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

Infect Control Hosp Epidemiol. 2014 Dec;35(12):1483-90. doi: 10.1086/678602. Epub 2014 Nov 7.

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.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Algorithms
  • Bacteremia* / diagnosis
  • Bacteremia* / epidemiology
  • Bacteremia* / etiology
  • Bacteremia* / prevention & control
  • Catheter-Related Infections* / diagnosis
  • Catheter-Related Infections* / epidemiology
  • Catheter-Related Infections* / prevention & control
  • Catheterization, Central Venous / adverse effects
  • Cross Infection* / diagnosis
  • Cross Infection* / epidemiology
  • Cross Infection* / prevention & control
  • Epidemiological Monitoring
  • Hospital Information Systems* / organization & administration
  • Hospital Information Systems* / standards
  • Humans
  • Infection Control / standards*
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data
  • Management Audit
  • Quality Improvement
  • Reproducibility of Results
  • Retrospective Studies
  • United States / epidemiology