Multicenter Evaluation of Computer Automated versus Traditional Surveillance of Hospital-Acquired Bloodstream Infections

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Lin, Michael Y. ; Woeltje, Keith F. ; Khan, Yosef M. ; Hota, Bala ; Doherty, Joshua A. ; Borlawsky, Tara B. ; Stevenson, Kurt B. ; Fridkin, Scott K. ; Weinstein, Robert A. ; Trick, William E.
• Description:
  OBJECTIVE.
  
  Central line–associated bloodstream infection (BSI) rates are a key quality metric for comparing hospital quality and safety. Traditional BSI surveillance may be limited by interrater variability. We assessed whether a computer-automated method of central line–associated BSI detection can improve the validity of surveillance.
  
  DESIGN.
  
  Retrospective cohort study.
  
  SETTING.
  
  Eight medical and surgical intensive care units (ICUs) in 4 academic medical centers.
  
  METHODS.
  
  Traditional surveillance (by hospital staff) and computer algorithm surveillance were each compared against a retrospective audit review using a random sample of blood culture episodes during the period 2004–2007 from which an organism was recovered. Episode-level agreement with audit review was measured with κ statistics, and differences were assessed using the test of equal κ coefficients. Linear regression was used to assess the relationship between surveillance performance (κ) and surveillance-reported BSI rates (BSIs per 1,000 central line–days).
  
  RESULTS.
  
  We evaluated 664 blood culture episodes. Agreement with audit review was significantly lower for traditional surveillance (κ [95% confidence interval (CI)] = 0.44 [0.37–0.51]) than computer algorithm surveillance (κ [95% CI] = 0.58 [0.52–0.64]; P = .001). Agreement between traditional surveillance and audit review was heterogeneous across ICUs (P = .01); furthermore, traditional surveillance performed worse among ICUs reporting lower (better) BSI rates (P = .001). In contrast, computer algorithm performance was consistent across ICUs and across the range of computer-reported central line–associated BSI rates.
  
  CONCLUSIONS.
  
  Compared with traditional surveillance of bloodstream infections, computer automated surveillance improves accuracy and reliability, making interfacility performance comparisons more valid.
  
  
• Subjects:
  Algorithms Bacteremia Catheter-Related Infections Catheterization, Central Venous Cross Infection Epidemiological Monitoring Hospital Information Systems Humans Infection Control Intensive Care Units Management Audit Quality Improvement Reproducibility Of Results Retrospective Studies United States

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• Source:
  Infect Control Hosp Epidemiol. 35(12):1483-1490
• Pubmed ID:
  25419770
• Pubmed Central ID:
  PMC8385404
• Document Type:
  Journal Article
• Funding:
  U01 CI000333/CI/NCPDCID CDC HHSUnited States/ ; U01-CI000328/CI/NCPDCID CDC HHSUnited States/ ; U01 CI000328/CI/NCPDCID CDC HHSUnited States/ ; U01-CI000327/CI/NCPDCID CDC HHSUnited States/ ; U01-CI000333/CI/NCPDCID CDC HHSUnited States/ ; U01 CI000327/CI/NCPDCID CDC HHSUnited States/
• Volume:
  35
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2ae40559ec7802532177503c8062a41d77f65e380a5a4b6021f3fc131854531dca9435a355373bff9f7e94bc7f1a7a5bba3da0b0df49972a3d181274cc170c48
• Download URL:
  https://stacks.cdc.gov/view/cdc/109341/cdc_109341_DS1.pdf
• File Type:
  [PDF - 436.01 KB ]