医院感染实时监控系统中疑似感染病例智能判断的实现

Intellectual judgement on suspected healthcare-associated infection cases in the real-time HAI surveillance system

目的研发医院感染实时监控系统,实现疑似医院感染病例的自动筛查与智能判断。方法依据《医院感染诊断标准(试行)》中的感染诊断条件,参考手工查阅病历的诊断经验,制订出疑似医院感染病例的筛查策略和预警条件。从医院管理信息系统中实时提取感染相关信息,系统根据各类信息与感染发生相关程度进行自动排序、整合、分析,按科室输出疑似感染病例预警信息。与手工查阅病历的回顾性调查结果作比较,验证系统的灵敏度与准确性。结果 3 600张床位的医院应用该监控系统后,每日发现疑似医院感染病例30～40例,针对每例病例生成直观形象的感染相关信息时序图,1名感染管理专职人员每日处理所有病例时间只需1～1.5 h;同时可自动生成各种感染数据报表。与回顾性调查数据比较,该监控系统确认的医院感染病例数增加20%,包含率>95%。结论该医院感染实时监控系统具有实时、高效、准确等特点。疑似医院感染病例的智能判断节约了感染管理专职人员病例筛查与感染诊断的时间,为临床干预赢得最佳时期。

Objective To achieve auto-screen and intellectual judgement on suspected healthcare-associated infection（HAI） cases in the real-time HAI surveillance system.Methods The screening strategy and prewarning condition of suspected HAI cases were formulated according to Diagnostic Criteria of Healthcare-associated Infections and experience in manually looking up HAI in medical records.The system can extract infection-related information from hospital information system（HIS）,lab information system（LIS）,radiology information system（RIS）,and electronic medical record（EMR） system.All the information can be sorted,integrated and analyzed according to the correlativity between extracted information and development of infection.Then the pre-warning information of suspected infection cases are output according to different departments.The sensitivity and correctness of the system is validated through comparing with the result of retrospective study by manually looking up medical records.Results 30-40 suspected HAI cases in the hospital with 3 600 beds are found by the system everyday,one infection management professional can deal with all suspected cases between 1 and 1.5 hours;then all the infection data can be obtained automatically.Comparing with the result of retrospective study by manually looking up medical records,HAI cases confirmed by the system increases by 20%.Conclusion Real-time HAI surveillance system has the features of timeliness,high efficiency,and correctness.Auto-screen and intellectual judgement can save time for infection management professionals to screen and diagnose infection,and improve efficiency and effectiveness in preventing and controlling infection.