title: Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.
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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lin
authors.forename: Keith F
authors.initials: KF
authors.lastname: Woeltje
authors.forename: Yosef M
authors.initials: YM
authors.lastname: Khan
authors.forename: Bala
authors.initials: B
authors.lastname: Hota
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.forename: Tara B
authors.initials: TB
authors.lastname: Borlawsky
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
mesh_terms: D000465:Algorithms; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D062665:Epidemiological Monitoring; D006751:Hospital Information Systems / Q000458:organization & administration / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008330:Management Audit; D058996:Quality Improvement; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology