Clinical Institute of Hospital Hygiene, Medical University of Vienna and Vienna General Hospital , Austria.
Appl Clin Inform. 2011 Sep 14;2(3):365-72. doi: 10.4338/ACI-2011-03-RA-0022. Print 2011.
Expert surveillance of healthcare-associated infections (HCAIs) is a key parameter for good clinical practice, especially in intensive care medicine. Assessment of clinical entities such as HCAIs is a time-consuming task for highly trained experts. Such are neither available nor affordable in sufficient numbers for continuous surveillance services. Intelligent information technology (IT) tools are in urgent demand.
MONI-ICU (monitoring of nosocomial infections in intensive care units (ICUs)) has been developed methodologically and practically in a stepwise manner and is a reliable surveillance IT tool for clinical experts. It uses information from the patient data management systems in the ICUs, the laboratory information system, and the administrative hospital information system of the Vienna General Hospital as well as medical expert knowledge on infection criteria applied in a multilevel approach which includes fuzzy logic rules.
We describe the use of this system in clinical routine and compare the results generated automatically by MONI-ICU with those generated in parallel by trained surveillance staff using patient chart reviews and other available information ("gold standard"). A total of 99 ICU patient admissions representing 1007 patient days were analyzed. MONI-ICU identified correctly the presence of an HCAI condition in 28/31 cases (sensitivity, 90.3%) and their absence in 68/68 of the non-HCAI cases (specificity, 100%), the latter meaning that MONI-ICU produced no "false alarms". The 3 missed cases were due to correctable technical errors. The time taken for conventional surveillance at the 52 ward visits was 82.5 hours. MONI-ICU analysis of the same patient cases, including careful review of the generated results, required only 12.5 hours (15.2%).
Provided structured and sufficient information on clinical findings is online available, MONI-ICU provides an almost real-time view of clinical indicators for HCAI - at the cost of almost no additional time on the part of surveillance staff or clinicians.
医疗保健相关性感染（HAI）的专家监测是良好临床实践的关键参数，尤其是在重症监护医学中。评估 HAI 等临床实体对于高度训练有素的专家来说是一项耗时的任务。此类专家既没有足够的数量，也没有足够的资源来提供连续的监测服务。因此迫切需要智能信息技术（IT）工具。
MONI-ICU（重症监护病房（ICU）医院感染监测）已以逐步的方式在方法学和实践上进行了开发，是临床专家进行可靠监测的 IT 工具。它使用 ICU 患者数据管理系统、实验室信息系统和维也纳综合医院行政医院信息系统中的信息，以及应用于多层次方法的感染标准的医学专家知识，其中包括模糊逻辑规则。
我们描述了该系统在临床常规中的使用，并将 MONI-ICU 自动生成的结果与经过培训的监测人员使用患者图表审查和其他可用信息（“金标准”）并行生成的结果进行了比较。共分析了 99 例 ICU 患者入院，代表 1007 个患者日。MONI-ICU 在 28/31 例（敏感性，90.3%）中正确识别出 HAI 状况的存在，在 68/68 例非 HAI 病例中正确识别出不存在（特异性，100%），后者意味着 MONI-ICU 没有产生“误报”。这 3 个漏诊病例是由于可纠正的技术错误。在 52 次病房访视中进行常规监测所需的时间为 82.5 小时。对相同患者病例进行 MONI-ICU 分析，包括仔细审查生成的结果，仅需 12.5 小时（15.2%）。
只要在线提供有关临床发现的结构化和充足信息，MONI-ICU 就可以几乎实时地提供 HCAI 的临床指标视图——而且几乎不会增加监测人员或临床医生的额外时间。
