Electronically assisted surveillance systems of healthcare-associated infections: a systematic review.

BackgroundSurveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency.ObjectivesTo give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them.MethodsIn this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented.ResultsA total of 78 studies were included. The majority of EASS (n = 72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n = 7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (> 0.8), but specificity varied (0.37-1). Less than 20% (n = 14) of the studies presented data on the efficiency gains achieved.ConclusionsElectronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency.

Computer-assisted, high-frequency, hospital-wide point prevalence surveys of hospital-acquired infections in a tertiary care hospital, the Netherlands, 2013 to 2014.

BackgroundSurveillance of hospital-acquired infections (HAI) often relies on point prevalence surveys (PPS) to detect major deviations in the occurrence of HAI, supplemented with incidence measurements when more detailed information is needed. In a 1,320-bed university medical centre in the Netherlands, we evaluated an electronically assisted surveillance system based on frequently performed computer-assisted PPS (CAPPS).AimThe primary goals were to evaluate the performance of this method to detect trends and to determine how adjustments in the frequency with which the CAPPS are performed would affect this performance. A secondary goal was to evaluate the performance of the algorithm (nosocomial infection index (Nii)) used.MethodsWe analysed the data of 77 hospital-wide PPS, performed over a 2-year period (2013 and 2014) and including 25,056 patients.ResultsSix trends with statistical significance were detected. The probability to detect such trends rapidly decreased when PPS are performed at a lower frequency. The Nii and its dynamics strongly correlated with the presence of HAI.ConclusionPerforming computer-assisted, high frequency hospital-wide PPS, is a feasible method that will detect even subtle changes in HAI prevalence over time.

Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit.

BACKGROUND: Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU. METHODS: We performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room). These periods were compared with respect to the occurrence of representative MDR Gram-negative bacteria. Routine microbiological screening, was performed on all patients on admission to the ICU and then twice a week. Multi-drug resistance was defined according to a national guideline. The first isolates per patient that met the MDR-criteria, detected during the ICU admission were included in the analysis. To investigate the clonality, isolates were genotyped by DiversiLab (bioMérieux, France) or Amplified Fragment Length Polymorphism (AFLP). To guarantee the comparability of the two periods, the 'before' and 'after' periods were chosen such that they were approximately identical with respect to the following factors: number of admissions, number of beds, bed occupancy rate, per year and month. RESULTS: Despite infection prevention efforts, high prevalence of MRD bacteria continue to occur in the original facility. A marked and sustained decrease in the prevalence of MDR-GN bacteria was observed after the migration to the new ICU, while there appear to be no significant changes in the other variables including bed occupancy and numbers of patient admissions. CONCLUSION: Single room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria.

An automated algorithm to preselect patients to be assessed individually in point prevalence surveys for hospital-acquired infections in surgery.

In this pilot study, we evaluate an algorithm that uses predictive clinical and laboratory parameters to differentiate between patients with hospital-acquired infection (HAI) and patients without HAI. Seventy-four percent of the studied population of surgical patients could be reliably (negative predictive value of 98%) excluded from detailed assessment by the infection control practitioner.

Evaluation of an algorithm for electronic surveillance of hospital-acquired infections yielding serial weekly point prevalence scores.

Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.

Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study.

Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection and may influence pregnancy outcome. This study was conducted to assess the effect of chlamydial infection during pregnancy on premature delivery and birthweight. Pregnant women attending a participating midwifery practice or antenatal clinic between February 2003 and January 2005 were eligible for the study. From 4,055 women self-administered questionnaires and urine samples, tested by PCR, were analysed for C. trachomatis infection. Pregnancy outcomes were obtained from midwives and hospital registries. Gestational ages and birthweights were analysed for 3,913 newborns. The C. trachomatis prevalence was 3.9%, but varied by age and socio-economic background. Chlamydial infection was, after adjustment for potential confounders, associated with preterm delivery before 32 weeks (OR 4.35 [95% CI 1.3, 15.2]) and 35 weeks gestation (OR 2.66 [95% CI 1.1, 6.5]), but not with low birthweight. Of all deliveries before 32 weeks and 35 weeks gestation 14.9% [95% CI 4.5, 39.5] and 7.4% [95% CI 2.5, 20.1] was attributable to C. trachomatis infection. Chlamydia trachomatis infection contributes significantly to early premature delivery and should be considered a public health problem, especially in young women and others at increased risk of C. trachomatis infection.

Chlamydia trachomatis and placental inflammation in early preterm delivery.

UNLABELLED: Chlamydia trachomatis may infect the placenta and subsequently lead to preterm delivery. Our aim was to evaluate the relationship between the presence of Chlamydia trachomatis and signs of placental inflammation in women who delivered at 32 weeks gestation or less. SETTING: placental histology and clinical data were prospectively obtained from 304 women and newborns at the Erasmus MC-Sophia, Rotterdam, the Netherlands. C. trachomatis testing of placentas was done retrospectively using PCR. C. trachomatis was detected in 76 (25%) placentas. Histological evidence of placental inflammation was present in 123 (40%) placentas: in 41/76 (54%) placentas with C. trachomatis versus 82/228 (36%) placentas without C. trachomatis infection (OR 2.1, 95% CI 1.2-3.5). C. trachomatis infection correlated with the progression (P = 0.009) and intensity (P = 0.007) of materno-fetal placental inflammation. C. trachomatis DNA was frequently detected in the placenta of women with early preterm delivery, and was associated with histopathological signs of placental inflammation.