BACKGROUND: Illinois’ XDRO registry supports inter-facility communication and timely infection control action. Carbapenem-resistant Enterobacteriaceae (CRE) are reportable to the registry; an automated alerting system emails infection preventionists when CRE-positive patients are admitted to their hospital. Following a successful 2015 pilot, auto alerting is being expanded to hospitals across Illinois. Additionally, a method for sending text message or pager alerts was developed for more rapid notification, especially outside normal office hours. The XDRO registry’s design allows for rapid scale-up to include emerging pathogens of concern. In 2016, CDC issued a clinical alert for multidrug-resistant Candida auris. After cases were identified in Illinois, the Illinois Department of Public Health (IDPH) decided to add C. auris to the registry.
METHODS: We prioritized hospitals for auto alert expansion based on social network connections among facilities. Highly connected hospitals were targeted, as were “bridge” hospitals in low-prevalence regions of Illinois that are connected to Illinois’ high-prevalence region (Chicagoland) and serve as hubs for patient transfer within low-prevalence regions. Providers, by default, receive email alerts and must log into the registry to view patient information. Now, providers can add the option of SMS text and pager alerts, sent real-time from 8am–8pm, with off-hours alerts queued until 8am the next day. Illinois’ communicable diseases administrative code allowed the addition of C. auris to the registry. The new report form and alerting method were based on infrastructure built for CRE.
RESULTS: In 2016, 4 Chicagoland and 2 bridge hospitals began receiving auto alerts, for a total of 16 hospitals. Text alerting began at one hospital, and pager alerting at another. From 1/7/2015 – 12/12/2016, the 16 hospitals received 475 alerts for 193 unique patients. Among the 182 correct patients for which there were data, the facility did not know CRE status for 78 (43%). Of those, 48 (62%) were not in contact precautions at the time of the alert. Even among 104 patients for whom facilities had prior CRE information, 24 (23%) were not in contact precautions. Reporting and alerting for C. auris is expected to start January 2017. Only IDPH personnel will report non-CRE pathogens to allow for rapid rollout of the new feature.
CONCLUSIONS: Although initially launched for CRE with manual reporting and querying, the XDRO registry has been enhanced to include C. auris and auto alerting. Recent developments have demonstrated the XDRO registry’s ability to adapt to and address emerging public health needs.