Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive careReportar como inadecuado




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Annals of Intensive Care

, 4:40

First Online: 21 December 2014Received: 04 July 2014Accepted: 11 December 2014

Abstract

BackgroundAvailability of a patient data management system PDMS has created the opportunity to develop trigger-based electronic surveillance systems ESSs. The aim was to evaluate a semi-automated trigger-based ESS for the detection of ventilator-associated pneumonia VAP and central line-associated blood stream infections CLABSIs in the intensive care.

MethodsProspective comparison of surveillance was based on a semi-automated ESS with and without trigger. Components of the VAP-CLABSI definition served as triggers. These included the use of VAP-CLABSI-related antibiotics, the presence of mechanical ventilation or an intravenous central line, and the presence of specific clinical symptoms. Triggers were automatically fired by the PDMS. Chest X-rays and microbiology culture results were checked only on patient days with a positive trigger signal from the ESS. In traditional screening, no triggers were used; therefore, chest X-rays and culture results had to be screened for all patient days of all included patients. Patients with pneumonia at admission were excluded.

ResultsA total of 553 patients were screened for VAP and CLABSI. The incidence of VAP was 3.3-1,000 ventilation days 13 VAP-3,927 mechanical ventilation days, and the incidence of CLABSI was 1.7-1,000 central line days 24 CLABSI-13.887 central line days. For VAP, the trigger-based screening had a sensitivity of 92.3%, a specificity of 100%, and a negative predictive value of 99.8% compared to traditional screening of all patients. For CLABSI, sensitivity was 91.3%, specificity 100%, and negative predictive value 99.6%.

ConclusionsPre-selection of patients to be checked for signs and symptoms of VAP and CLABSI by a computer-generated automated trigger system was time saving but slightly less accurate than conventional surveillance. However, this after-the-fact surveillance was mainly designed as a quality indicator over time rather than for precise determination of infection rates. Therefore, surveillance of VAP and CLABSI with a trigger-based ESS is feasible and effective.

KeywordsHospital-acquired infection HAI Quality improvement Electronic surveillance system Decision support capabilities Infection prevention IP Patient data management system Electronic supplementary materialThe online version of this article doi:10.1186-s13613-014-0040-x contains supplementary material, which is available to authorized users.

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Autor: Anna Maria Kaiser - Evelien de Jong - Sabine FM Evelein-Brugman - Jan M Peppink - Christina MJE Vandenbroucke-Grauls - Ar

Fuente: https://link.springer.com/







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