Increasing the Reliability of Fully Automated Surveillance for Central Line-Associated Bloodstream Infections.

OBJECTIVE: To increase reliability of the algorithm used in our fully automated electronic surveillance system by adding rules to better identify bloodstream infections secondary to other hospital-acquired infections. METHODS: Intensive care unit (ICU) patients with positive blood cultures were reviewed. Central line-associated bloodstream infection (CLABSI) determinations were based on 2 sources: routine surveillance by infection preventionists, and fully automated surveillance. Discrepancies between the 2 sources were evaluated to determine root causes. Secondary infection sites were identified in most discrepant cases. New rules to identify secondary sites were added to the algorithm and applied to this ICU population and a non-ICU population. Sensitivity, specificity, predictive values, and kappa were calculated for the new models. RESULTS: Of 643 positive ICU blood cultures reviewed, 68 (10.6%) were identified as central line-associated bloodstream infections by fully automated electronic surveillance, whereas 38 (5.9%) were confirmed by routine surveillance. New rules were tested to identify organisms as central line-associated bloodstream infections if they did not meet one, or a combination of, the following: (I) matching organisms (by genus and species) cultured from any other site; (II) any organisms cultured from sterile site; (III) any organisms cultured from skin/wound; (IV) any organisms cultured from respiratory tract. The best-fit model included new rules I and II when applied to positive blood cultures in an ICU population. However, they didn't improve performance of the algorithm when applied to positive blood cultures in a non-ICU population. CONCLUSION: Electronic surveillance system algorithms may need adjustment for specific populations.

Advancing the competency of infection preventionists.

The Association of Professionals in Infection Control and Epidemiology (APIC) has identified advancing infection prevention competency as a core goal in their Strategic Plan 2020. To achieve this goal, APIC has published a self-assessment tool to help infection preventionists identify where they are on a predefined scale. This project trialed APIC's self-assessment tool along with an internally developed objective assessment. The objective was to determine if the tools help identify areas for improvement to advance overall group competency at BJC HealthCare, a large Midwestern health care system with nearly 30 infection preventionists.

Development of a standardized process improvement protocol to address elevated health care-associated infection rates on an incented quality scorecard.

This practice forum report details a standardized improvement process that was created both to improve patient outcomes related to various hospital-acquired infections and to address leadership concerns related to incented quality metrics. A 3-year retrospective review identified common issues to guide future interventions and confirmed that this methodology reduced the rate of recurrent infections across the health care system. Process tool samples are provided.

Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study.

OBJECTIVE: To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU). DESIGN: Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003. SETTING: Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri. PATIENTS; All patients admitted to 4 general medical wards. RESULTS: A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place. CONCLUSIONS: Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.