Computer-assisted Surveillance Research Articles

Internal and External Validation of a Computer-Assisted Surveillance System for Hospital-Acquired Infections in a 754-Bed General Hospital in the Netherlands.

OBJECTIVE To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs). DESIGN Validation cohort. SETTING A 754-bed teaching hospital in the Netherlands. METHODS For the internal validation of a CAPPS for HAIs, 2,526 patients were included. All patient records were retrospectively reviewed in depth by 2 infection control practitioners (ICPs) to determine which patients had suffered an HAI. Preventie van Ziekenhuisinfecties door Surveillance (PREZIES) criteria were used. Following this internal validation, 13 consecutive CAPPS were performed in a prospective study from January to March 2013 to determine weekly, monthly, and quarterly HAI point prevalence. Finally, a CAPPS was externally validated by PREZIES (Rijksinstituut voor Volksgezondheid en Milieu [RIVM], Bilthoven, Netherlands). In all evaluations, discrepancies were resolved by consensus. RESULTS In our series of CAPPS, 83% of the patients were automatically excluded from detailed review by the ICP. The sensitivity of the method was 91%. The time spent per hospital-wide CAPPS was ~3 hours. External validation showed a negative predictive value of 99.1% for CAPPS. CONCLUSIONS CAPPS proved to be a sensitive, accurate, and efficient method to determine serial weekly point-prevalence HAI rates in our hospital. Infect Control Hosp Epidemiol 2016;1-6.

Prognosis of Possible Reassortments in Recent H5N2 Epidemic Influenza in USA: Implications for Computer-Assisted Surveillance As Well As Drug/Vaccine Design.

The recent H5N2 flu epidemic in US Midwest has led to deaths of millions of turkeys and farm bred poultry. While no human infections are reported to date, the rapid mutations in flu viruses can lead to more pathogenic subtypes. We have investigated such possibilities and have shown that H5N4, H5N9 and H5N6 are the most likely candidates for next round of viral reassortments, amongst which H5N9, if reassorted from Asiatic strains, could be highly pathogenic. We discuss here possibilities of anticipatory rational vaccine design based on work done earlier.

Validity analysis of a unique infection surveillance system in the intensive care unit by analysis of a data warehouse built through a workflow-integrated software application

An electronic decision support programme was developed within the intensive care unit (ICU) that provides an overview of all infection-related patient data, and allows ICU physicians to add clinical information during patient rounds, resulting in prospective compilation of a database. To assess the validity of computer-assisted surveillance (CAS) of ICU-acquired infection performed by analysis of this database. CAS was compared with prospective paper-based surveillance (PBS) for ICU-acquired respiratory tract infection (RTI), bloodstream infection (BSI) and urinary tract infection (UTI) over four months at a 36-bed medical and surgical ICU. An independent panel reviewed the data in the case of discrepancy between CAS and PBS. PBS identified 89 ICU-acquired infections (13 BSI, 18 UTI, 58 RTI) and CAS identified 90 ICU-acquired infections (14 BSI, 17 UTI, 59 RTI) in 876 ICU admissions. There was agreement between CAS and PBS on 13 BSI (100 %), 14 UTI (77.8 %) and 42 RTI (72.4 %). Overall, there was agreement on 69 infections (77.5%), resulting in a kappa score of 0.74. Discrepancy between PBS and CAS was the result of capture error in 11 and 14 infections, respectively. Interobserver disagreement on probability (13 RTI) and focus (two RTI, one UTI) occurred for 16 episodes. The time required to collect information using CAS is less than 30% of the time required when using PBS. CAS for ICU-acquired infection by analysis of a database built through daily workflow is a feasible surveillance method and has good agreement with PBS. Discrepancy between CAS and PBS is largely due to interobserver variability.

Surveillance of Healthcare-Acquired Infections in Queensland, Australia: Data and Lessons From the First 5 Years

To present healthcare-acquired infection surveillance data for 2001-2005 in Queensland, Australia. Observational prospective cohort study. Twenty-three public hospitals in Queensland. We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons. A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI. The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%-1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%-10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80, 0.28, and 0.22 episodes per 1,000 occupied bed-days in level 1, 2, and 3 hospitals, respectively. Staphylococcus aureus was the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus-associated BSI. Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions.

Implementation of a novel on-ward computer-assisted surveillance system for device-associated infections in an intensive care unit

For the presented study a computer-based surveillance system for detecting nosocomial infections (NI) with direct data input from attending on-ward physicians was implemented. During a 12-month period surveillance of ventilator-associated pneumonia (VAP) and catheter-associated bloodstream infections (BSI) was performed prospectively by on-ward physicians guided by infection control specialists on an 11-bed medical intensive care unit in a German university hospital. In 603 patients 3282 patient days were assessed. Completeness of data entry during the routine phase was 94% for ventilator days and 88% for central venous catheter days. The concordance of infection detection by automated evaluation and evaluation based clinical considerations was fairly good and was quantified by kappa measures of 0.49 for VAP and 0.57 for BSI. Detected infection rates ranged within the German national reference data. Personnel costs for on-ward physicians and infection control personnel were 1.01 Euro per device day in the routine phase. Time expenditure of less than 3 min per device day, rendered in about equal parts by physicians and infection control personnel, was lower than in studies relying on on-ward assessment by infection control personnel.

Highly Sensitive and Efficient Computer–Assisted System for Routine Surveillance for Surgical Site Infection

Surveillance of surgical site infections (SSIs) is effective in reducing the rates of these complications, but it is extremely time-consuming and, consequently, underused. We determined the sensitivity and specificity of a computer-assisted surveillance system, compared with a conventional method involving review of medical records, and the time saved with the computer-assisted system. A prospective study was conducted from January 1 to December 31, 2001. With the computer-assisted method, screening for SSIs relied on identification in the laboratory database of positive results of microbiological tests of surgical-site specimens; confirmation was obtained via computer-generated questionnaires completed by the surgeon in charge of the patient. In the conventional method, SSIs were identified by exhaustive chart review. The time spent on surveillance was recorded for both methods. A 25-bed gastrointestinal surgery unit in a tertiary care hospital. A total of 766 consecutive patients who underwent gastrointestinal surgery. The sensitivity of the computer-assisted method was 84.3% (95% confidence interval, 0.66-0.94); the specificity was 99.9%. For the 807 surgical procedures in the study, 197 had an SSI identified by culture of a surgical-site specimen. After elimination of 63 duplicate cultures with positive results, 134 questionnaires were sent to the surgeons, who confirmed 27 SSIs. The conventional method identified 32 SSIs. The computer-assisted method required 60% less time than the conventional method (90 hours vs 223 hours). Surveillance for SSIs using computer-assisted, laboratory-based screening and case confirmation by surgeons is as efficient as and far less time-consuming than the conventional method of chart review. This method permits routine surveillance for SSIs with reliable accuracy.

Extensive Hospital-Wide Spread of a Multidrug-Resistant Enterobacter cloacae Clone, with Late Detection Due to a Variable Antibiogram and Frequent Patient Transfer

A hospital-wide increase in the number of patients with aminoglycoside-resistant Enterobacter cloacae (AREC) isolated from clinical cultures was detected in December 2002 using a classical surveillance system (CSS). CSS refers to a strategy based on the recognition of an increased incidence of a species with a particular antibiogram at certain wards in a limited period. Since clonal spread was suspected, hospital records were reviewed for E. cloacae culture-positive patients. Based upon genotyping of 139 clinical E. cloacae isolates from 80 patients, it was concluded that 53 patients had had clinical cultures with a single AREC clone since April 2001. Determinants for unnoticed spread were investigated retrospectively, as was the possibility that a computer-assisted surveillance method would have detected this outbreak at an earlier stage. Determinants associated with late detection of clonal spread were the following: (i) the absence of a hospital-wide increase in incidence of E. cloacae cases for 1.5 years, (ii) the long time interval between cases, (iii) the hospital-wide occurrence of new cases, due to a high number of patient transfers between wards, (iv) the large variety of clinical sites, and (v) the high variability of antibiograms (n = 33). Retrospective application of a recently described computer-assisted surveillance method as well as an "in-house"-developed algorithm resulted in earlier detection of the outbreak of 6 and 12 months, respectively. These findings suggest that computerized tools for surveillance may recognize resistance trends that are too complex to be detected by manual review and indicate the need for prospective evaluation of such algorithms.

Surveillance of hospital-acquired infections based on electronic hospital registries

Computer-assisted surveillance of hospital-acquired infections (HAIs) was compared with conventional manual registration (our gold standard i.e. reference method) by chart reviews of nosocomial infections in patients from surgical and medical departments. By combining selected infection parameters from various electronic hospital registries, the computer detected general HAIs with a sensitivity of 94% and a specificity of 47%. However, defining septicaemia, urinary tract infection (UTI), pneumonia and postoperative wound infection (PWI) specifically by sets of simplified criteria (infection parameters), computer-assisted surveillance was able to detect these infections with a sensitivity ranging between 82% (UTI) and 100% (septicaemia), and a specificity ranging between 91% (PWI) and 100% (septicaemia) compared with conventional manual registration. We conclude that computer surveillance based on data collected for other purposes in electronic hospital registries is an effective method for monitoring HAIs.

Computer-Assisted Surveillance: Does It Work?

ISSUE: Traditional surveillance for nosocomial infections is labor-intensive and time-consuming. In today's healthcare setting, infection control professionals (ICPs) must be continuously searching for time-efficient alternative ways to collect reliable data. We sought to determine whether electronic review of our clinical-financial database could identify post–cesarean section (C-section) endometritis with sufficient accuracy to provide sound data to the obstetrics (OB) service. PROJECT: Our Labor and Delivery Department was asked to provide a monthly list of C-section patients, ASA scores, wound classifications, and durations of surgery. A Performance Improvement Specialist used DRGs to identify C-section patients and then ICD9 codes to identify cases of endometritis. Validity of the electronic data was confirmed by chart for the first 2 months. RESULTS: During the early phases, we found that chorioamnionitis was also captured. This was eliminated by changing the ICD9 screening codes. Other infections being captured under this code which were discounted were urinary tract infections and were due to coding errors. Electronic versus traditional surveillance initially showed only a 79% match. After changing our method of collecting the ICD9 codes, the match was 88%. The OB service now receives data they can benchmark against National Nosocomial Infection Surveillance (NNIS) rates. Providing them with this information has allowed them to evaluate their service and identify tools to improve the quality of patient care in our facility. LESSONS LEARNED: With a little effort up front, surveillance time can be greatly reduced without compromising the quality of the data received. Computer-assisted surveillance can be a valuable tool for today's ICP, but the success of this method is dependent on the accuracy of chart documentation and the experience of the coders.

Computer-Assisted Surveillance: Does It Work?

Computer-Assisted Surveillance: Does It Work?

Computer-assisted surveillance for detecting clonal outbreaks of nosocomial infection.

Whole-house surveillance for healthcare-associated infection is no longer the recommended practice because of the large personnel time investment required. We developed a computer-based tracking system using microbiologic data as an aid in detecting potential outbreaks of healthcare-associated infections on a hospital-wide basis. Monthly total isolates of 25 clinically significant hospital pathogens were tallied from 1991 to 1998 to form a database for future comparison. Two different algorithm tools (based on increases of organism numbers over baseline) were applied to determine alert thresholds for suspected outbreaks using this information. The first algorithm (2SD) defined an alert as two standard deviations above the mean monthly number of isolates. The second (MI) defined an alert as either a 100% increase from the baseline organism number over 2 months or a >/=50% increase (compared to baseline) during a three-consecutive-month period. These two methods were compared to standard infection control professional surveillance (ICP) for the detection of clonal outbreaks over 12 months. Overall, a total of seven clonal outbreaks were detected during the 1-year study. Using standard methods, ICP investigated nine suspected outbreaks, four of which were associated with clonal microbes. The 2SD method signaled a suspected outbreak 15 times, of which three were clonal and ICP had detected one. The MI method signaled a suspected outbreak 30 times; four of these were clonal, and ICP had detected one. The sensitivity and specificity values for ICP, 2SD, and MI for detecting clonal outbreaks were 57, 43, and 57% and 17, 83, and 67%, respectively. Statistical methods applied to clinical microbiology laboratory information system data efficiently supplement infection control efforts for outbreak detection.

Computer-assisted ADR detection vs surveillance by daily ward rounds

Computer-assisted ADR detection vs surveillance by daily ward rounds

Active surveillance of maternal mortality in New York City.

This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City. Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997. Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, 1 was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively. Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.

Computer-assisted antimicrobial surveillance in a community teaching hospital

A computer-assisted, pharmacy-managed antimicrobial surveillance service is described. Rising drug costs and inappropriate use of antimicrobial drugs led to the January 1994 implementation of an antimicrobial surveillance program at a 369-bed community teaching hospital. A computer interface between the pharmacy and microbiology laboratory data-bases was established that allows pharmacists quick access to culture and susceptibility test results and provides timely reports identifying patients for whom intervention may be necessary. Pharmacists review the reports, assess the patient's condition, and, when appropriate, recommend changes in therapy to the prescribing physician. Data on interventions, costs, and outcomes are reviewed monthly. From January to July 1994, pharmacists monitored the antimicrobial therapy of 1384 patients. Interventions were recommended for 348 patients (25%). Physicians accepted 289 (83%) of the recommendations. The infection subsided in 280 (97%) of the patients for whom recommendations were accepted. The cost avoidance achieved by the interventions exceeded $32,000, which more than justified the one full-time pharmacist position assigned to the service. A computer-assisted antimicrobial surveillance service managed by pharmacists helped control costs and achieve favorable clinical outcomes.

The epidemiology of antibiotic resistance in hospitals.

Changes in antibiotic susceptibility among different species are a function of the interaction of bacterial genomes (chromosomes, plasmids, transposons) with specific host and environmental factors. Computer-assisted surveillance of resistance patterns and plasmid fingerprinting with restriction endonucleases have facilitated resistance gene tracking. Certain nosocomial plasmids have persisted for many years within specific centres, others are widely distributed by species and location, and others may have a narrow host range or undergo rapid molecular evolution. Klebsiella pneumoniae is most often the index species for the dissemination of nosocomial plasmids, which are frequently multiresistant. Acute increases in antibiotic resistance may be due to antibiotic selection pressures, introduction of new, well-adapted species, over-crowding and other environmental changes. The most resistant organisms are found in units where patients are immunocompromised, are subject to invasive procedures or remain for long periods. Although large-scale studies have not shown uniform increases in the prevalence of resistant bacteria, acute outbreaks in specific niches have resulted in increased patient morbidity, necessitating rapid changes in antibiotic usage. Further molecular epidemiological studies are required in order to understand better how to anticipate the spread of antibiotic resistance.

Surveillance for postoperative infections in outpatient gynecologic surgery.

Postoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the "clean-contaminated" wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.

A method of computer-assisted pacemaker surveillance from a patient's home via telephone

A system is described for remote computer-assisted surveillance of implanted pacemakers from a patient's home. Using an inexpensive, portable, frequency-modulated transmitter, a patient's electrocardiogram is sent over voice-grade telephone lines to any cardiology clinic. The signal can be demodulated and the pacemaker spike plus electrocardiogram recorded on paper for visual review by the physician. The modulated signal is further transmitted to a remote on-line computer system. The computer calculates the spike-spike interval to approximately five millisecond precision, stores pacemaker information and other patient data on disk, and displays calculated results on a cathode ray screen in the cardiology clinic. The cardiologist can immediately review past and present pacemaker function, patient medications, and other pertinent data from the computer terminal. If further medical action is warranted, the patient can be immediately advised.