Increasing the Reliability of Fully Automated Surveillance for Central Line–Associated Bloodstream Infections

Snyders, Rachael; Goris, Ashleigh J.; Gase, Kathleen A.; Leone, Carole; Doherty, Joshua A.; Woeltje, Keith F.

doi:10.1017/ice.2015.199

Cited by 10 publications

(18 citation statements)

References 11 publications

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“…All studies used administrative data in their automated algorithms, including admission dates (all studies) and discharge dates [ 21 – 24 ]. Microbiological data were automatically extracted in eight out of the nine studies [ 19 – 22 , 24 – 27 ], with dates of blood culture sampling in fours studies [ 20 , 22 , 25 , 26 ]. Only one study used a semi-automated CLABSI surveillance system with manual extraction of microbiological results [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Microorganisms were considered identical if the species identification and antimicrobial susceptibility profile matched [ 19 , 20 ]. Snyders et al evaluated the addition of cultures from other body sites (a sterile site, skin, wound, respiratory tract) in the algorithm [ 26 ]. Hota et al included all positive and negative cultures from blood and other body sites, except catheter tips and surveillance cultures [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…The presence of a central line was included in the dataset of five studies [ 22 , 23 , 25 – 27 ]. Four studies included clinical data, such as fever (> 38.0 °C) [ 22 , 23 , 25 , 26 ] or blood pressure [ 23 ], in their automated system. Only one study used machine learning to convert free text data into structured data to be used for automated surveillance [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

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Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters

Lotfinejad,

Januel,

Tschudin-Sutter

et al. 2024

Antimicrob Resist Infect Control

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Introduction Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). Methods We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies. Results We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules. Conclusion The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters

Lotfinejad,

Januel,

Tschudin-Sutter

et al. 2024

Antimicrob Resist Infect Control

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show abstract

“…Furthermore, physician surveys to gauge the clinician’s perceptions toward the alerts can help understand the contribution of alarm burden and alarm fatigue to the alert response. There is definitely an increased interest in incorporating fully automated surveillance to detect healthcare-acquired infections and early signs of clinical deterioration [ 6 - 8 , 25 - 26 ]. Comparing alerts and interventions in other pediatric inpatient healthcare institutions that incorporate automated electronic medical record surveillance as well as analyzing their patient care outcomes would result in the ability to collect a more robust sample of data that can help identify the type of alerts greatly impacting the care of the patient.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Automated Electronic Surveillance of Electronic Medical Records on Pediatric Inpatient Care

Emmanuel

Torres

2018

Cureus

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PurposeTo assess the impact of the automated surveillance of the electronic medical record process on clinical interventions among hospitalized children at a tertiary care pediatric center.MethodsA retrospective chart review of the alerts triggered for central line-associated blood stream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), neonatal sepsis, or clinical deterioration through elevated pediatric early warning scores (PEWS) by automated electronic surveillance of the hospital electronic medical record (EMR) over a five-month period among hospitalized children. Interventions instituted in response to the alerts were reviewed from the hospital EMR. Fisher’s exact test was performed to detect any significant difference in the proportion of interventions performed for alerts triggered between groups.ResultsA total of 244 alerts were collected (27 CAUTI, 55 CLABSI, 10 neonatal sepsis, and 152 PEWS alerts). A significant difference in the proportion of interventions instituted after neonatal sepsis and PEWS alerts (9/162, 5.6%) as compared to CLABSI and CAUTI alerts (20/82, 24.4%) was observed (p<0.001; Odds ratio (95% CI): 0.182 (0.079-0.422)). Neonatal sepsis triggered the least number of alerts (10/244, 4.1%) and proportionately fewer interventions than the other clinical alerts.ConclusionsAlerts for potential device-associated infections resulted in more clinical intervention than less-specific alerts. Neonatal sepsis alerts resulted in minimal interventions undertaken in response to the alert. Identifying and focusing on alerts benefitting the patient can serve as a better allocation of time and resources. Future studies should explore which newer alerts and their accompanying interventions improve patient outcomes.

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“…A decade ago, researchers reported a positive predictive value of 20% for HAIs identified by administrative data as compared with 100% identified through active surveillance by an experienced infection prevention professional [7]. More recently, Snyders et al [8] found that electronic algorithms to identify central line associated BSI required adjustment for various populations, and others have noted discrepancies in diagnosing SSIs, depending on definitions used [9,10]. Singh et al [11] found a significant discrepancy between SSI rates reported to a national United Kingdom surveillance system when compared with rates identified by a retrospective review of electronic medical records, with higher rates identified electronically.…”

Section: Discussionmentioning

confidence: 99%

Electronic Surveillance of Surgical Site Infections

Cato

Liu

Cohen

et al. 2017

Surgical Infections

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Increasing the Reliability of Fully Automated Surveillance for Central Line–Associated Bloodstream Infections

Abstract: Electronic surveillance system algorithms may need adjustment for specific populations.

Cited by 10 publications

References 11 publications

Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters

Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters

The Impact of Automated Electronic Surveillance of Electronic Medical Records on Pediatric Inpatient Care

Electronic Surveillance of Surgical Site Infections

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