Electronic Surveillance for Healthcare-Associated Central Line-Associated Bloodstream Infections Outside the Intensive Care Unit
Electronic Surveillance for Healthcare-Associated Central Line-Associated Bloodstream Infections Outside the Intensive Care Unit
复制标题
DOI：
10.1086/662181
复制
发表时间：
2011-11-01
影响因子：
4.5
通讯作者：
Doherty, Joshua A.
中科院分区：
文献类型：
--
作者：
Woeltje, Keith F.;McMullen, Kathleen M.;Doherty, Joshua A.
背景由感染预防从业人员对中心静脉导管相关血流感染（CLABSI）进行手动监测非常耗时，并且通常仅限于重症监护室（ICU）。使用现有的数据库与患者水平的变量和微生物学数据的自动化监测系统进行了调查。对2005年7月1日至2006年12月31日在巴恩斯犹太医院4个非ICU病房中血培养阳性的患者进行了评价。通过2个来源确定这些患者的CLABSI;手动病历审查和电子可用数据的自动审查。这2个来源之间的一致性用于开发最佳拟合电子算法，该算法使用一组规则来识别CLABSI。以人工病历回顾作为参考标准，计算各种规则集的敏感性、特异性、预测值和皮尔逊相关性。在研究期间，对来自331名患者的391例阳性血培养进行了评价。其中85例（22%）经人工病历审查确认为CLABSI。最佳拟合模型包括存在导管、已知病原体的血培养阳性或通过第二次阳性培养确认的具有常见皮肤污染物的血培养以及发热的存在，以及来自另一个无菌部位的相同微生物的无阳性培养。与强化人工监测相比，最佳执行规则集的总体敏感性为95.2%，特异性为97.5%，阳性预测值为90%，阴性预测值为99.2%。虽然CLABSI略高于预测电子监视与人工图表审查相比，该方法提供了执行可接受的良好的监视在资源不允许传统的人工监视的地区的可能性。感染控制医院流行病学2011; 32（11）：1086-1090
BACKGROUND. Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patient-level variables and microbiology data was investigated.METHODS. Patients with a positive blood culture in 4 non-ICU wards at Barnes-Jewish Hospital between July 1, 2005, and December 31, 2006, were evaluated. CLABSI determination for these patients was made via 2 sources; a manual chart review and an automated review from electronically available data. Agreement between these 2 sources was used to develop the best-fit electronic algorithm that used a set of rules to identify a CLABSI. Sensitivity, specificity, predictive values, and Pearson's correlation were calculated for the various rule sets, using manual chart review as the reference standard.RESULTS. During the study period, 391 positive blood cultures from 331 patients were evaluated. Eighty-five (22%) of these were confirmed to be CLABSI by manual chart review. The best-fit model included presence of a catheter, blood culture positive for known pathogen or blood culture with a common skin contaminant confirmed by a second positive culture and the presence of fever, and no positive cultures with the same organism from another sterile site. The best-performing rule set had an overall sensitivity of 95.2%, specificity of 97.5%, positive predictive value of 90%, and negative predictive value of 99.2% compared with intensive manual surveillance.CONCLUSIONS. Although CLABSIs were slightly overpredicted by electronic surveillance compared with manual chart review, the method offers the possibility of performing acceptably good surveillance in areas where resources do not allow for traditional manual surveillance. Infect Control Hosp Epidemiol 2011; 32(11): 1086-1090