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van Niekerk JM, Vos MC, Stein A, Braakman-Jansen LMA, Voor in ‘t holt AF, van Gemert-Pijnen JEWC. Risk factors for surgical site infections using a data-driven approach. PLoS One 2020; 15:e0240995. [PMID: 33112893 PMCID: PMC7592760 DOI: 10.1371/journal.pone.0240995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objective The objective of this study was to identify risk factors for surgical site infection from digestive, thoracic and orthopaedic system surgeries using clinical and data-driven cut-off values. A second objective was to compare the identified risk factors in this study to risk factors identified in literature. Summary background data Retrospective data of 3 250 surgical procedures performed in large tertiary care hospital in The Netherlands during January 2013 to June 2014 were used. Methods Potential risk factors were identified using a literature scan and univariate analysis. A multivariate forward-step logistic regression model was used to identify risk factors. Standard medical cut-off values were compared with cut-offs determined from the data. Results For digestive, orthopaedic and thoracic system surgical procedures, the risk factors identified were preoperative temperature of ≥38°C and antibiotics used at the time of surgery. C-reactive protein and the duration of the surgery were identified as a risk factors for digestive surgical procedures. Being an adult (age ≥18) was identified as a protective effect for thoracic surgical procedures. Data-driven cut-off values were identified for temperature, age and CRP which can explain the SSI outcome up to 19.5% better than generic cut-off values. Conclusions This study identified risk factors for digestive, orthopaedic and thoracic system surgical procedures and illustrated how data-driven cut-offs can add value in the process. Future studies should investigate if data-driven cut-offs can add value to explain the outcome being modelled and not solely rely on standard medical cut-off values to identify risk factors.
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Affiliation(s)
- J. M. van Niekerk
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M. C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - A. Stein
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - L. M. A. Braakman-Jansen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - A. F. Voor in ‘t holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - J. E. W. C. van Gemert-Pijnen
- Department of Psychology, Health and Technology/Centre for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
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Streefkerk HRA, Verkooijen RP, Bramer WM, Verbrugh HA. Electronically assisted surveillance systems of healthcare-associated infections: a systematic review. ACTA ACUST UNITED AC 2020; 25. [PMID: 31964462 PMCID: PMC6976884 DOI: 10.2807/1560-7917.es.2020.25.2.1900321] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency. Objectives To give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them. Methods In this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented. Results A total of 78 studies were included. The majority of EASS (n = 72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n = 7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (> 0.8), but specificity varied (0.37–1). Less than 20% (n = 14) of the studies presented data on the efficiency gains achieved. Conclusions Electronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency.
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Affiliation(s)
- H Roel A Streefkerk
- Albert Schweitzer Hospital/Rivas group Beatrix hospital/Regionaal Laboratorium medische Microbiologie, Dordrecht/Gorinchem, the Netherlands.,Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Roel Paj Verkooijen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henri A Verbrugh
- Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
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Malheiro R, Rocha-Pereira N, Duro R, Pereira C, Alves CL, Correia S. Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency. Int J Infect Dis 2020; 99:355-361. [PMID: 32777583 DOI: 10.1016/j.ijid.2020.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess whether electronic records data could improve the efficiency, exhaustiveness, and representativeness of SSI surveillance by selecting a group of high-risk patients for manual review. METHODS Colorectal surgeries (2016-2018) and cholecystectomies (2017-2018) were selected. Post-surgical antibiotic use, positive culture, C-reactive protein (CRP) values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission were retrieved. For representativeness, procedures registered in HAI-Net were compared with non-included procedures, and the validity of each variable (or combination) was tested considering the presence of SSI as the gold standard. The proportion of procedures flagged for manual review by each criterion was estimated. RESULTS Little more than 50% of procedures were included in HAI-Net (SSI risk: 10.6% for colorectal and 2.9% for cholecystectomies). Non-included procedures showed higher proportions of infection markers. Antibiotic use and CRP >100 mg/dl presented the highest sensitivity for both surgical groups, while antibiotic use achieved the highest positive predictive value in both groups (22% and 21%, respectively) and flagged fewer colorectal procedures (47.7%). CONCLUSIONS Current SSI surveillance has major limitations. Thus, the reported incidence seems unreliable and underestimated. Antibiotic use appears to be the best criterion to select a sub-sample of procedures for manual review, improving the exhaustiveness and efficiency of the system.
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Affiliation(s)
- Rui Malheiro
- Eastern Porto Public Health Unit (ACES Porto Oriental), Administração Regional de Saúde, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Nuno Rocha-Pereira
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário S. João, Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Raquel Duro
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário S. João, Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Pereira
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Carlos Lima Alves
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina Universidade do Porto, Porto, Portugal
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Streefkerk HRA, Willemsen SP, van der Hoeven CP, Vos MC, Verkooijen RP, Verbrugh HA. Computer-assisted, high-frequency, hospital-wide point prevalence surveys of hospital-acquired infections in a tertiary care hospital, the Netherlands, 2013 to 2014. ACTA ACUST UNITED AC 2020; 24. [PMID: 30940313 PMCID: PMC6446511 DOI: 10.2807/1560-7917.es.2019.24.13.1800177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Surveillance of hospital-acquired infections (HAI) often relies on point prevalence surveys (PPS) to detect major deviations in the occurrence of HAI, supplemented with incidence measurements when more detailed information is needed. In a 1,320-bed university medical centre in the Netherlands, we evaluated an electronically assisted surveillance system based on frequently performed computer-assisted PPS (CAPPS). Aim The primary goals were to evaluate the performance of this method to detect trends and to determine how adjustments in the frequency with which the CAPPS are performed would affect this performance. A secondary goal was to evaluate the performance of the algorithm (nosocomial infection index (Nii)) used. Methods We analysed the data of 77 hospital-wide PPS, performed over a 2-year period (2013 and 2014) and including 25,056 patients. Results Six trends with statistical significance were detected. The probability to detect such trends rapidly decreased when PPS are performed at a lower frequency. The Nii and its dynamics strongly correlated with the presence of HAI. Conclusion Performing computer-assisted, high frequency hospital-wide PPS, is a feasible method that will detect even subtle changes in HAI prevalence over time.
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Affiliation(s)
- H Roel A Streefkerk
- Regional Laboratory for Medical Microbiology, Dordrecht, the Netherlands.,Beatrix hospital/Rivas Group, Gorinchem, the Netherlands.,Albert Schweitzer Hospital, Dordrecht, the Netherlands.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Conrad P van der Hoeven
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Roel Paj Verkooijen
- Department of Medical Microbiology, University Medical Centre, Groningen, the Netherlands
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Beerlage-de Jong N, van Gemert-Pijnen L, Wentzel J, Hendrix R, Siemons L. Technology to Support Integrated Antimicrobial Stewardship Programs: A User Centered and Stakeholder Driven Development Approach. Infect Dis Rep 2017; 9:6829. [PMID: 28458796 PMCID: PMC5391533 DOI: 10.4081/idr.2017.6829] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 11/23/2022] Open
Abstract
The rise of antimicrobial resistance (AMR) is a severe global health problem. Tackling this problem requires the prudent prescribing of antimicrobials. This is promoted through Antimicrobial Stewardship Programs (ASPs). In this position paper we describe i) how a socio-technical multidisciplinary approach (based on the CeHRes Roadmap) can be applied in the development and implementation of Antimicrobial Stewardship technologies and ii) how this approach can be of value to support Antimicrobial Stewardship in practice. The CeHRes Roadmap entails five different phases to explore and test how an eHealth technology can be tailored to the target group and successfully implemented in practice: i) contextual inquiry, ii) value specification, iii) design, iv) operationalization, v) evaluation. In this position paper we describe the lessons learned from research and practice to guide future developments of technology based ASP interventions. Since AMR is a huge wicked problem on a global level, it requires innovative methods and models to empower general public and professionals to be proactive rather than reactive in a digitalized world. We highlight how to combat the dangerous rise of antimicrobial resistance in the future.
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Affiliation(s)
- Nienke Beerlage-de Jong
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede
| | - Lisette van Gemert-Pijnen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede
| | - Jobke Wentzel
- Department of Media, Communication and Organization, University of Twente, Enschede
| | - Ron Hendrix
- Clinical Bacteriology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen
- Certe Laboratory for Infectious Diseases, Groningen, the Netherlands
| | - Liseth Siemons
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede
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Internal and External Validation of a Computer-Assisted Surveillance System for Hospital-Acquired Infections in a 754-Bed General Hospital in the Netherlands. Infect Control Hosp Epidemiol 2016; 37:1355-1360. [PMID: 27488723 DOI: 10.1017/ice.2016.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs). DESIGN Validation cohort. SETTING A 754-bed teaching hospital in the Netherlands. METHODS For the internal validation of a CAPPS for HAIs, 2,526 patients were included. All patient records were retrospectively reviewed in depth by 2 infection control practitioners (ICPs) to determine which patients had suffered an HAI. Preventie van Ziekenhuisinfecties door Surveillance (PREZIES) criteria were used. Following this internal validation, 13 consecutive CAPPS were performed in a prospective study from January to March 2013 to determine weekly, monthly, and quarterly HAI point prevalence. Finally, a CAPPS was externally validated by PREZIES (Rijksinstituut voor Volksgezondheid en Milieu [RIVM], Bilthoven, Netherlands). In all evaluations, discrepancies were resolved by consensus. RESULTS In our series of CAPPS, 83% of the patients were automatically excluded from detailed review by the ICP. The sensitivity of the method was 91%. The time spent per hospital-wide CAPPS was ~3 hours. External validation showed a negative predictive value of 99.1% for CAPPS. CONCLUSIONS CAPPS proved to be a sensitive, accurate, and efficient method to determine serial weekly point-prevalence HAI rates in our hospital. Infect Control Hosp Epidemiol 2016;1-6.
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Redder JD, Leth RA, Møller JK. Incidence rates of hospital-acquired urinary tract and bloodstream infections generated by automated compilation of electronically available healthcare data. J Hosp Infect 2015; 91:231-6. [PMID: 26162918 DOI: 10.1016/j.jhin.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Monitoring of hospital-acquired infection (HAI) by automated compilation of registry data may address the disadvantages of laborious, costly and potentially subjective and often random sampling of data by manual surveillance. AIM To evaluate a system for automated monitoring of hospital-acquired urinary tract (HA-UTI) and bloodstream infections (HA-BSI) and to report incidence rates over a five-year period in a Danish hospital trust. METHODS Based primarily on electronically available data relating to microbiology results and antibiotic prescriptions, the automated monitoring of HA-UTIs and HA-BSIs was validated against data from six previous point-prevalence surveys (PPS) from 2010 to 2013 and data from a manual assessment (HA-UTI only) of one department of internal medicine from January 2010. Incidence rates (infections per 1000 bed-days) from 2010 to 2014 were calculated. FINDINGS Compared with the PPSs, the automated monitoring showed a sensitivity of 88% in detecting UTI in general, 78% in detecting HA-UTI, and 100% in detecting BSI in general. The monthly incidence rates varied between 4.14 and 6.61 per 1000 bed-days for HA-UTI and between 0.09 and 1.25 per 1000 bed-days for HA-BSI. CONCLUSION Replacing PPSs with automated monitoring of HAIs may provide better and more objective data and constitute a promising foundation for individual patient risk analyses and epidemiological studies. Automated monitoring may be universally applicable in hospitals with electronic databases comprising microbiological findings, admission data, and antibiotic prescriptions.
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Affiliation(s)
- J D Redder
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - R A Leth
- Department of Clinical Microbiology, Aarhus University Hospital, Denmark
| | - J K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Akhloufi H, Streefkerk RH, Melles DC, de Steenwinkel JEM, Schurink CAM, Verkooijen RP, van der Hoeven CP, Verbon A. Point prevalence of appropriate antimicrobial therapy in a Dutch university hospital. Eur J Clin Microbiol Infect Dis 2015; 34:1631-7. [PMID: 26017664 PMCID: PMC4514905 DOI: 10.1007/s10096-015-2398-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/03/2015] [Indexed: 12/01/2022]
Abstract
Antimicrobial stewardship teams have been shown to increase appropriate empirical antibiotic therapy and reduce medical errors and costs in targeted populations, but the effect in non-targeted populations is still unclear. The aim of this study was to determine the prevalence of inappropriate antibiotic use in a large university hospital and identify areas in which antimicrobial stewardship will be the most effective. In a point prevalence survey we assessed the appropriateness of antibiotic therapy using an electronic surveillance system in combination with a standardized method for duration of therapy, dosage, dosage interval, route of administration, and choice of antibiotic drug. Patients using at least one antibiotic drug were included. Among 996 patients admitted in the surveyed wards, 337 patients (33.8 %) used one or more antibiotic drugs. Two hundred and twenty-one patients (22.2 %) used antibiotic medication therapeutically, with a total of 307 antibiotic prescriptions. Antibiotic therapy was deemed inappropriate in 90 (29.3 %) of these prescribed antibiotics, with an unjustified prescription as the most common reason for an inappropriate prescription. Use of fluoroquinolones and amoxicillin/clavulanic acid and a presumed diagnosis of fever of unknown origin, urinary tract infection, and respiratory tract infection were associated with inappropriate antibiotic therapy. Our study provides insight into the (in)appropriateness of antibiotic prescriptions in a tertiary care center in the Netherlands and identifies areas for improvement. The use of an electronic surveillance system for this point prevalence study is easy and may serve as a baseline measurement for the future effect of antibiotic stewardship.
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Affiliation(s)
- H Akhloufi
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Streefkerk RHRA, Borsboom GJJM, van der Hoeven CP, Vos MC, Verkooijen RP, Verbrugh HA. Evaluation of an algorithm for electronic surveillance of hospital-acquired infections yielding serial weekly point prevalence scores. Infect Control Hosp Epidemiol 2014; 35:888-90. [PMID: 24915222 DOI: 10.1086/676869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.
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Affiliation(s)
- Roel H R A Streefkerk
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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