Erfahrungen mit einem neuen Computer-gestützten System zur automatischen Erfassung und Überwachung von nosokomialen Infektionen an Intensivstationen – MONI 4 A. Blacky, W. Koller, H. Mandl, und K.P. Adlassnig Fully Automated Surveillance of Healthcare-Associated Infections with MONI-ICU A Breakthrough in Clinical Infection Surveillance
32
Embed
A. Blacky, W. Koller, H. Mandl, und K.P. Adlassnig - Alexander Blacky.pdfA. Blacky, W. Koller, H. Mandl, und K.P. Adlassnig Fully Automated Surveillance of Healthcare-Associated Infections
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Erfahrungen mit einem neuen Computer-gestützten System zur automatischen Erfassung und Überwachung von nosokomialen Infektionen an Intensivstationen –
MONI 4
A. Blacky, W. Koller, H. Mandl, und K.P. Adlassnig
Fully Automated Surveillance of Healthcare-Associated Infections with MONI-ICU
A Breakthrough in Clinical Infection Surveillance
ICU Wards at the Vienna General Hospital
• 13B1• 13B3• 13C1• 13C2• 13C3• 13H1• 13H3• 13I1• 13I2• 13I3• transplant ICU• neurosurgery ICU• NICU 9C• NICU E10• NICU E12
Erfolge bei der Infektions- prävention
Aufwand für die Surveillance
Hoher Dokumentationsaufwand bei hoher Datenredundanz:
Viele Daten liegen redundant in verschiedenen IT-Systemen vor . . .So often are the same data in various IT-Systems stored ….. Verwaltungssystem, Laborinformationssystem,Billingsystems, Laboratorysystems, ……Pflegedokumentation, Anästhesieinformationssystem,Caredocumentation, ……Medizinische Patientendokumentation, etc.
HIS: hospital information system (here: HIS of the City of Vienna)PDMS: patient data management systems (here: CareVue by Philips)CDA: clinical data archiveISM: information support martLIS: laboratory information system of the microbiology (here: HIS of the City of Vienna)HIS DB: relational data base of medical data
LIS
PDMS s
CDA
ISMHIS
DBHIS
…
Moni 4
clinical data
microbiological data
CareVueCareVue
CareVueCareVue
administrative data +
HIS
patient-specific alerts
infection control
natural-language definitions of nosocomial infections
Fuzzy theories
Artificial intelligence
Monitoring of
nosocomial infections
knowledge-based systems
fuzzy sets and logic
ICUICU
microbiology
cockpit surveillance remote
clinical data
Medicine
data on microorganisms
cockpit surveillance at ward ICU
Cockpit Surveillance at the infection control unit
* comprising 18 HCAI episodes: 7 with one, 1 with two and 3 with three distinct infection episodes during one stay
MONI 4: Evaluierung
1 ICU:
MONI reported: 11 stays with HCAI 44 stays without HCAI
HCAI present 8 (72.7%) 0 (0%)
HCAI absent 3* (27.3%) 44 (100%)
human expert reported:
HCAI present 8 (72.7%) 1** (2.3%)
HCAI absent 3*** (27.3%) 43 (97.7%)
# one or more HCAIs during one stay* 2 PN episodes and 1 CRI episode not reported due to missing import of electronic microbiology report ** human expert wrongly reported a UTI due to clinical notes in dismission report which could not be verified by any data in the patient charts (UT-colonisation only)*** human expert missed 2 CRI and 1 BSI episodes
HCAI condition# per ICU stay correctly or falsely identified by MONI and by the human expert
Sensitivity and specificity of automated MONI vs. human expert HCAI surveillance
MONI human expert
syndrome n sensitivity specificity sensitivity specificity
BSI 3 100% 100% 0% 100%
CRI 9 88.8% 100% 33.3% 100%
PN 5 40% 100% 100% 100%
overall HCAI** 11 72.7% 100% 72.7% 97.7%
** comprising 18 HCAI episodes: 7 with one, 1 with two and 3 with three distinct infection episodes during one stay