title: Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive care.
abstract: BACKGROUND
  Availability 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.
  
  
  METHODS
  Prospective 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.
  
  
  RESULTS
  A 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%.
  
  
  CONCLUSIONS
  Pre-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.
authors: Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands ; Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Anna Maria
authors: AM
authors: Kaiser
authors: Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Evelien
authors: E
authors: de Jong
authors: Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Sabine Fm
authors: SF
authors: Evelein-Brugman
authors: Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Jan M
authors: JM
authors: Peppink
authors: Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Christina Mje
authors: CM
authors: Vandenbroucke-Grauls
authors: Department of Intensive Care, VU University Medical Centre, Amsterdam, 1007 MB, The Netherlands.
authors: Armand Rj
authors: AR
authors: Girbes
keywords: Decision support capabilities; Electronic surveillance system; Hospital-acquired infection (HAI); Infection prevention (IP); Patient data management system; Quality improvement
references: Infect Control Hosp Epidemiol. 2008 Jan;29(1):31-7
references: 18171184
references: Infect Control Hosp Epidemiol. 2008 Sep;29(9):842-6
references: 18713052
references: N Engl J Med. 2009 Jan 1;360(1):20-31
references: 19118302
references: Am J Infect Control. 2009 Jun;37(5):351-7
references: 19201510
references: Infect Control Hosp Epidemiol. 2013 Apr;34(4):433-6
references: 23466919
references: Am J Infect Control. 2008 Jun;36(5):309-32
references: 18538699
references: Am J Infect Control. 2010 Sep;38(7):509-14
references: 20176411
references: Am J Infect Control. 2008 Apr;36(3 Suppl):S37-46
references: 18374211
references: Am J Infect Control. 2005 Oct;33(8):439-43
references: 16216656
references: Crit Care Med. 2010 Aug;38(8 Suppl):S399-404
references: 20647798
references: PLoS One. 2011 Mar 22;6(3):e18062
references: 21445364
references: Clin Infect Dis. 2012 Aug;55(3):364-70
references: 22539665
references: J Hosp Infect. 2013 Jun;84(2):103-5
references: 23643390
references: J Healthc Eng. 2014;5(2):163-84
references: 24918182
references: J Am Med Inform Assoc. 2013 Mar-Apr;20(2):369-72
references: 22871398
references: Clin Infect Dis. 2013 Jul;57(1):85-93
references: 23532476
references: J Hosp Infect. 2006 Jan;62(1):71-9
references: 16099539