Follow that Infection

June 24, 2011
John Glaser, Ph.D. The use of real-time location systems (RTLS) has been shown to generate significant benefits in the hospital setting in terms of
John Glaser, Ph.D.
The use of real-time location systems (RTLS) has been shown to generate significant benefits in the hospital setting in terms of time and cost savings. The technology enables staff members to quickly access information about the location and status of medical equipment, making it easier to find an available IV pump or wheelchair. These benefits have been well-documented. However, another use is starting to surface for RTLS, as a handful of facilities have recently begun leveraging the technology to help control the spread of infections in hospitals. It is, in the words of Partners HealthCare (Boston) CIO John Glaser, Ph.D., an “interesting idea” that can further drive what is already a growing trend in the health IT industry.

According to Mike Liard, research director for the RFID and Contactless Group at New York-based ABI Research, the total market for RFID is currently estimated at around $3.9 billion and could climb to $8.5 billion by 2012.

“There's a lot of interest and a lot of activity around RFID adoption,” says Liard. “Healthcare is certainly enjoying some of the more solid growth rates for sure. Part of what's driving that growth is that it's coming from a small base of installed technology. It's been growing quite well at a high rate the last few years, and we expect that trend to continue.”

Current adoption rates, however, are still somewhat low, with just 23 percent of providers reporting that they use the technology, according to data from the Healthcare Informatics Research Series.

One factor that could give the technology a boost is the infection control angle. Wayne Memorial Hospital, a 316-bed facility based in Goldsboro, N.C., is one of a handful of centers that are leveraging RTLS capabilities for infection control to more effectively locate and monitor equipment that has come into contact with patients carrying antibiotic-resistant organizations. Using this technology, staff members may be able to prevent — or at least manage — the spread of infections.

According to John Jernigan, deputy chief of prevention and response for the Center for Disease Control and Prevention's (CDC, Atlanta) Division of Healthcare Quality Promotion, the need for this type of technology is certainly pressing. The CDC estimates that there are 1.7 million hospital-acquired infections annually in United States hospitals, resulting in 98,000 deaths.

“Hospital-acquired infections are an important public health problem, and we need to do a lot more in terms of preventing the spread of these infections,” says Jernigan, who pinpoints Methicillin-resistant Staphylococcus aureus (MRSA) infections as the most serious one due to their ability to invade an entire body site.

An estimated 94,000 MRSA infections are reported in the United States each year, according to the CDC. Of those infections, says Jernigan, around 86 percent are associated with the delivery of healthcare. While he cites hand hygiene as the cornerstone of infection prevention, he feels that environmental cleaning and disinfection of equipment are vital as well.

MRSA usually results from transmission from one infected or colonized patient to another indirectly through either contaminated hands of healthcare personnel or equipment that was shared between patients, Jernigan says. This factor, he says, makes it all the more critical for healthcare workers to be able to identify and isolate equipment that may have been exposed to the virus. “Anything we can do to more fully implement the cleaning and disinfection procedures that exist in hospitals would be an important step in preventing transmission.”

With MRSA cases costing roughly $30,000 per patient, according to the CDC, it's logical to assume that any technology that can help diminish the number of incidents would be welcomed by most administrators. But is the case for asset tracking as an aid in infection control strong enough?

Tom Bradshaw
According to Liard, the potential is certainly there. “A lot is being done with asset tracking in healthcare,” he says, referring to the technology's primary capability of tracking equipment. “But then there are these secondary stories like infection control that are equally exciting and bring RFID technology into the fold and its capabilities.”

Making the case

At Wayne Memorial, where the RTLS from RadarFind (Research Triangle Park, N.C.) was implemented in 2007, infection control was certainly not a driving force for Tom Bradshaw and his staff; it wasn't until later down the road that they started to think about the system's other functionalities. Bradshaw, chief operations officer at Wayne, chose to deploy RadarFind's product in order to enable his staff to more efficiently monitor and locate the status of mobile medical equipment, and, potentially, improve both the quality of patient care and the proficiency of hospital operations.

Soon after implementation, the hospital was able to leverage the system's capability to gather utilization rate data to more effectively plan medical equipment purchases, resulting in significant cost savings, according to Bradshaw. With the RTLS system, he says, the staff at Wayne was able to capture data and determine how much time the IV pumps were being used — and perhaps more importantly — how much time they were not being utilized.

“We were able to analyze three months worth of data on our IV pumps,” says Bradshaw. “We ended up purchasing 53 fewer than we had budgeted, which saved us $300,000 on capital purchases.”

As Bradshaw and his staff became more familiar with the RTLS system, they started to explore its other functionalities, including the capability to assist in controlling the spread of infections.

“If we had an infection issue,” he says, “we could pull a report and track down the equipment that may have come into contact with a patient who might be infected. We could see what IV pumps were in the patient's room in the last 24 hours, what wheelchair they used, and what bed that patient was on.”

The RadarFind system, which is deployed at several other facilities including Our Lady of Lourdes Medical Center (a 410-bed facility based in Camden, N.J. that is part of Newtown Square, Pa.-based Catholic Health East) and WakeMed Health and Hospitals (Raleigh, N.C.), tracks individual devices and reports the time-stamped location history, indicating whether a device is available, in use, or needs to be cleaned. This data can then be used by the facility as part of an infection control surveillance system to identify equipment that has come into contact with patients who have contracted antibiotic-resistant organisms.

The data from the status portion of the tag monitors whether the device has passed through the appropriate decontamination process before it is allocated to another patient. With this functionality, facilities can determine causal relationships between contaminated medical devices by known infected patients, as Bradshaw says, enabling facilities to institute preventative measures to reduce the spread of infections.

“With the reports and information we have, we can tell where a particular piece of equipment has been,” he says. “It's not going to say whether that patient is infected or not.” However, if there was concern that a patient had been exposed to MRSA, the staff can then immediately isolate the equipment that needs to be sterilized.

Protection on a larger scale

While the infection control component is impressive to Liard, he still isn't sure whether it has enough legs on its own to attract many CIOs. For a health system to seek out RTLS for infection control, Bradshaw says, it's most likely going to be a facility that is located in a high-risk area, has experienced a high number of hepatitis or tuberculosis cases, or has had historical challenges in addressing these types of situations. Otherwise, he says, it becomes difficult to justify this kind of investment — unless, of course, the technology offers added capabilities, either on its own or through integration with other systems.

“You've got to look at the existing infrastructures in hospitals and start thinking about how you may be able to leverage technologies such as RFID and RTLS,” he says. In order to do this, the hospital IT team needs to examine what type of wireless infrastructure is installed and look at what they have in house “that can be leveraged that the RFID data and the technology is ultimately going to touch.”

At Wayne Memorial, the RadarFind RTLS system was designed to integrate with the hospital's existing infrastructure and operations, which opens up the possibility of utilizing the technology in other areas beyond equipment tracking. According to Bradshaw, the hospital is in the early stages of testing RFID tracking for patients and staff as well as assets. It is a concept that, he says, may help further leverage a technology that has already proven a worthy investment.

“We're looking to do this in the future,” he says, “not to watch what people are doing, but more to know if they were exposed to anything and for how long.” Although he notes that there will probably be issues to deal with and kinks to iron out, Bradshaw sees a great deal of potential for infection control in this capacity.

For other facilities, the focus is on continuing to grow equipment tracking on a larger scale. At Brigham and Women's Hospital in Boston, the real-time location platform from Andover, Mass.-based Radianse that was originally implemented in the cardiac care and perioperative units is now deployed in all of the medical and surgical units at the facility — including the ICU, OR and ED, as well as in the newly opened Carl J. and Ruth Shapiro Cardiovascular center. There are also plans to install the technology at the Mary Horrigan Connors Center for Women and Newborns, according to Michael Fraai, director of biomedical engineering at Brigham.

Although the facility is currently concentrating its efforts on expanding RFID asset tracking to different departments, an undertaking that is certainly time-consuming in a 747-bed institution, there are plans to leverage the technology for additional functionalities in the future.

“We are evaluating using it for patient tracking to do some efforts around process improvements for the ideal patient care experience,” says Fraai, adding that Brigham will also look to explore RFID for medication tracking down the road.

At Partners, Glaser says there is a lot of interest, and that “people are experimenting with tracking as they move through large clinics or hospitals.”

However, while some health systems are able to pilot technologies like RFID for different functionalities or in different areas and then make decisions based on what trials work out, others are too limited in resources to make that kind of jump until they are certain that a particular project warrants funding. This, according to Liard, is where prioritization becomes critical.

And according to Liard, “There needs to be solid program management within hospitals around RFID technology adoption. It's about business process change and solving the problems first, and it's about the technology change secondly. You have to think about what kind of business problems you're trying to solve, what are the pain points you're trying to address and what's the value proposition.”

For Bradshaw, infection control wasn't the primary issue when he first implemented an RTLS system, and it still isn't the technology's main selling point. Instead, he views it as a “secondary benefit,” adding that while the ability to slow the progression of an infection isn't something that has been incorporated into the day-to-day practice, “It's there if we need it.”

This is the type of thinking, according to Liard, that may boost the utilization of RTLS for the surveillance and prevention of the spread of infections. “It makes sense to me that it would. To what degree and how sophisticated is a question. But I see this whole field growing more and more, and I think certainly infection control is one of those areas where RTLS can be a major player.”

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