De Bus L, Diet G, Gadeyne B, Leroux-Roels I, Claeys G, Steurbaut K, Benoit D, De Turck F, Decruyenaere J, Depuydt P. Validity analysis of a unique infection surveillance system in the intensive care unit by analysis of a data warehouse built through a workflow-integrated software application.
J Hosp Infect 2014;
87:159-64. [PMID:
24856115 DOI:
10.1016/j.jhin.2014.03.010]
[Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND
An electronic decision support programme was developed within the intensive care unit (ICU) that provides an overview of all infection-related patient data, and allows ICU physicians to add clinical information during patient rounds, resulting in prospective compilation of a database.
AIM
To assess the validity of computer-assisted surveillance (CAS) of ICU-acquired infection performed by analysis of this database.
METHODS
CAS was compared with prospective paper-based surveillance (PBS) for ICU-acquired respiratory tract infection (RTI), bloodstream infection (BSI) and urinary tract infection (UTI) over four months at a 36-bed medical and surgical ICU. An independent panel reviewed the data in the case of discrepancy between CAS and PBS.
FINDINGS
PBS identified 89 ICU-acquired infections (13 BSI, 18 UTI, 58 RTI) and CAS identified 90 ICU-acquired infections (14 BSI, 17 UTI, 59 RTI) in 876 ICU admissions. There was agreement between CAS and PBS on 13 BSI (100 %), 14 UTI (77.8 %) and 42 RTI (72.4 %). Overall, there was agreement on 69 infections (77.5%), resulting in a kappa score of 0.74. Discrepancy between PBS and CAS was the result of capture error in 11 and 14 infections, respectively. Interobserver disagreement on probability (13 RTI) and focus (two RTI, one UTI) occurred for 16 episodes. The time required to collect information using CAS is less than 30% of the time required when using PBS.
CONCLUSION
CAS for ICU-acquired infection by analysis of a database built through daily workflow is a feasible surveillance method and has good agreement with PBS. Discrepancy between CAS and PBS is largely due to interobserver variability.
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