Evans et al. described how an established system for surveillance
was updated within their hospital.44 The system was
comprised of a number of modules, which contained rules that
could support the detection of HCAI if evidence was found
within the many data sets feeding into the system. Daily HCAI
alerts were retrieved from the system, as well as infections at
sterile body sites, reportable diseases, antibiotic-resistant organisms,
and alerts of patients not receiving appropriate
antimicrobial therapy based on culture and susceptibility
results.
Doherty et al. explained how, after increasing interest, a
system was adapted for use in several institutions.45 The system
was originally developed in one hospital and had been in
use at that institution for over a decade. Adaptations to the
original system included the replacement of text report rules
(specific to the original hospital where the original system was
developed) with generic XML-based rule sets. The new system
was installed successfully in a large academic hospital and two
community hospitals, although numerous issues related to
differences in pre-existing systems and infrastructure at each
individual hospital had to be addressed first.
The application of electronic methods for objectives beyond
the detection of HCAI has also been demonstrated. Kac et al.
developed a computerized system that involved the daily
merger of multi-drug-resistant bacteria data and the admissionedischargeetransfer
database.46 The aim of this study was
to improve staff compliance with the implementation of
isolation procedures around patients with infections caused by
multi-drug-resistant bacteria. The results of the study
confirmed that the computerized system did improve clinical
practice, and was associated with sustained effect following
the intervention. Passerini et al. aimed to introduce a standardized
method for alerting relevant members of staff to
positive microbiological results.47 An automated email system
was developed and implemented in 2006 for routine use within
the hospital, which resulted in the rapid detection and notification
of alert conditions.
Electronic surveillance systems excluding
microbiological data
As seen in Table I, the majority of electronic systems identified
included the use of microbiological data. However, the
systematic search also identified several studies that did not
utilize microbiological data.48e51 Inacio et al. used a hybrid
system to detect cases of SSI following total joint replacement
procedures.48 The system involved the screening of data contained
within a registry, which was used to identify all total
joint replacement procedures, ICD-9-CM codes for electronic
screening, and a review of electronic health records of flagged