Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T14:11:19.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia

Published online by Cambridge University Press:  02 January 2015

Emma S. McBryde ,
Judy Brett ,
Philip L. Russo ,
Leon J. Worth ,
Ann L. Bull  and
Michael J. Richards
Emma S. McBryde*
Affiliation:
Victorian Infectious Diseases Service, Centre for Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Judy Brett
Affiliation:
Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, Melbourne, Victoria, Australia
Philip L. Russo
Affiliation:
Austin Hospital, Melbourne, Victoria, Australia
Leon J. Worth
Affiliation:
Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, Melbourne, Victoria, Australia
Ann L. Bull
Affiliation:
Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, Melbourne, Victoria, Australia
Michael J. Richards
Affiliation:
Victorian Infectious Diseases Service, Centre for Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, Melbourne, Victoria, Australia
*
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia (emma.mcbryde@mh.org.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).

Design.

Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.

Setting.

Six Victorian public hospitals with more than 100 beds.

Methods.

Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.

Results.

Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.

Discussion.

The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1045 - 1049
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.CrossRefGoogle ScholarPubMed
2.Rosenthal, VD, Guzman, S, Migone, O, Safdar, N. The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005;33:157–161.CrossRefGoogle ScholarPubMed
3.Vandijck, DM, Depaemelaere, M, Labeau, SO, et al.Daily cost of antimicrobial therapy in patients with intensive care unit-acquired, laboratory-confirmed bloodstream infection. Int J Antimicrob Agents 2008;31:161–165.CrossRefGoogle ScholarPubMed
4.Coello, R, Charlett, A, Ward, V, et al.Device-related sources of bacteraemia in English hospitals—opportunities for the prevention of hospital-acquired bacteraemia. J Hosp Infect 2003;53:46–57.Google Scholar
5.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al.Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–2020.CrossRefGoogle ScholarPubMed
6.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
7.Emori, TG, Culver, DH, Horan, TC, et al.National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
8.Gaynes, RP, Culver, DH, Emori, TG, et al.The National Nosocomial Infections Surveillance system: plans for the 1990s and beyond. Am J Med 1991;91(Suppl 3B):S116–S120.Google Scholar
9.Kritchevsky, SB, Braun, BI, Kusek, L, et al.The impact of hospital practice on central venous catheter-associated bloodstream infection rates at the patient and unit level: a multicenter study. Am J Med Qual 2008;23:24–38.Google Scholar
10.Haley, RW, Schaberg, DR, McClish, DK, et al.The accuracy of retrospective chart review in measuring nosocomial infection rates: results of validation studies in pilot hospitals. Am J Epidemiol 1980;111:516–533.Google Scholar
11.Glenister, H, Taylor, L, Bartlett, C, Cooke, M, Sedgwick, J, Leigh, D. An assessment of selective surveillance methods for detecting hospital-acquired infection. Am J Med 1991;91(Suppl 3B):S121–S124.Google Scholar
12.Emori, TG, Edwards, JR, Culver, DH, et al.Accuracy of reporting nosocomial infections in intensive-care-unit patients to the National Nosocomial Infections Surveillance system: a pilot study. Infect Control Hosp Epidemiol 1998;19:308–316.CrossRefGoogle Scholar
13.Gaynes, R, Richards, C, Edwards, J, et al.Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295–298.CrossRefGoogle ScholarPubMed
14.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
15.Huotari, K, Lyytikainen, O, Seitsalo, S. Patient outcomes after simultaneous bilateral total hip and knee joint replacements. J Hosp Infect 2007;65:219–225.CrossRefGoogle ScholarPubMed
16.Friedman, ND, Russo, PL, Bull, AL, Richards, MJ, Kelly, H. Validation of coronary artery bypass graft surgical site infection surveillance data from a statewide surveillance system in Australia. Infect Control Hosp Epidemiol 2007;28:812–817.CrossRefGoogle ScholarPubMed
17.McBryde, ES, Kelly, H, Marshall, C, Russo, PL, McElwain, DL, Pettitt, AN. Using samples to estimate the sensitivity and specificity of a surveillance process. Infect Control Hosp Epidemiol 2008;29:559–563.CrossRefGoogle ScholarPubMed
18.Kelly, H, Bull, A, Russo, P, McBryde, ES. Estimating sensitivity and specificity from positive predictive value, negative predictive value and prevalence: application to surveillance systems for hospital-acquired infections. J Hosp Infect 2008;69:164–168.Google Scholar
19.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
20.Bennett, NJ, Bull, AL, Dunt, DR, et al.Bloodstream infection surveillance in smaller hospitals. Aust Infect Control 2007;12:45–47.CrossRefGoogle Scholar
21.Worth, LJ, Brett, J, Bull, AL, McBryde, ES, Russo, PL, Richards, MJ. Impact of revising the National Nosocomial Infection Surveillance system definition for catheter-related bloodstream infection in ICU: reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals. Am J Infect Control 2009;37:643–648.Google Scholar