Evaluation of manual and electronic healthcare-associated infections surveillance: a multi-center study with 21 tertiary general hospitals in China

Process analysis of the patient pathway for automated data collection: an exemplar using pituitary surgery

Introduction

Automation of routine clinical data shows promise in relieving health systems of the burden associated with manual data collection. Identifying consistent points of documentation in the electronic health record (EHR) provides salient targets to improve data entry quality. Using our pituitary surgery service as an exemplar, we aimed to demonstrate how process mapping can be used to identify reliable areas of documentation in the patient pathway to target structured data entry interventions.

Materials and methods

This mixed methods study was conducted in the largest pituitary centre in the UK. Purposive snowball sampling identified frontline stakeholders for process mapping to produce a patient pathway. The final patient pathway was subsequently validated against a real-world dataset of 50 patients who underwent surgery for pituitary adenoma. Events were categorized by frequency and mapped to the patient pathway to determine critical data points.

Results

Eighteen stakeholders encompassing all members of the multidisciplinary team (MDT) were consulted for process mapping. The commonest events recorded were neurosurgical ward round entries (N = 212, 14.7%), pituitary clinical nurse specialist (CNS) ward round entries (N = 88, 6.12%) and pituitary MDT treatment decisions (N = 88, 6.12%) representing critical data points. Operation notes and neurosurgical ward round entries were present for every patient. 43/44 (97.7%) had a pre-operative pituitary MDT entry, pre-operative clinic letter, a post-operative clinic letter, an admission clerking entry, a discharge summary, and a post-operative histopathology pituitary multidisciplinary (MDT) team entries.

Conclusion

This is the first study to produce a validated patient pathway of patients undergoing pituitary surgery, serving as a comparison to optimise this patient pathway. We have identified salient targets for structured data entry interventions, including mandatory datapoints seen in every admission and have also identified areas to improve documentation adherence, both of which support movement towards automation.

Effectiveness of an artificial intelligence-based training and monitoring system in prevention of nosocomial infections: A pilot study of hospital-based data

This work describes a novel artificial intelligence-based training and monitoring system (AITMS) that was used to control and prevent nosocomial infections (NIs) by improving the skills of donning/removing personal protective equipment (PPE). The AITMS has two working modes, namely an AI-based protective equipment surveillance mode and an AI-based training mode, that were used for routine surveillance and training, respectively. Data revealed that the accuracy rate of donning/removing PPE improved as a result of the AITMS. Interestingly, the frequency of NIs decreased with the use of the AITMS. This study suggested the key role of using PPE in controlling and preventing NIs. Data preliminarily proved that appropriate donning/removing PPE may help to reduce the risk of NIs. In addition, the newest computerized technologies, such as AI, have proven to be useful in controlling and preventing NIs. These findings should helpful to formulate a better strategy against NIs in the future.

Development of a knowledge-based healthcare-associated infections surveillance system in China

BACKGROUND

In the modern era of antibiotics, healthcare-associated infections (HAIs) have emerged as a prominent and concerning health threat worldwide. Implementing an electronic surveillance system for healthcare-associated infections offers the potential to not only alleviate the manual workload of clinical physicians in surveillance and reporting but also enhance patient safety and the overall quality of medical care. Despite the widespread adoption of healthcare-associated infections surveillance systems in numerous hospitals across China, several challenges persist. These encompass incomplete coverage of all infection types in the surveillance, lack of clarity in the alerting results provided by the system, and discrepancies in sensitivity and specificity that fall short of practical expectations.

METHODS

We design and develop a knowledge-based healthcare-associated infections surveillance system (KBHAIS) with the primary goal of supporting clinicians in their surveillance of HAIs. The system operates by automatically extracting infection factors from both structured and unstructured electronic health data. Each patient visit is represented as a tuple list, which is then processed by the rule engine within KBHAIS. As a result, the system generates comprehensive warning results, encompassing infection site, infection diagnoses, infection time, and infection probability. These knowledge rules utilized by the rule engine are derived from infection-related clinical guidelines and the collective expertise of domain experts.

RESULTS

We develop and evaluate our KBHAIS on a dataset of 106,769 samples collected from 84,839 patients at Gansu Provincial Hospital in China. The experimental results reveal that the system achieves a sensitivity rate surpassing 0.83, offering compelling evidence of its effectiveness and reliability.

CONCLUSIONS

Our healthcare-associated infections surveillance system demonstrates its effectiveness in promptly alerting patients to healthcare-associated infections. Consequently, our system holds the potential to considerably diminish the occurrence of delayed and missed reporting of such infections, thereby bolstering patient safety and elevating the overall quality of healthcare delivery.

Nosocomial Infections in Adult Patients Receiving Extracorporeal Membrane Oxygenation in China: A Retrospective Cohort Study

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has been increasingly used in China, but nosocomial infections (NI) in patients receiving ECMO remain poorly characterized. Thus, this study aimed to investigate the incidence rate, causative pathogens, and risk factors of NIs in ECMO patients.

METHODS

A retrospective cohort study of patients receiving ECMO between January 2015 and October 2021 was conducted in a tertiary hospital. General demographics and clinical data of included patients were collected from the electronic medical record system and the real-time nosocomial infection surveillance system.

RESULTS

A total of 86 infected patients with 110 episodes of NIs were identified in 196 patients receiving ECMO. The incidence of NI was 59.2/1000 ECMO days. The median time for the first NI in ECMO patients was 5 days (IQR: 2-8 days). Hospital acquired pneumonia (HAP) and bloodstream infection (BSI) were common types of NIs in ECMO patients, and the main pathogens were Gram-negative bacteria. Pre-ECMO invasive mechanical ventilation (OR=2.40, 95%CI:1.12-5.15) and prolonged duration of ECMO (OR=1.26, 95%CI:1.15-1.39) were risk factors for NIs during ECMO support.

DISCUSSION

This study identified the main infection sites and pathogens of NIs in ECMO patients. Although NIs may not affect the successful ECMO weaning, additional measures should be implemented to reduce the incidence of NI during ECMO support.

Investigating healthcare worker mobility and patient contacts within a UK hospital during the COVID-19 pandemic

BACKGROUND

Insights into behaviours relevant to the transmission of infections are extremely valuable for epidemiological investigations. Healthcare worker (HCW) mobility and patient contacts within the hospital can contribute to nosocomial outbreaks, yet data on these behaviours are often limited.

METHODS

Using electronic medical records and door access logs from a London teaching hospital during the COVID-19 pandemic, we derive indicators for HCW mobility and patient contacts at an aggregate level. We assess the spatial-temporal variations in HCW behaviour and, to demonstrate the utility of these behavioural markers, investigate changes in the indirect connectivity of patients (resulting from shared contacts with HCWs) and spatial connectivity of floors (owing to the movements of HCWs).

RESULTS

Fluctuations in HCW mobility and patient contacts were identified during the pandemic, with the most prominent changes in behaviour on floors handling the majority of COVID-19 patients. The connectivity between floors was disrupted by the pandemic and, while this stabilised after the first wave, the interconnectivity of COVID-19 and non-COVID-19 wards always featured. Daily rates of indirect contact between patients provided evidence for reactive staff cohorting in response to the number of COVID-19 patients in the hospital.

CONCLUSIONS

Routinely collected electronic records in the healthcare environment provide a means to rapidly assess and investigate behaviour change in the HCW population, and can support evidence based infection prevention and control activities. Integrating frameworks like ours into routine practice will empower decision makers and improve pandemic preparedness by providing tools to help curtail nosocomial outbreaks of communicable diseases.

PRAISE: providing a roadmap for automated infection surveillance in Europe

INTRODUCTION

Healthcare-associated infections (HAI) are among the most common adverse events of medical care. Surveillance of HAI is a key component of successful infection prevention programmes. Conventional surveillance - manual chart review - is resource intensive and limited by concerns regarding interrater reliability. This has led to the development and use of automated surveillance (AS). Many AS systems are the product of in-house development efforts and heterogeneous in their design and methods. With this roadmap, the PRAISE network aims to provide guidance on how to move AS from the research setting to large-scale implementation, and how to ensure the delivery of surveillance data that are uniform and useful for improvement of quality of care.

METHODS

The PRAISE network brings together 30 experts from ten European countries. This roadmap is based on the outcome of two workshops, teleconference meetings and review by an independent panel of international experts.

RESULTS

This roadmap focuses on the surveillance of HAI within networks of healthcare facilities for the purpose of comparison, prevention and quality improvement initiatives. The roadmap does the following: discusses the selection of surveillance targets, different organizational and methodologic approaches and their advantages, disadvantages and risks; defines key performance requirements of AS systems and suggestions for their design; provides guidance on successful implementation and maintenance; and discusses areas of future research and training requirements for the infection prevention and related disciplines. The roadmap is supported by accompanying documents regarding the governance and information technology aspects of implementing AS.

CONCLUSIONS

Large-scale implementation of AS requires guidance and coordination within and across surveillance networks. Transitions to large-scale AS entail redevelopment of surveillance methods and their interpretation, intensive dialogue with stakeholders and the investment of considerable resources. This roadmap can be used to guide future steps towards implementation, including designing solutions for AS and practical guidance checklists.

Infection Control in the Era of Antimicrobial Resistance in China: Progress, Challenges, and Opportunities

More than 3 decades have passed since infection control was implemented nationwide in China in 1986. A comprehensive set of regulations and guidelines has been developed, and almost all hospitals have established infection control teams. However, compliance is variable and is usually suboptimal. The incidence of certain multidrug-resistant organisms (MDROs), including carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP), is increasing, and associated infections are mainly hospital-acquired in China. Carbapenem-resistant Pseudomonas aeruginosa has remained relatively stable, whereas methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterobacter faecium have been decreasing. The spread of CRAB and CRKP in China is largely mediated by dominant high-risk lineages, namely, clonal complex 92 for CRAB and sequence type 11 for CRKP. However, challenges owing to MDROs bring opportunities for rethinking, taking coordinated action, building capacity, changing behavior, and performing studies that reflect everyday situations in the Chinese healthcare system.

An interventional implementation project: hand hygiene improvement

Background

Good hand hygiene is the most effective basic measure for preventing hospital-acquired infections. This research project, which originated from a project report on improving hand hygiene at a general hospital in Hangzhou, Zhejiang, China, aimed to investigate the effectiveness of hand hygiene improvement among the hospital staff.

Methods

Since 2017, a hand hygiene improvement project involving the staff of a 2,500-bed general teaching hospital in Zhejiang, China, has been carried out. This study summarized the implementation and effectiveness of the project, which is based on the five factors of systematic evaluation. The research summary was divided into three phases: phase I (December 2017 to August 2018), phase 2 (September 2018 to April 2019), and phase 3 (May 2019 to December 2019). The data of hand hygiene compliance rates of different groups of professionals in the different research periods were statistically analyzed.

Results

The results showed that continuous intervention led to a gradual increasing trend (Ptrend<0.001) in the hand hygiene implementation rate with as the intervention time and phases progressed. The hand hygiene compliance rates differed significantly during different phases (76.61%, 79.95%, and 83.34% in phases 1, 2, and 3, respectively, P<0.001). At the same time, the compliance rates of hand hygiene at each phase differed significantly between different professions (P<0.001, the compliance rate of hand hygiene among nurses was the highest and lowest among workers). The compliance rate of hand hygiene for different professions during the three phases were: nurses, 84.73%; doctors, 78.35%; interns, 77.62%; and other hospital workers, 72.79%.

Conclusions

The hand hygiene compliance rate was effectively improved among the hospital staff after the implementation of the hand hygiene improvement project. In this hospital, the project yielded remarkable results. Hand hygiene must be continuously practiced and improved to develop good habits. Effective and detailed planning as well as key factors, such as hand hygiene facilities, information monitoring, the active participation and response of employees, training and education, and supervision and feedback, could help to guarantee the effectiveness of the project.