image)
Figure 1.
Display of Illinois XDRO registry's submission page. Completion of 1 report is contained within this single page. Asterisk indicates required fields. Field names in gray font (i.e., Escherichia coli and Klebsiella spp. criterion and mechanism of resistance) are conditioned on prior responses, organism name and XDRO criteria, respectively. The field "For laboratories and IDPH only" is not visible for other users; this field enables public health and reference laboratories to input isolates for facilities that have not submitted a report. XDRO, extensively drug-resistant organism.
(Enlarge Image)
Figure 2.
Conceptual framework of the XDRO registry, Illinois, USA. XDRO, extensively drug-resistant organism
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