Abstract
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.
Highlights
Surveillance of healthcare-associated infections (HAI) entails the systematic collection of data on the presence of HAI, analysis and transformation of the data into information and sharing this information with those who can take action to prevent HAI
In this review of the literature we found that very few electronically assisted surveillance systems (EASS) are ‘all types, hospital-wide’, performance characteristics of these systems are generally good
The absence of traditional hospital-wide surveillance of HAI by the infection preventionist, which can be used as gold standard for validation can be one cause
Summary
Surveillance of healthcare-associated infections (HAI) entails the systematic collection of data on the presence of HAI, analysis and transformation of the data into information and sharing this information with those who can take action to prevent HAI. Surveillance and epidemiology are the first criteria included in the minimum standard of practice of an infection preventionist (Association for Professionals in Infection Control and Epidemiology (APIC) 2016 professional and practice standards). They are a core task according to the Dutch society of Hygiene and Prevention in Healthcare (VHIG 2014, professional profile). Surgical site infection (SSI) after specific orthopaedic procedures and bariatric surgery were not covered anymore This change reflected the importance of HAI surveillance and prevention. 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. 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
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