Senior doctor with tablet in his office. Case Studies

Successful Infection Control and Prevention

  • SmartSteward™’s real-time antibiogram from the facility identified isolates of carbapenem resistant Enterobacteriaceae (CRE) at the facility.
  • CRE cause serious infections including UTI infections, bloodstream infections, wound infections, and pneumonia.
  • The facility’s DON and physicians were notified about the CRE and acted to successfully prevent spread of infection.
Real time antibiogram||Heat map identifying CRE||smartsteward-mdro-screen
  • SmartSteward™ EYE identified a new clone of ESBL in 4 separate patients in 2 wings was discovered.
  • Extended spectrum beta-lactamases (ESBLs) are caused by the overuse of Cephalosporins and Fluoroquinolones.
  • The SmartSteward™ EYE heat map function indicated patients were in close proximity and notified the facility DON.
  • SmartSteward™ reviewed and recommended actions to take, including suggesting potential sources, infection control practices, and guidance on future use of antibiotics.
  • SmartSteward™ EYE deployed a new algorithm for the detection of Carbapenem Resistant Pseudomonas (CRP) immediately identify and new CRP isolate in our pilot facility right after deployment.
  • Carbapenem Resistant Pseudomonas (CRP) occur in patients whose care requires devices like ventilators, urinary and intravenous catheters.
  • The lab report did not highlight this dangerous MDRO and no one at the facility was aware of its presence.
  • SmartSteward™ alerted the facility’s IPCO and medical director and sent guidance on isolation to prevent the spread of the CRP.
  • The facility contacted the testing lab to confirm the presence of the CRP and requested a retest which came back positive to the presence of this CRP isolate.
  • The facility was then able to isolate the patient to prevent the spread of this dangerous CRP.

Reducing Rehospitalizations

  • Infections are one of the primary causes of rehospitalizations in SNFs.
  • Physicians are often offsite and lack information about the patient and their current condition.


  • SmartSteward™ allows for 24/7 surveillance of infections throughout the facility.
  • SmartSteward™ has a built-in communication tool that makes it easy to share information like labs, radiographic images and pictures.
  • Nurse was concerned about a patient with a left arm that was red, swollen, warm and tender to touch and alerted the doctor.
  • Doctor was not at the facility, lacked patient information and was inclined to readmit.
  • Nurse informed Doctor that patient had a left arm cephalic vein thrombosis before transfer from hospital.
  • Doctor requested more information from the nurse on current drug profile.
  • Nurse indicated no antibiotic treatment currently and sent a picture to attending physician.
  • Based on the image, doctor decided no antibiotics were needed and decided not to readmit the patient to hospital.
SmartSteward Prevents Rehospitalizations

Antibiotic Reassessment

  • Communication between nurses and doctors is key to the successful management of infection events and challenging when doctors are frequently offsite.
  • Patient reassessment during antibiotic treatment is a critical element of antibiotic stewardship which is often neglected.


  • SmartSteward™ sets 24 to 72 hour timeout reminders to reassess with every antibiotic prescription.
  • SmartSteward™ automatically notifies nurses when it’s time to reassess the patient.
  • Nurse on day shift was concerned of patient’s altered mental status and used SmartSteward™ to reach out to the doctor who requested a urinary analysis.
  • Abnormal UA lab result was forwarded by nurse to doctor.
  • Doctor issued Rx Cefdinir 300 mg/5 days. Doctor also requested a 48 hr. reassessment.
  • Nurse on evening shift was sent reminder to reassessed at 48 hrs and found no change in patient’s condition and alerted doctor.
  • Doctor ordered a new urinanalysis which was positive.
  • Doctor discontinued cefdinir.
  • Started new prescription for optimal therapy – (Nitrofurantoin 100 mg/7 days).
  • Patient’s condition improved.

Change in Facility Resistance Patterns

  • Prescribing doctors often don’t have the right information in hand at the point of prescribing
  • Semi-annual antibiograms are outdated and difficult to interpret
  • Prescribing without the most up to date resistance patterns in the facility causes antibiotic resistance
  • The following resistance trend appeared at a facility


  • SmartSteward™ enables prescribers with real-time data at the point of prescribing
  • SmartSteward™’s customized real time antibiograms are easy to read and help prescribers optimize their prescribing
  • SmartSteward™’s feedback to physicians can change their prescribing habits and lower facility resistance
  • SmartSteward™ sent the following alert:
    • Notification to Facility: “Please note the rather dramatic drop in cephalosporin activity in recent cultures of gram negatives at Ayers.  This is from just a few urine specimens but to prevent them from spreading I have asked Drs. Smith and Jones (via text) to avoid cephalosporin use for 6 weeks.  Please note that Fosfomycin, Bactrim, and Macrodantin retain pretty good activity.  This graph is on your ASP dashboard”.

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