Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T03:18:44.346Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Automated Strategies for Surveillance of Nosocomial Bacteremia

Published online by Cambridge University Press:  02 January 2015

Cristina Bellini ,
Christiane Petignat ,
Patrick Francioli ,
Aline Wenger ,
Jacques Bille ,
Adriana Klopotov ,
Yannick Vallet ,
René Patthey  and
Giorgio Zanetti
Cristina Bellini*
Affiliation:
Service of Hospital Preventive Medecine, University Hospital, Lausanne, Switzerland
Christiane Petignat
Affiliation:
Service of Hospital Preventive Medecine, University Hospital, Lausanne, Switzerland
Patrick Francioli
Affiliation:
Service of Hospital Preventive Medecine, University Hospital, Lausanne, Switzerland
Aline Wenger
Affiliation:
Microbiological Institute, University Hospital, Lausanne, Switzerland
Jacques Bille
Affiliation:
Microbiological Institute, University Hospital, Lausanne, Switzerland
Adriana Klopotov
Affiliation:
Informatics Institute, University Hospital, Lausanne, Switzerland
Yannick Vallet
Affiliation:
Informatics Institute, University Hospital, Lausanne, Switzerland
René Patthey
Affiliation:
Informatics Institute, University Hospital, Lausanne, Switzerland
Giorgio Zanetti
Affiliation:
Service of Hospital Preventive Medecine, University Hospital, Lausanne, Switzerland
*
Service de Médecine Préventive Hospitalière—CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance.

Methods.

Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data.

Setting.

An 850-bed university hospital.

Participants.

All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years.

Results.

The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%.

Conclusion.

Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 9 , September 2007 , pp. 1030 - 1035
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309–317.Google Scholar
2. Sax, H, Pittet, D. Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002;162:2437–2442.Google Scholar
3. Scheckler, WE, Bobula, JA, Beamsley, MB, Hadden, ST. Bloodstream infections in a community hospital: a 25-year follow-up. Infect Control Hosp Epidemiol 2003;24:936–941.Google Scholar
4. Hugonnet, S, Sax, H, Eggimann, P, Chevrolet, JC, Pittet, D. Nosocomial bloodstream infection and clinical sepsis. Emerg Infect Dis 2004;10:76–81.CrossRefGoogle ScholarPubMed
5. Collin, BA, Leather, HL, Wingard, JR, Ramphal, R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001;33:947–953.Google Scholar
6. Pittet, D, Wenzel, RP. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177–1184.CrossRefGoogle ScholarPubMed
7. Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.Google Scholar
8. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
9. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002;51(RR-10):1–29.Google Scholar
10. Suljagic, V, Cobeljic, M, Jankovic, S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control 2005;33:333–340.Google Scholar
11. Gaynes, R, Richards, C, Edwards, J, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295–298.Google Scholar
12. McLaws, ML, Taylor, PC. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. J Hosp Infect 2003;53:259–267.Google Scholar
13. Pittet, D. Infection control and quality health care in the new millennium. Am J Infect Control 2005;33:258–267.CrossRefGoogle ScholarPubMed
14. Burke, JP. Surveillance, reporting, automation, and interventional epidemiology. Infect Control Hosp Epidemiol 2003;24:10–12.Google Scholar
15. Classen, DC, Burke, JP, Pestotnik, SL, Evans, RS, Stevens, LE. Surveillance for quality assessment: IV. Surveillance using a hospital information system. Infect Control Hosp Epidemiol 1991;12:239–244.Google Scholar
16. Institute of Healthcare Improvement. 100,000 Lives campaign: 2006 media coverage. Available at: http://www.ihi.org/IHI/Programs/Campaign/100000LivesCampaign2006MediaCoverage.htm. Accessed March 1, 2007.Google Scholar
17. Burke, JP. Infection control—a problem for patient safety. N Engl J Med 2003;348:651–656.Google Scholar
18. Trick, WE, Zagorski, BM, Tokars, JI, et al. Computer algorithms to detect bloodstream infections. Emerg Infect Dis 2004;10:1612–1620.Google Scholar
19. Graham, PL III San, GP, Lutwick, S, Haas, J, Saiman, L. Validation of a multicenter computer-based surveillance system for hospital-acquired bloodstream infections in neonatal intensive care departments. Am J Infect Control 2004;32:232–234.Google Scholar
20. Manangan, LP, Pearson, ML, Tokars, JI, Miller, E, Jarvis, WR. Feasibility of national surveillance of health-care–associated infections in homecare settings. Emerg Infect Dis 2002;8:233–236.Google Scholar
21. Horan, TC, Gaynes, RP. Centers for Disease Control and Prevention definitions of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2004:1659–1702. Available at: http://www.cdc.gov/ncidod/dhqp/pdf//NNIS/NosInfDefinitions.pdf. Accessed June 21, 2007.Google Scholar
22. Worthington, T, Elliott, TS. Diagnosis of central venous catheter related infection in adult patients. J Infect 2005;51:267–280.Google Scholar
23. Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.Google Scholar