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Health Information Technology to Reduce Healthcare-Associated Infections (HIT-HAI)

Principal Investigator

Elaine Larson, PhD, RN, CIC, FAAN
Associate Dean for Research
Columbia University School of Nursing

Funded by the National Institute for Nursing Research, National Institutes of Health, 2R01NR010822 $1,098,141 awarded March 6, 2013 through December 31, 2015

Project Summary

The development and expansion of health information technology holds great promise for improving coordination and standardization of clinical care and health outcomes for individual patients and across health care settings. In addition, the availability of vast amounts of treatment and outcome data make it possible to evaluate on a large scale the clinical efficacy, effectiveness, and cost-effectiveness of preventive and therapeutic interventions and to assess relevant epidemiological aspects of care, such as risk factors, clinical presentations, and changes in outcomes or trends over time. Such potential, however, has yet to be fulfilled because data must often be gathered from multiple unlinked sources (e.g. data regarding laboratory tests, costs, radiology, physician orders and nursing notes, DRG coding, patient location, surgery, etc.) which do not ‘talk to’ each other. The result is that while huge volumes of patient- and institution-level information are collected, they are not optimally used to improve care or for comparative effectiveness, clinical or health services research. Even within the same healthcare system, data sources are often ‘siloed’ and unlinked.

With funding from the National Institute of Nursing Research (Distribution of the Costs of Antimicrobial Resistant Infections, R01 NR010822), we have developed a database of >319,000 patient discharges from four Manhattan hospitals for the years 2006-8. The primary aim of this study was to estimate the hospital costs of healthcare-acquired and community acquired resistant infections across a range of infections and in four distinct hospital settings, and we have demonstrated that antimicrobial resistance is associated with significantly greater costs and mortality risk than comparable infections with antimicrobial susceptible organisms. This database has also been used to answer a variety of clinical questions regarding healthcare-associated infections (HAI), but to continue to be useful and relevant, we have expanded and integrated the database as a targeted research data registry into the Clinical Data Warehouse of a large health care system so that it is continuously updated and sustained. The registry is available to a wide cadre of researchers for use for comparative effectiveness research (CER) and to track trends over time. This database provides a unique, sustainable, and rich source of information to examine a number of clinical questions regarding prevention of infections. In addition, we have investigated three specific aims: 1. Evaluate the effectiveness of adherence to transmission-based isolation precautions for preventing the spread of infections in acute care settings using transmission visualization techniques. 2. Examine the impact of nursing organizational factors (e.g., staffing, skill mix, turnover) on rates and types of HAI among hospitalized patients. 3. Compare the effectiveness of universal contact precautions with standard practice in intensive care units (ICUs) to reduce rates of acquisition and infection caused by multidrug-resistant organisms (MDROs) and Clostridium difficile.

Publications

Cato K, Liu J, Cohen B, Larson E.  Electronic surveillance of surgical site infections.  Surgical Infections (Larchmont) 2017;18:498-502.

Kelly AM, D’Agostino JF, Andrada LV, Liu J, Larson E.  Delayed tuberculosis diagnosis and costs of contact investigations for hospital exposure: New York City, 2010-2014.  American Journal of Infection Control 2017;45:483-486.

Cohen ME, Hathway JM, Salmasian H, Liu J, Terry M, Abrams JA, Freedberg DE.  Prophylaxis for stress ulcers with proton pump inhibitors is not associated with increased risk of bloodstream infections in the intensive care unit.  Clinical Gastroenterology and Hepatology 2017;15:1030-1036.

Tchakoute CT, Larson E, Liu J, Cohen B. Risk factors and temporal trends of hospital-acquired infections (HAIs) among HIV positive patients in urban New York City hospitals: 2006 to 2014.  Rev Recent Clin Trials 2016. [Epub ahead of print.]

Fonseca G, Burgermaster M, Larson E, Seres DS. The relationship between parenteral nutrition and central line-associated bloodstream infections.  Journal of Parenteral and Enteral Nutrition 2017. [Epub ahead of print.]

Hessels AJ, Agarwal M, Liu J, Larson E.  Incidence and risk factors for health-care associated infections after hip operation.  Surgical Infections (Larchmont) 2016;17:761-765.

Monteserin N, Larson E.  Temporal trends and risk factors for healthcare-associated vancomycin-resistant enterococci in adults.  Journal of Hospital Infection 2016;94:236-241.

Thurman CB, Abbott M, Liu J, Larson E.  Risk for health care-associated bloodstream infections in pediatric oncology patients with various malignancies.  Journal of Pediatric Oncology Nursing 2017;34:196-202.

Park SO, Liu J, Furuya EY, Larson EL.  Carbapenem-Resistant Klebsiella pneumoniae Infection in Three New York City Hospitals Trended Downwards From 2006 to 2014.  Open Forum Infections Disease 2016;3(4):ofw222.

Yoon S, Cohen B, Cato KD, Liu J, Larson E.  Visualization of data regarding infections using eye tracking techniques.  Journal of Nursing Scholarship 2016;48:224-53.

Baker P, Cohen B, Liu J, Larson E.  Incidence and risk factors for community-associated methicillin-resistant Staphylococcus aureus in New York City, 2006-2012.  Epidemiology and Infection 2016;144:1014-7.

Chen Y, Liu J, Larson E.  Temporal trends and factors associated with pediatric hospitalizations with respiratory infection.  Journal of Asthma 2016;53:15-18.

Ellis D, Cohen B, Lui J, Larson E.  Risk factors for hospital-acquired antimicrobial-resistant infection caused by Acinetobacter baumannii.  Antimicrobial Resistance and Infection Control 2015;4:40.

Cohen B, Vawdrey DK, Liu J, Caplan D, Furuya EY, Mis FW, Larson E.  Challenges associated with using large data sets for quality assessment and research in clinical settings.  Policy, Politics, & Nursing Practice 2015;16:117-24.

Conway LJ, Carter EJ, Larson EL.  Risk factors for nosocomial bacteremia secondary to catheter-associated bacteruria: a systematic review.  Urologic Nursing 2015; 35:191-203

Ippolito P, Larson EL, Furuya EY, Liu J, Seres DS. Utility of electronic medical records to assess the relationship between parenteral nutrition and central line-associated bloodstream infections in adult hospitalized patients.   Journal of Parenteral and Enteral Nutrition 2015;39:929-34.

Miko BA, Kamath SS, Cohen BA, Jeon C, Jia H, Larson EL.  Epidemiologic associations between short-bowel syndrome and bloodstream infection among hospitalized children.  Journal of the Pediatric Infectious Diseases Society 2015;4:192-7.

Shang J, Stone PW, Larson E.  Studies on nurse staffing and health care-associated infection: methodological challenges and potential solutions.  American Journal of Infection Control 2015;43:581-8.

Cato KD, Cohen B, Larson E.  Data elements and validation methods used for electronic surveillance of healthcare-associated infections:  a systematic review.  American Journal of Infection Control 2015;43:600-5.

Spadafino JT, Cohen B, Liu J, Larson E.  Temporal trends and risk factors for extended-spectrum beta-lactamase-producing Escherichia coli in adults with catheter-associated urinary tract infections.  Journal of Antimicrobial Resistance and Infection Control 2014;3:39.

Jeon CY, Muennig P, Furuya EY, Cohen B, Nash D, Larson EL.  Burden of present-on-admission infections and healthcare-associated infections by race and ethnicity.  American Journal of Infection Control 2014;42:1296-1302.

Mitha M, Furuya EY, Larson E.  Risk of healthcare associated infections in HIV positive patients.  Journal of Infection Prevention 2014;15:214-220.

Wolfe CM, Cohen B, Larson E.  Prevalence and risk factors for antibiotic-resistant community-associated bloodstream infections.  Journal of Infection and Public Health 2014;7:224-32.

Hogle NJ, Cohen B, Hyman S, Larson E, Fowler D.  Incidence and risk factors for and the effect of a program to reduce the incidence of surgical site infection after cardiac surgery.  Surgical Infections 2014;15:299-304.

Cohen B, Choi YJ, Hyman S, Furuya EY, Neidell M, Larson E.  Gender differences in risk of bloodstream and surgical site infections.  Journal of General Internal Medicine 2013;28:1318-25.