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Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.

Abstract：

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; 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.

journal_name

Infect Control Hosp Epidemiol

journal_title

Infection control and hospital epidemiology

authors

Lin MY,Woeltje KF,Khan YM,Hota B,Doherty JA,Borlawsky TB,Stevenson KB,Fridkin SK,Weinstein RA,Trick WE,Centers for Disease Control and Prevention Epicenter Program.

doi

10.1086/678602

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

1483-90

issue

eissn

0899-823X

issn

1559-6834

pii

S0195941700093875

journal_volume

pub_type

杂志文章,多中心研究

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Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.