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Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center

Published online by Cambridge University Press:  10 May 2016

H. L. Wald ,
B. Bandle ,
A. Richard  and
S. Min
H. L. Wald*
Affiliation:
University of Colorado School of Medicine, Aurora, Colorado
B. Bandle
Affiliation:
University of Colorado School of Medicine, Aurora, Colorado
A. Richard
Affiliation:
University of Colorado School of Medicine, Aurora, Colorado
S. Min
Affiliation:
University of Colorado School of Medicine, Aurora, Colorado
*
Campus Box F480, 13199 West Montview Boulevard, Suite 400, Aurora, CO (heidi.wald@ucdenver.edu).
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Abstract

Objective.

To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).

Design.

Diagnostic accuracy study.

Setting.

A 425-bed university hospital.

Subjects.

A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.

Methods.

An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.

Results.

Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.

Conclusion.

The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.

Infect Control Hosp Epidemiol 2014;35(6):685–691

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 6 , 01 June 2014 , pp. 685 - 691
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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