Graduation Date

Summer 8-14-2015

Document Type


Degree Name

Doctor of Philosophy (PhD)


Biomedical Informatics

First Advisor

James McClay, M.D.

Second Advisor

Ann Fruhling, Ph.D.

Third Advisor

Trevor Van Schooneveld, M.D.


Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission.

Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, and frequency of contacts may compromise the effectiveness of infection prevention and control in hospitals. It was hypothesized that providing HCPs with a graphical user interface (GUI) to visualize spatial information on the risks of exposure to ABRIs would effectively increase HCPs’ SA. Increased SA may enhance biosurveillance and result in tactical decisions leading to better patient outcomes. The study employed a mixed qualitative-quantitative research method encompassing conceptualization of GUI content, transcription of electronic health record and biosurveillance data into GUI visual artifacts, and evaluation of the GUI’s impact on HCPs’ perception and comprehension of the conditions that increase the risk of ABRI transmission.

The study provided pilot evidence that visualization of spatial disease distribution and spatially-linked exposures and interventions significantly increases HCPs’ SA when compared to current practice. The research demonstrates that the SA-oriented GUI enables the HCPs to promptly answer the question, “At a given location, what are the risks of infection transmission there?”

This research provides a new form of medical knowledge representation for spatial population-based decision-making within enclosed environments. The next steps include rapid application development and further hypothesis testing concerning the impact of this GUI on decsion-making.


This work attempted to address the Centers for Disease Control and Prevention's call to create opportunity for innovative decisions to fight antibiotic resistant infections by visualizing electronic biosurveillance data and big data available in local EHR systems.