Electronically assisted surveillance systems of healthcare-associated infections: A systematic review

Background: Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency. Objectives: To give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them. Methods: In this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented. Results: A total of 78 studies were included. The majority of EASS (n = 72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n = 7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (> 0.8), but specificity varied (0.37 1). Less than 20% (n = 14) of the studies presented data on the efficiency gains achieved. Conclusions: Electronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency

Can routinely collected electronic health data be used to develop novel healthcare associated infection surveillance tools?

Background: Healthcare associated infections (HCAI) pose a significant burden to health systems both within the UK and internationally. Surveillance is an essential component to any infection control programme, however traditional surveillance systems are time consuming and costly. Large amounts of electronic routine data are collected within the English NHS, yet these are not currently exploited for HCAI surveillance. Aim: To investigate whether routinely collected electronic hospital data can be exploited for HCAI surveillance within the NHS. Methods: This thesis made use of local linked electronic health data from Imperial College Healthcare NHS Trust, including information on patient admissions, discharges, diagnoses, procedures, laboratory tests, diagnostic imaging requests and traditional infection surveillance data. To establish the evidence base on surveillance and risks of HCAI, two literature reviews were carried out. Based on these, three types of innovative surveillance tools were generated and assessed for their utility and applicability. Results: The key findings were firstly the emerging importance of automated and syndromic surveillance in infection surveillance, but the lack of investigation and application of these tools within the NHS. Syndromic surveillance of surgical site infections was successful in coronary artery bypass graft patients; however it was an inappropriate methodology for caesarean section patients. Automated case detection of healthcare associated urinary tract infections, based on electronic microbiology data, demonstrated similar rates of infection to those recorded during a point prevalence survey. Routine administrative data demonstrated mixed utility in the creation of simplified risk scores or infection, with poorly performing risk models of surgical site infections but reasonable model fit for HCA UTI. Conclusion: Whilst in principle routine administrative data can be used to generate novel surveillance tools for healthcare associated infections; in reality it is not yet practical within the IT infrastructure of the NHS

Detecting hospital-acquired infections: A document classification approach using support vector machines and gradient tree boosting

Peer reviewe

Gender differences in patients with hip fracture - aspects on care and recovery

Hip fractures in the elderly are common and impose a substantial burden on the healthcare system. This fracture population consists of many subgroups that often require differentiated and extensive acute and postfracture care. The aim of this thesis was to basically characterise a hip fracture population at time of admission, present postoperative results and discuss aspects that may influence recovery. Gender differences are specifically addressed. Study I, II and IV derive from a consecutive series of 2213 patients with hip fracture admitted to four major hospitals in Stockholm, while Study III was a small pilot study. In Study I we investigated the effect of time-to-surgery on: ability to return to own home, incidence of pressure ulcers, length of stay (LOS), and mortality. Patients who had surgery within 24, 36 or 48 hours were compared with those who had surgery later. The ability to return to own home was affected in patients who had to wait longer than 36 and 48 hours. The incidence of pressure ulcers and LOS increased at all time limits. In Study II we investigated gender differences in two subgroups, characterized by normal cognitive function versus cognitive dysfunction, and whether such differences influenced patient ability to: return to own home, regain walking ability and perform activities of daily living (ADL). Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Dysfunction was equally common by gender. Patients with normal function (SPMSQ 8-10) were younger and healthier, resided more often in their own homes and were able to manage ADL independently, with no gender differences. In patients with dysfunction (SPMSQ 0-7), men had more comorbidity on admission, greater loss of walking ability and higher mortality after the fracture episode. We found that cognitive status was the overarching most important factor for predicting outcome. In Study III we examined gastric emptying time of 400 ml carbohydrate rich drink in ten elderly women with acute hip fracture, and compared results with two reference groups of healthy women. The mean half gastric emptying time in the study group was 57 ± 5 (39-82) minutes, to be compared with 58 ±4 (41-106) and 58 ±5 (33-72) in the two reference groups. No adverse event was observed during anesthesia. Consequently, it should be possible to give patients a carbohydrate-rich drink before surgery instead of ordering strict fasting (NPO), which in turn could improve the patients’ chances to recover and regain prefracture status. In Study IV we focused on gender differences in complications; specifically on factors associated with common general complications. Complications were common with an incidence of 59% in men and 56% in women (ns). Most common were urinary tract infection, pressure ulcer, cardiac complications and pneumonia. Male gender emerged as an independent risk factor for suffering from pneumonia, and female gender for urinary tract infection. Besides gender, time-to-surgery, cognitive function, cardiovascular and pulmonary disease on admission were independent risk factors for suffering complication. In conclusion, there are gender differences among patients admitted to a hospital for acute hip fracture, both with regard to status on admission and outcome. Cognitive dysfunction, equally common among women and men, has a major impact on incidence of complication and functional recovery. Men with cognitive dysfunction are at greater risk. With increased awareness of risk factors and gender bias, along with reduced waiting time for surgery, it should be possible to decrease complication incidence and improve outcome. We found no evidence for prolonged gastric emptying time of a carbohydrate-rich beverage, which implies it may be possible to provide patients with a carbohydrate-rich drink before surgery instead of adhering to strict fasting