title: Building and Validating a Computerized Algorithm for Surveillance of Ventilator-Associated Events.
abstract: OBJECTIVE
  To develop an automated method for ventilator-associated condition (VAC) surveillance and to compare its accuracy and efficiency with manual VAC surveillance
  
  
  METHODS
  The intensive care units (ICUs) of 4 hospitals
  
  
  METHODS
  This study was conducted at Detroit Medical Center, a tertiary care center in metropolitan Detroit. A total of 128 ICU beds in 4 acute care hospitals were included during the study period from August to October 2013. The automated VAC algorithm was implemented and utilized for 1 month by all study hospitals. Simultaneous manual VAC surveillance was conducted by 2 infection preventionists and 1 infection control fellow who were blinded to each another's findings and to the automated VAC algorithm results. The VACs identified by the 2 surveillance processes were compared.
  
  
  RESULTS
  During the study period, 110 patients from all the included hospitals were mechanically ventilated and were evaluated for VAC for a total of 992 mechanical ventilation days. The automated VAC algorithm identified 39 VACs with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%. In comparison, the combined efforts of the IPs and the infection control fellow detected 58.9% of VACs, with 59% sensitivity, 99% specificity, 91% PPV, and 92% NPV. Moreover, the automated VAC algorithm was extremely efficient, requiring only 1 minute to detect VACs over a 1-month period, compared to 60.7 minutes using manual surveillance.
  
  
  CONCLUSIONS
  The automated VAC algorithm is efficient and accurate and is ready to be used routinely for VAC surveillance. Furthermore, its implementation can optimize the sensitivity and specificity of VAC identification.
authors.affiliation: 1General ICU,Assaf-Harofeh Medical Center,Tsrifin,Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Mann
authors.affiliation: 2Department of Corporate Quality and Safety/Epidemiology,Detroit Medical Center,Detroit,Michigan,United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ellsworth
authors.affiliation: 3Department of Medicine,Henry Ford Hospital,Detroit,Michigan,United States.
authors.forename: Najia
authors.initials: N
authors.lastname: Huda
authors.affiliation: 4Carolina Health System,Charlotte,North Carolina,United States.
authors.forename: Anupama
authors.initials: A
authors.lastname: Neelakanta
authors.affiliation: 2Department of Corporate Quality and Safety/Epidemiology,Detroit Medical Center,Detroit,Michigan,United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chevalier
authors.affiliation: 5Detroit Medical Center,Detroit Michigan,United States.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Sims
authors.affiliation: 6Department of Medicine,Wayne State University/Detroit Medical Center,Detroit,Michigan,United States.
authors.forename: Sorabh
authors.initials: S
authors.lastname: Dhar
authors.affiliation: 2Department of Corporate Quality and Safety/Epidemiology,Detroit Medical Center,Detroit,Michigan,United States.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Robinson
authors.affiliation: 6Department of Medicine,Wayne State University/Detroit Medical Center,Detroit,Michigan,United States.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000465:Algorithms; D006801:Humans; D001239:Inhalation; D007362:Intensive Care Units; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010100:Oxygen / Q000502:physiology; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000209:etiology; D011159:Population Surveillance / Q000379:methods*; D018467:Positive-Pressure Respiration, Intrinsic; D011237:Predictive Value of Tests; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000209:etiology; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology; D012985:Software Design; D012986:Software Validation
chemical_list: D010100:Oxygen