In the aftermath of the recent SARS crisis, health-care facilities have invested a great deal of time and innovative thinking to identifying and preventing the spread of new viral infections. Although the incidence of SARS was limited to a few acute care facilities, there was concern that there had been the potential for exposure among the staff and patients of Bridgepoint Hospital. The implications of an incident of SARS in a Complex Care facility were extremely grave, given the fragile health status of the patients. Bridgepoint responded quickly and imaginatively.
To keep a continuous flow of clean, uncontaminated air, most acute care hospitals have negative pressure rooms that are designed to constantly filter and exhaust inside air to the outdoors. But, a hospital like Bridgepoint, having a much lower rate of contact with infectious illness, has a correspondingly lower requirement for negative pressure rooms.
When we knew that there had been a possible exposure to SARS, we had to act quickly to create negative pressure rooms. The best thing to do was to get portable air filtration units but there weren’t any left among health-care suppliers due to the demand by acute care facilities. Quick thinking lead us to an asbestos abatement supplier; asbestos abatement companies specialize in high powered air cleaning engineering and, sure enough, they were able to immediately provide us with portable units.
Negative pressure rooms, however, were only part of the solution. We quickly realized that the SARS situation fundamentally changed what we think of as “normal”. We had to provide long-term solutions for the “new normal”.
Tracking the numbersIt became clear that in order to track infections, we had to have better monitoring of the flow of people in and out of the facility. Detailed screening procedures that were adopted during the crisis were going to have to become part of the “new normal”. However, compiling data and managing those screening procedures had placed a significant burden on administrative staff Ð since the number of people coming and going on any given day was, surprisingly, around 400. Forms had to be filled out manually and checked repeatedly. Daily visitors had to go through identical, lengthy screening procedures for each visit.
We quickly realized that the recording and tracking of patient, visitor and staff activity would continue to be a critical aspect of infection control. We also realized that the resources required to capture and maintain all this data was impossible to sustain over an extended period of time without jeopardizing the efficiency of operations.
A better wayBridgepoint Hospital decided as early as April, to re-examine the screening process. We needed to find a more efficient and cost-effective solution that would improve infection control and, at the same time, would also improve overall security and safety. Better use of information technology appeared to be the logical path to take.
We began working with a technology partner to develop a new screening, access control and monitoring software. A software solution was quickly developed in conjunction with Queen’s University’s Anaesthesiology Informatics Laboratory (QUAIL) at Kingston General Hospital. In a collaborative process, QUAIL worked with Bridgepoint Hospital to test and pilot the solution and see if we could expand its functionality in a live setting. It was a resounding success and word quickly got out that Bridgepoint had a monitoring system that saved time, saved money and efficiently monitored human traffic. A number of other hospitals are looking at the software and the Baycrest Centre for Geriatric Care has already installed it.
In simple terms, we have added a bar code system onto an identity card for staff and patients. By swiping their card as they enter and exit, data on patients or staff is automatically retrieved from the database. Updated or new information can be logged and stored in the database immediately.
While visitors are not issued a bar-coded card, information is entered on the system at the time of their first visit. The data can then be retrieved during any subsequent visit by simply entering the visitor’s name. This eliminates the need for repetition of basic information, allows for immediate storage of updated information, shortens the time spent on screening procedures and reduces the clerical burdens on administrative staff.
Essentially, this process allows us to create an audit trail, which is critical to managing the spread of infectious diseases and ensuring the safety of our patients and staff.
Taking a longer viewWhile the initial application of the software was to alleviate the SARS situation, the longer-term benefits to infection control practices are clearly evident. It provides a better record of who is in the building, which would be helpful in the case of an emergency situation.
SARS has made all of us more aware that we need to know more about who leaves and enters our facilities, where they are going, and the impact their movements can have on other patients, staff and the community at large. Having the systems and processes in place to manage that activity has become an integral part of infection control in particular, and daily life in general.