Validation of Statewide Surveillance System Data on Central Line-Associated Bloodstream Infection in Intensive Care Units in Australia
Validation of Statewide Surveillance System Data on Central Line-Associated Bloodstream Infection in Intensive Care Units in Australia
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DOI：
10.1086/606168
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发表时间：
2009-11-01
影响因子：
4.5
通讯作者：
Richards, Michael J.
中科院分区：
文献类型：
--
作者：
McBryde, Emma S.;Brett, Judy;Richards, Michael J.
OBJECTIVE.测量提交给全州监测系统的数据的观察者间一致性、敏感性、特异性、阳性预测值和阴性预测值，以识别中心静脉导管相关血流感染（BSI）。回顾性审查医院病历，根据中心线相关BSI的定义，将报告的数据与金标准进行比较。六个维多利亚州的公立医院超过100张病床。监测结果报告由医院感染控制从业人员进行。由维多利亚医院获得性感染监测系统（VICNISS）的独立感染控制从业人员对监测过程进行回顾性评价。对报告发生中心线相关BSI的患者记录样本进行评估，以确定其是否符合中心线相关BSI的定义。还对评估期间重症监护室中未报告中心线相关BSI的菌血症患者的记录样本进行了评估，以确定其是否符合中心线相关BSI的定义。对108例患者的记录进行了审查;监测报告与VICNISS评估之间的一致性为67.6%（kappa = 0.31）。在报告的46例中心线相关BS I中，27例被确认为中心线相关BS I，阳性预测值为59%（95%置信区间[CI]，43%-73%）。在审查的62例未报告为中心线相关BSI的菌血症病例中，45例与中心线无关，阴性预测值为73%（95% CI，60%-83%）。估计敏感性为35%，特异性为87%。阳性似然比为3.0，阴性似然比为0.72。中心静脉相关BSI报告与金标准定义应用之间的一致性低得不可接受。假阴性结果是有问题的;维多利亚州公立医院可能会错过一半以上的中心线相关BSI。
OBJECTIVE. To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).DESIGN. Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line-associated BSI.SETTING. Six Victorian public hospitals with more than 100 beds.METHODS. Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line-associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line-associated BSI were also assessed to see whether they met the definition of central line-associated BSI.RESULTS. Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (kappa = 0.31). Of the 46 reported central line-associated BSIs, 27 were confirmed to be central line-associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%-73%). Of the 62 cases of bacteremia reviewed that were not reported as central line associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%-83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.DISCUSSION. The agreement between the reporting of central line-associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line-associated BSIs may be missed in Victorian public hospitals.