When Atlanta attorney Andrew Speaker boarded a series of flights from the United States to Europe and back earlier this year, he set off a public health scare that caused Americans to focus their attention on superbugs, in this case a drug-resistant form of tuberculosis known as XDR-TB.

Although the incidence of TB in any of its varieties is rarer here than in other countries, superbugs are not. Hospitals nationwide are stepping up efforts to control these antibiotic-fighting microorganisms, many of which take advantage of hospital patients' weakened immune systems. And they're getting stronger. Studies have found that 70 percent of hospital-acquired infections (HAIs) resist the effects of two or more antibiotics.

Now a handful of Veterans Affairs Department hospitals - including facilities in Atlanta, Los Angeles and Pittsburgh - are installing automated disease surveillance systems to help clinicians track HAIs and other infections.

"The system alerts you to resistant or reportable organisms or clusters of unusual diseases you shouldn't be seeing," said Laura Morris, an infection control practitioner at the VA Medical Center in Pittsburgh.

The three facilities are deploying an electronic system that dovetails with a VA directive issued earlier this year to reduce incidents of Methicillin-resistant Staphylococcus aureus (MRSA), the virulent staph infection that plagues hospitals and nursing homes.

The surveillance system comes from TheraDoc, which is working with VA to incorporate the agency's existing MRSA-screening protocols into the application.

"The VA is trying to do rapid testing to figure out which people are at risk for contracting MRSA in the hospital and to identify people who may already be carriers so they can be isolated," said Scott Walker, vice president of strategic development at TheraDoc.

Once the protocols are integrated into the application, doctors and nurses will receive alerts when at-risk patients are not screened within predetermined time periods, he added.

The VA center in Pittsburgh is now testing the automated system alongside an existing paper-based surveillance program that uses reports generated by VA's Computerized Patient Record System and its Veterans Health Information Systems and Technology Architecture, which provides an electronic medical record.

"We're using both [the paper and automated] systems now to make sure everything is working, but the goal is to get rid of paper as we try to reduce the time we spend on surveillance," Morris said.

Deadly threats
VA and public hospitals have strong incentives to track HAIs closely. Patients suffer when they must remain under care beyond what's needed for their original illnesses, and the worst HAI cases result in death. Close monitoring of lab cultures using automated surveillance systems can help reduce infection rates by 13.5 percent, said Dr. Patrick Hymel, medical director at surveillance-system vendor MedMined.

The infections also result in hefty financial costs for hospitals. One study of cases complicated by central-line associated bloodstream infections found that hospitals pay an average of $26,839 in unreimbursed fees because of extended admissions and treatment regimens, said Dr. Dan Peterson, vice president and medical director at Premier, an alliance of nonprofit hospitals that manages a subscription-based disease-surveillance system.

Despite clinical and financial incentives, hospitals have been slow to adopt such systems. In a Premier survey of 150 professionals who specialize in controlling hospital-based infections, only about 13 percent said they relied on surveillance programs, in part because of administrators' reluctance to allocate precious funds to such applications, Peterson said.

Hospitals pay $100,000 to $300,000 for surveillance systems, vendors say. For example, MedMined prices its system based on a hospital's annual admissio
ns and the services it selects. A midsize facility with 10,000 admissions a year would pay about $150,000, Hymel said. Because surveillance systems reduce unreimbursed costs, the return on investment can be 4-to-1 in the first year a hospital uses the system, he added.

Time saver
Automated systems are less cumbersome and present information in easier-to-read formats than paper systems, said Carol Ward, program manager at Virtua Health, a multihospital health care system based in Marlton, N.J. She said she spends about 15 minutes each morning reviewing summaries of hospital labs' tests for infections.

The reports show infection types, incident rates and affected clinical areas. It used to take her as long as an hour to pore over paper reports to get the same snapshot of an outbreak, she said.

Surveillance systems home in on three main information sources: positive test results from nasal smears and similar procedures analyzed in the hospital's labs; data from admission and discharge reports that reveals infection clusters in different hospital units; and antibiotic treatments, which show hospital dosing patterns and can be used to prevent overuse of the drugs, thereby thwarting the rise of superbugs. Peterson said a surveillance system that tracked antibiotic treatments reduced the cost of those drugs by 23 percent at one hospital.

In addition, Ward uses Premier's system to slice and dice electronic reports, looking for incidents of difficult-to-treat diseases beyond MRSA, including Clostridium difficile and vancomycin-resistant enterococci.

"At a glance, I can sort the columns by facility, by organism or by the type of specimen they were isolating in the lab," she said. "That's what we were looking for - something to save us time."

"Some facilities still have their reports sent to them as 20 to 40 pages of paper with the pre-lab, post-lab and final results," Ward said. That's a lot of data to go through every day. Especially with the amount of drug-resistant organisms that we're seeing these days, we can in a more timely manner place patients into isolation. The system also lets us run real-time reports if I see a couple people on one unit that have an organism."

The pitch
In time, the reports generated by disease-surveillance systems could travel beyond hospital walls to state and local public health agencies and then onto the Centers for Disease Control and Prevention's national monitoring programs.

MedMined created a custom reporting module in its application that displays information from Pennsylvania hospitals in formats that conform to those requested by the state. Premier built an automated reporting capability that feeds information about reportable diseases from Nebraska hospitals directly to the state's public health authorities.

"When the results come in from the lab, there's no need for anyone at the hospital to call, write or send faxes to the state," Peterson said. "The results are automatically forwarded to the appropriate authorities."

He added that Premier is discussing similar communications links with other states and federal agencies.

But before surveillance systems can expand their regional reporting activities, more health departments must install technology that supports CDC's Public Health Information Network Messaging System (PHINMS).

"In order to pitch a baseball, you need a pitcher and a catcher," Peterson said. "Health departments haven't set up the catcher's mitt to receive the PHINMS messages."