Digital Detective

From the Winter 2018 edition of Vanderbilt Medicine Magazine

Not so long ago, when patients’ laboratory reports came back to Vanderbilt University Medical Center (VUMC) indicating the possible presence of serious infections, Infection Prevention team members would print out the reports and divvy them up so they could visit the Medical Center’s clinical floors to investigate each case.

“We were printing off hundreds of lab reports each morning and cutting them apart into piles to distribute to each infection preventionist (IP),” said Vicki Brinsko, RN, MSN, who joined the Infection Prevention team in 1986 as the nursing director of Infection Control. “We would then take these piles of cut-up paper inside alphabetized folders with us when we did our rounds.”

An internally developed infection surveillance platform known as VIPER streamlined that process, bypassed the scissors and brought the infection prevention team into the 21st century.

“Instead of cutting up ‘paper dolls,’ we can focus on initiatives that concentrate on preventing patient harm and keeping our patients safe.”

VIPER stands for the Vanderbilt Infection Prevention Electronic Resource. It was first launched in 2008 through a collaboration between HealthIT and the Department of Infection Prevention. When VIPER was developed a decade ago, the team decided there was no data surveillance product on the market that met VUMC’s needs, so they built their own.

VIPER quickly analyzes data and runs algorithms to determine if the data indicates a troubling infection. This triggers the Infection Prevention team, which can then work with clinicians to quickly put any needed infection prevention and patient isolation measures into action.

“VIPER scans through laboratory results for VUMC patients to identify positive cultures for antibiotic-resistant and epidemiologically important organisms, and positive cultures or laboratory tests for reportable, communicable pathogens,” explained Ted Anders, one of VIPER’s original architects.

VIPER also identifies patients with suspected healthcare-associated infections (HAIs), including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and ventilator-associated events (VAE).

VIPER integrates clinical data, including vital signs such as temperature and blood pressure, from a patient’s electronic medical record (EMR) with laboratory results. It also includes the patient’s location history — exactly where they’ve been moved within the hospital during their stay. Those cases that match the Centers for Disease Control and Prevention (CDC) criteria for an infection are flagged for the infection preventionists to investigate more closely, including visiting the clinical floor to examine the patient and consulting with the nursing staff. VIPER pulls all the information together in one view for the infection preventionist so they don’t have to search for the data they need to make their assessment.

VIPER also simplifies the regulatory, state, and CDC reporting of HAIs. For example, VIPER generates data the Infection Prevention team then submits to the CDC’s National Healthcare Safety Network (NHSN), a national healthcare-associated infection tracking system. The system also provides data for in-house reporting, including information patient care units use to measure their progress, all the way up to data to support Pillar Goals requested by Medical Center leadership, said Jim Rickwa, an Infection Prevention business intelligence developer.

“VIPER really shows its usefulness when you consider what a hospital is required to do, both internally and externally,” Rickwa said. “Externally, we have to submit information about the hospital to CMS (the Centers for Medicare & Medicaid Services). We also need to submit information to the state for community health reasons, and then we also need to understand how the hospital is doing internally for our own patient safety and hospital management.

“VIPER does a lot of the legwork for an infection preventionist,” Rickwa added. “Any algorithm or rules that a computer can perform, we let the computer bring it all together and make the relationships it can to save the IPs from having to do that. Then they can focus entirely on the clinical aspect of patient safety.”