Computer-automated CLABSI surveillance review

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“We assessed whether a computer-automated method of central line-associated BSI detection can improve the validity of surveillance.” Lin et al (2014).

Reference:

Lin, M.Y., Woeltje, K.F., Khan, Y.M., Hota, B., Doherty, J.A., Borlawsky, T.B., Stevenson, K.B., Fridkin, S.K., Weinstein, R.A. and Trick, W.E. (2014) Multicenter Evaluation of Computer Automated versus Traditional Surveillance of Hospital-Acquired Bloodstream Infections. Infection Control and Hospital Epidemiology. 35(12), p.1483-1490.

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 [Formula: see text] [0.37-0.51]) than computer algorithm surveillance (κ [95% [Formula: see text] [0.52-0.64]; [Formula: see text]). Agreement between traditional surveillance and audit review was heterogeneous across ICUs ([Formula: see text]); furthermore, traditional surveillance performed worse among ICUs reporting lower (better) BSI rates ([Formula: see text]). 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.

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