An automated outbreak detection tool reduced
the size of outbreaks by 64% in the trial period preceding the
COVID-19 pandemic in a study of 82 hospitals
An automated tool that improves outbreak detection for hundreds
of pathogens successfully served as an early warning system to find
and respond to potential hospital outbreaks, as reported
today in NEJM Evidence.
A Trial of Automated Outbreak Detection to Reduce Hospital
Pathogen Spread
The large multi-state, real-world study was conducted in 82
hospitals and led by Harvard Pilgrim Health Care Institute, HCA
Healthcare, University of California, Irvine (UCI) Health and the
Centers for Disease Control and Prevention (CDC).
Contagious bacteria and other pathogens can spread in hospitals,
increasing the risk of harmful infections in patients. While
hospitals and health systems work to prevent infections and reduce
the opportunity for outbreaks to occur, there is no standardized
approach for detecting transmission. Early detection can lead to a
rapid response that reduces the chance for outbreaks to occur.
"Despite significant progress in reducing healthcare-associated
infection outbreaks, including of antimicrobial-resistant
pathogens, they remain an industry challenge and can present as
clusters that signal potential for transmission to patients,” said
Joseph Perz, DrPH, MA, Senior Advisor for Public Health Programs in
CDC’s Division of Healthcare Quality Promotion, and committee
member for the CDC’s Council for Outbreak Response:
Healthcare-Associated Infections. “The CLUSTER trial provides
evidence that early detection powered by automation tools and quick
action can prevent outbreaks from growing."
Most hospitals focus on a small number of antibiotic-resistant
organisms and miss outbreaks from other pathogens. To address this,
investigators developed an algorithm-driven statistical outbreak
detection tool that used clinical laboratory data to provide
real-time alerts to hospital infection prevention programs about
potential transmission of over 100 bacterial and fungal species.
This method relied on an automated review of organisms grown from
patients’ clinical cultures and a statistical assessment of whether
an increase was seen compared to prior experience. Detected
increases triggered an automatic notification for hospital
personnel to implement a response protocol to prevent additional
cases.
“Outbreaks in hospitals are often missed or detected late, after
preventable infections have occurred. This study provides a
practical and standardized approach to identify early transmission
and halt events that could become an outbreak in hospitals,” said
lead investigator, Meghan A. Baker, MD, ScD, Harvard Medical School
assistant professor of population medicine at the Harvard Pilgrim
Health Care Institute.
The automated outbreak detection method was tested from
2019-2022 in a randomized clinical trial in 82 hospitals across 16
states in the HCA Healthcare system, a leader in real-world
evidence-based research. Half of the hospitals implemented the
automated early detection method, and the other half continued with
usual care. Hospitals that were assigned to receive and respond to
the automated alerts experienced a 64% reduction in the size of
potential outbreaks until the trial was interrupted by the COVID-19
pandemic. During the pandemic, personnel were not able to respond
as effectively to automated alerts, and across the combined
pre-pandemic and pandemic trial period, there was no overall
effect. Nevertheless, in analyses restricted to the pre-pandemic
period, the outbreak detection tool was associated with a
demonstrable and significant reduction in cases. While the actual
risks of an outbreak are low, even one outbreak can be significant.
The automated system notified hospitals about possible events
approximately three times per year per hospital so early
preventative responses could be taken to maximize patient
safety.
“This ongoing collaboration continues to leverage our scale –
both the number of our hospitals and our advanced data ecosystem –
as we work to rapidly answer clinical questions that benefit
patients everywhere,” said Kenneth Sands, MD, MPH, chief
epidemiologist at HCA Healthcare. “We are using this detection tool
in the hospitals where we tested it and are evaluating
implementation more widely across our system.”
The underlying software is available for free to all hospital
systems but must be integrated into their respective electronic
health record system or other clinical workflow platforms.
The study was funded by CDC and conducted through a longstanding
scientific consortium, including HCA Healthcare, Harvard Pilgrim
Health Care Institute's Department of Population Medicine, the
University of California, Irvine and the CDC’s Prevention
Epicenters Program. It is part of a growing body of work by the
partners to improve patient care and reduce risk of
healthcare-associated infections.
About Harvard Pilgrim Health Care Institute’s Department of
Population Medicine
The Harvard Pilgrim Health Care Institute's Department of
Population Medicine is a unique collaboration between Harvard
Pilgrim Health Care and Harvard Medical School. Created in 1992, it
is the first appointing medical school department in the United
States based in a health plan. The Institute focuses on improving
health care delivery and population health through innovative
research and education, in partnership with health plans, delivery
systems, and public health agencies. Point32Health is the parent
company of Harvard Pilgrim Health Care and Tufts Health Plan.
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About HCA Healthcare
Nashville-based HCA Healthcare is one of the nation’s leading
providers of healthcare services comprising 186hospitals and
approximately 2,400 ambulatory sites of care, including surgery
centers, freestanding ERs, urgent care centers, and physician
clinics, in 20 states and the United Kingdom. With its founding in
1968, HCA Healthcare created a new model for hospital care in the
United States, using combined resources to strengthen hospitals,
deliver patient-focused care and improve the practice of medicine.
With a robust system for analyzing clinical data across large and
diverse patient populations, HCA Healthcare is a leader in
pragmatic research like the Swap Out, ABATE and REDUCE MRSA trials
that can help identify new standards of care. HCA Healthcare is a
learning health system that uses its more than 43 million annual
patient encounters to advance science, improve patient care and
save lives.
About UCI Health
UCI Health is the clinical enterprise of the University of
California, Irvine, and the only academic health system in Orange
County. Patients can access UCI Health at primary and specialty
care offices across Orange County and at its main campus, UCI
Medical Center in Orange, Calif. The 459-bed, acute care hospital,
listed among America’s Best Hospitals by U.S. News & World
Report for 22 consecutive years, provides tertiary and quaternary
care, ambulatory and specialty medical clinics, behavioral health
and rehabilitation services. UCI Medical Center is home to Orange
County’s only National Cancer Institute-designated comprehensive
cancer center, high-risk perinatal/neonatal program and American
College of Surgeons-verified Level I adult and Level II pediatric
trauma center and regional burn center. UCI Health serves a region
of nearly 4 million people in Orange County, western Riverside
County and southeast Los Angeles County. Follow us on Facebook,
Instagram, LinkedIn and Twitter.
About the Centers for Disease Control and Prevention
(CDC)
Whether diseases start at home or abroad, are curable or
preventable, chronic or acute, or from human activity or deliberate
attack, CDC’s world-leading experts protect lives and livelihoods,
national security and the U.S. economy by providing timely,
commonsense information, and rapidly identifying and responding to
diseases, including outbreaks and illnesses. CDC drives science,
public health research, and data innovation in communities across
the country by investing in local initiatives to protect everyone’s
health.
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version on businesswire.com: https://www.businesswire.com/news/home/20240423503926/en/
HCA HEALTHCARE: Investor Contact Frank Morgan
615-344-2688
Media Contact Harlow Sumerford 615-344-1851
UCI HEALTH: Sophia Papa 661-369-6968 spapa@hs.uci.edu
CENTERS FOR DISEASE CONTROL AND PREVENTION: Martha Sharan
404-998-1787 msharan@cdc.gov
HARVARD PILGRIM HEALTH CARE INSTITUTE: Maya Dutta-Linn
Maya_Dutta-Linn@hphci.harvard.edu
Jessica Meuleman Jessica_Meuleman@hphci.harvard.edu
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