Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.
Infect Control Hosp Epidemiol
; 35(12): 1483-90, 2014 Dec.
Article
in En
| MEDLINE
| ID: mdl-25419770
ABSTRACT
OBJECTIVE:
Central line-associated bloodstream infection (BSI) rates are a key quality metric for comparing hospital quality and safety. Traditional BSI surveillance may be limited by interrater variability. We assessed whether a computer-automated method of central line-associated BSI detection can improve the validity of surveillance.DESIGN:
Retrospective cohort study.SETTING:
Eight medical and surgical intensive care units (ICUs) in 4 academic medical centers.METHODS:
Traditional surveillance (by hospital staff) and computer algorithm surveillance were each compared against a retrospective audit review using a random sample of blood culture episodes during the period 2004-2007 from which an organism was recovered. Episode-level agreement with audit review was measured with κ statistics, and differences were assessed using the test of equal κ coefficients. Linear regression was used to assess the relationship between surveillance performance (κ) and surveillance-reported BSI rates (BSIs per 1,000 central line-days).RESULTS:
We evaluated 664 blood culture episodes. Agreement with audit review was significantly lower for traditional surveillance (κ [95% confidence interval (CI) = 0.44 [0.37-0.51]) than computer algorithm surveillance (κ [95% CI] = 0.58; P = .001). Agreement between traditional surveillance and audit review was heterogeneous across ICUs (P = .01); furthermore, traditional surveillance performed worse among ICUs reporting lower (better) BSI rates (P = .001). In contrast, computer algorithm performance was consistent across ICUs and across the range of computer-reported central line-associated BSI rates.Conclusions:
Compared with traditional surveillance of bloodstream infections, computer automated surveillance improves accuracy and reliability, making interfacility performance comparisons more valid.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cross Infection
/
Hospital Information Systems
/
Infection Control
/
Bacteremia
/
Catheter-Related Infections
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Evaluation_studies
/
Observational_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Infect Control Hosp Epidemiol
Journal subject:
DOENCAS TRANSMISSIVEIS
/
ENFERMAGEM
/
EPIDEMIOLOGIA
/
HOSPITAIS
Year:
2014
Document type:
Article
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA