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

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

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

BackgroundSurveillance 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.ObjectivesTo give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them.MethodsIn 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.ResultsA 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.ConclusionsElectronically 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

HHS action plan to prevent healthcare-associated infections

"The Department of Health and Human Services (HHS) "Action Plan to Prevent Healthcare-Associated Infections" represents a culmination of several months of research, deliberation, and public comment to identify the key actions needed to achieve and sustain progress in protecting patients from the transmission of serious, and in some cases, deadly infections. In response to the increasing threat of HAIs and national and international concern, the Department has composed a Steering Committee of senior-level representatives from the Offices and Operating Divisions of HHS and conducted a number of in-person meetings and conferences with Federal experts. The Department's Action Plan toward the prevention and elimination of HAIs includes goals toward which the healthcare and public health communities have been moving over the past several years." p 1-2Executive summary -- Introduction -- Prevention: metrics and targets -- Prevention: prioritized recommendations -- Research -- Information systems and technology -- Incentives and oversight -- Outreach and messaging -- Coordination, evaluation, and conclusion -- AppendicesAgency for Healthcare Research and Quality, Office of the Assistant Secretary for Public Affairs, Office of the Assistant Secretary for Planning and Evaluation, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Food and Drug Administration, National Institutes of Health, Office of the National Coordinator for Health Information Technology, Office of Public Health and Science."06222009."Title from title screen (viewed on March 17, 2011)

Predicting infections using computational intelligence – A systematic review

Infections encompass a set of medical conditions of very diverse kinds that can pose a significant risk to health, and even death. As with many other diseases, early diagnosis can help to provide patients with proper care to minimize the damage produced by the disease, or to isolate them to avoid the risk of spread. In this context, computational intelligence can be useful to predict the risk of infection in patients, raising early alarms that can aid medical teams to respond as quick as possible. In this paper, we survey the state of the art on infection prediction using computer science by means of a systematic literature review. The objective is to find papers where computational intelligence is used to predict infections in patients using physiological data as features. We have posed one major research question along with nine specific subquestions. The whole review process is thoroughly described, and eight databases are considered which index most of the literature published in different scholarly formats. A total of 101 relevant documents have been found in the period comprised between 2003 and 2019, and a detailed study of these documents is carried out to classify the works and answer the research questions posed, resulting to our best knowledge in the most comprehensive study of its kind. We conclude that the most widely addressed infection is by far sepsis, followed by Clostridium difficile infection and surgical site infections. Most works use machine learning techniques, from which logistic regression, support vector machines, random forest and naive Bayes are the most common. Some machine learning works provide some ideas on the problems of small data and class imbalance, which can be of interest. The current systematic literature review shows that automatic diagnosis of infectious diseases using computational intelligence is well documented in the medical literature.publishedVersio

Recommendations for change in infection prevention programs and practice

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future

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

A cost analysis of the conventional culture method versus polymerase chain reaction testing for methicillin-resistant staphylococcus aureus at a South African public hospital

A Dissertation Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Medicine in the Department of Pharmacy and Pharmacology Johannesburg, January 2016Methicillin-Resistant Staphylococcus aureus (MRSA) infections increase the cost and consequences of patient care within hospitals. Patients can be tested for MRSA using the Conventional Culture Method or new rapid Polymerase Chain Reaction (PCR) tests, such as the Xpert MRSA test. International studies have compared the costs and consequent management pathways for these two methods of MRSA testing. However, in the South African context where socio-economic status and access to healthcare may contribute different influences, no such models exist. Therefore, the aim of this study was to investigate the costs of the management pathways associated with using the current Conventional Culture Method for MRSA testing, to construct decision-tree-analytic models and compare them to the new PCR testing, in order to inform decision-making. TreeAge decision-tree-analytic models were developed to depict the current pathways, and associated costs, incurred by patients with a suspected MRSA infection in an orthopaedic and vascular ward at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa in 2013. These models were then compared to theoretical pathways including implementing the Xpert MRSA. The models were populated with input parameters from observations conducted in the two wards, the microbiology laboratory and the main dispensary, and costs were calculated using the retrospective utilization reviews formulated from the antibiotics administered and laboratory tests that isolated MRSA in the study population. Sensitivity analyses were performed to evaluate the effect of the variables on the models. The average total cost of antibiotics and MRSA laboratory tests utilised per patient in the orthopaedic and vascular wards were R3 846.82 and R2 964.39 respectively. Based on ethnographic observations and retrospective utilization reviews, three pathways for a patient with a suspected infection were identified: Empiric Antibiotics followed by Microscopy, Culture and Sensitivity (MCS); MCS followed by Empiric Antibiotics; Empiric Antibiotics and MCS concurrently. The fourth pathway included implementing the Xpert MRSA test. Analysis of these pathways revealed that implementation of the Xpert MRSA would be the optimal strategy in the orthopaedic ward, but the most expensive strategy in the vascular ward. In conclusion, these costs and pathways highlight the utilization of scarce resources. Thus, it is suggested that, before new methods of MRSA testing are introduced, the current practices and pathways for patients with a suspected MRSA infection should be further evaluated and improved.MT201