Department of Quality Improvement/Infection Control, Harborview Medical Center, Seattle, Washington 98104, USA.
Infect Control Hosp Epidemiol. 2011 Aug;32(8):757-62. doi: 10.1086/661103.
To develop and validate an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs).
Retrospective cohort study.
413-bed university-affiliated urban teaching hospital.
An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).
During January and February 2010, 204 positive urine cultures (≥10(3) colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (κ, 0.80; 95% confidence interval, 0.71-0.89).
We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.
开发并验证一种用于导管相关尿路感染（CAUTI）的电子监测工具。
回顾性队列研究。
413 床位的大学附属城市教学医院。
根据国家医疗保健安全网络（NHSN）定义的客观成分，包括发热、尿液分析和尿液培养，为 CAUTI 和导尿管使用开发了一种电子监测工具。结果与感染预防员（IP）的手动图表审查进行了比较。
2010 年 1 月至 2 月，在住院期间留置导尿管的 136 名患者中，共检出 204 例阳性尿液培养（≥10(3) 菌落形成单位/ml）。电子监测工具检测到 60 例 CAUTI 病例和 7098 个导尿管日，CAUTI 发病率为每 1000 个导尿管日 8.5 例。导尿管使用率（Foley 日/患者日）分别为：急症护理病房，0.27（3637/13229）；重症监护病房，0.77（3461/4469）；整体，0.40（7098/17698）。相比之下，IP 通过手动审查确定了 59 例，敏感性为 59 例中的 51 例（86.4%），特异性为 145 例中的 136 例（93.8%），阴性预测值为 144 例中的 136 例（94.4%）。手动确定的 59 例 CAUTI 病例中，54 例（91.5%）存在发热，而仅在 6 例（10.2%）感染中记录了主观标准。电子监测与手动 IP 审查之间的一致性评估为非常好（κ，0.80；95%置信区间，0.71-0.89）。
我们报告了尝试自动化监测 CAUTI 的情况。该电子工具具有较高的阴性预测值，可更有效地监测 CAUTI，并有助于进行全院范围内的发病率和导尿管使用率趋势分析。这种方法应在不同的患者群体中进行验证。
