1. APIC CHAPTER 13 Journal Club
January 17, 2018
Presented by: Talia Lefkowitz, BSN, RN, CIC
Mount Sinai Hospital

2. Contact tracing with real-time location system: A case study of increasing relative effectiveness in an emergency department
Contact tracing with real-time location system: A case study of increasing relative effectiveness in an emergency department
American Journal of Infection Control, Volume 45, Issue 12,
Thomas R. Hellmich MD, Casey M, Clements MD, PhD, Nibras El-Sherif MBBS, Kalyan S. Pasupathy PhD, David M. Nestler MD, MS, Andy Boggust MD, Vickie K. Ernste DNP, RN, Gomathi Marisamy BS, Kyle R. Koenig BS, M. Susan Hallbeck PhD, CPE, PE
Affiliated with Mayo Clinic, Rochester, MN

3. Background
Contact tracing is a critical strategy required for timely prevention and control of infectious disease outbreaks
Conventional methods (chart review, staff interviews) are imperfect:
Time-consuming (30-60 minutes)
Can miss a significant number of potential exposures
Failure to identify persons in contact with infected patients:
Increases the risk of transmission
Places healthcare workers and patients at risk
Disrupts healthcare services
Costly for healthcare systems

4. Background New technology Real-time location systems (RTLS)
May identify exposed individuals in a timely, efficient, and exhaustive manner
Becoming increasingly affordable
Real-time location systems (RTLS)
Radiofrequency identification (RFID) tracking
RFID in healthcare settings
Face-to-face contact frequency and duration
Identify the most and least connected health care workers with patients
This study compares current method (chart review) and RTLS tracking for confirmed pertussis cases in an emergency room

5. Materials and Methods Equipment
54,450 sq ft ED and radiology (supporting ED services)
194 in-ceiling, passive RFID readers
734 antennas
212 locations
System was reliable for 6 months before data collection
Core ED staff wore RFID-enabled ID tags
Some ancillary staff in ED did not have RFID-enabled ID tags

6. Materials and Methods Study protocol Retrospective case study
9 cases of confirmed pertussis June 14- August 31, 2016
Large ED of tertiary medical center
74,000 patient encounters per year
All cases diagnosed within 1-2 days after ED visit, none admitted to hospital

7. Materials and Methods Study protocol (continued)
Existing contact tracing protocol
Review of EMR (Infection control and nurse leadership)
Possible exposure included any health care worker with face-to-face contact with index patient in exam room or triage area and documented in EMR
RTLS event mapping
Identified patients and staff, colocations and movement over time and space
Then, list of possible exposures limited to colocation in ED exam rooms or triage areas where droplet exposures are most likely
< 5 minutes
All possible exposures were offered standard prophylaxis

8. Materials and methods Analysis
Compared number and roles of possible exposures identified via EMR vs RTLS
Used descriptive statistics and paired t tests
Correlation between length of stay (LOS) and number of contacts identified by each methodology

9. Results 9 cases of pertussis total EMR RTLS
Identified 45 potential contacts
13 were identified by EMR alone (the other 33 were also identified by the RTLS)
RTLS
Identified 77 contacts
Of the 77, 45 were identified by RTLS alone (the other 32 were also identified by the EMR)
RTLS identified 2X possible contacts than EMR (P<.01)
Increased the average contacts per case from 5/case to 10/case

10. Discussion
Statistically significant positive correlation with ED LOS and RTLS-identified contacts
Increase LOS of contagious patients increases potential for nosocomial spread
The longer the stay = the more encounters with healthcare workers
RTLS saves time and resources
RTLS may reduce recall bias
RTLS failed to identify 13 healthcare workers: 4 were not given RFID, 6 RNs were missed (their antenna has since been moved), 1 MD badge not read, 1 MD not wearing correct RFID badge, and 1 RN not picked up unclear
RTLS is costly, need to justify

11. Discussion Study limitations which make it less generalizable
Small sample size
Only one ED
Only one disease
Did not include the mitigating effect of PPE use
Did not take cost into account

12. Conclusions
RTLS identified more potential contacts than traditional method
Technology can accelerate the process of active screening and facilitate timely cessation in the chain of transmission
RTLS may be even more beneficial in tertiary care medical systems with higher acuity; event mapping using RTLS is customizable to pick up brief exposures in the event of high-risk emerging infections transmitted by airborne spread