Automated surveillance for central line-associated bloodstream infection in intensive care units.

Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
Keith F WoeltjeThomas C Bailey

Abstract

To develop and evaluate computer algorithms with high negative predictive values that augment traditional surveillance for central line-associated bloodstream infection (CLABSI). Barnes-Jewish Hospital, a 1,250-bed tertiary care academic hospital in Saint Louis, Missouri. We evaluated all adult patients in intensive care units who had blood samples collected during the period from July 1, 2005, to June 30, 2006, that were positive for a recognized pathogen on culture. Each isolate recovered from culture was evaluated using the definitions for nosocomial CLABSI provided by the National Healthcare Safety Network of the Centers for Disease Control and Prevention. Using manual surveillance by infection prevention specialists as the gold standard, we assessed the ability of various combinations of dichotomous rules to determine whether an isolate was associated with a CLABSI. Sensitivity, specificity, and predictive values were calculated. Infection prevention specialists identified 67 cases of CLABSI associated with 771 isolates recovered from blood samples. The algorithms excluded approximately 40%-62% of the isolates from consideration as possible causes of CLABSI. The simplest algorithm, with 2 dichotomous rules (ie, the collect...Continue Reading

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