An automated retrospective VAE-surveillance tool for future quality improvement studies

Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22′442 ventilated admissions with a total of 37′221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1–22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93–1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies.

A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator

Objective: The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks. Methods: The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk. Results: In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD. Conclusion: ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.

Establishment of an automated surveillance for the French STI clinics: the SurCeGGID system (Preprint)

BACKGROUND Viral and bacterial sexually transmitted infections (STI) are public health concerns worldwide but surveillance systems are not comprehensive enough to design and monitor accurately STI control strategies in most countries. In 2016, 320 STI clinics (CeGIDD in French) with expanded sexual health missions were implemented in France, primarily targeting most exposed populations, although access is free of charge for anybody. OBJECTIVE This article describes the mandatory surveillance system (SurCeGIDD) based on CeGIDDs’ individual data aiming to better guide STI prevention. METHODS A decree ensured the use of software to manage consultations in CeGIDDs and to transfer surveillance data. A webservice was implemented to secure data transfer from CeGIDDs’ softwares to a centralized database. CeGIDDs can also transfer data in CSV format via a secured data-sharing platform. Then, data are automatically checked before integration. Socio-demographic variables, sexual exposure, blood exposure, symptoms, STI tests, STI diagnoses and sexual health services delivery were collected for the previous year (n-1). Preliminary and descriptive analyses of 2017-2018 data, respectively transmitted in 2018 and 2019, were performed using numbers and proportions for qualitative variables. RESULTS In 2017, 54 (out of 320 , i.e. 17%) of CeGIDD transmitted their data. In 2018, this number of participants increased to 143 (45%) CeGIDDs. Corresponding volume of records increased from 2,414 in 2017 to 382,890 in 2018. In 2018, majority of attendances were hospital based (69%, n= 263,480). Considering the growing volume of information, an advisory committee was set up to guide the construction of algorithms enabling accurate data management and analyses. CONCLUSIONS The automated surveillance SurCeGID is functional despites challenges hampering its expansion. The effectiveness of surveillances using routinely collected records, demonstrated through the monitoring of Covid-19 pandemic, might help to better guide and evaluate STI prevention and services delivery.