医院感染病例预警系统的综合评价

Comprehensive evaluation of real-time healthcare-associated infection surveillance system for cases of nosocomial infection

目的综合评价医院感染实时监控软件(简称院感系统)的病例预警系统。方法根据2019年4-12月常州市肿瘤医院的医院感染现况和院感系统同期产生的预警数据,采用受试者工作特征曲线(ROC)评价院感病例预警系统的诊断效能;采用灵敏度、院感病例例次数阳性预测值和误报率一系列指标评价预警系统的漏报率和准确性。结果医院共出院19 099例病例,医院感染161例,165例次;预警系统抓取预警病例1 528例和预警条目2 132条,其中确认为医院感染的病例数和病例例次数分别为144例和147例次,错误预警1 796条,ROC曲线下面积为0.911,95%CI为(0.883~0.938),预警灵敏度为89.09%,医院感染病例例次数阳性预测值为9.62%,误报率为84.24%。结论目前预警系统的诊断效能和灵敏度在全院层面较高,提高了院感病例监测的效率,但是该预警系统的准确性总体较低,灵敏度在不同科室、不同感染部位差别很大。

OBJECTIVE To comprehensively evaluate the real-time healthcare-associated infection surveillance system for cases of nosocomial infection. METHODS The diagnostic efficiency of the early warning system was evaluated based on the early warning data that were generated from the prevalence of nosocomial infection and nosocomial infection system from Apr 2019 to Dec 2019 by using receiver operating characteristic(ROC) curve, and a series of indexes, including the sensitivity, positive predictive and false discovery rate, were used to evaluate the missing report rate and accuracy of the early warning system. RESULTS Totally 19 099 patients were discharged, 161(165 case-times) of whom had nosocomial infection. A total of 144 patients(147 case-times of patients) were confirmed with nosocomial infection among 1 528 warned cases and 2 132 warned items that were captured by the early warning system, there were 1 796 false warned items. The area under ROC curve was 0.911, the 95% confidence interval was 0.883-0.938, then sensitivity of the early warning was 89.09%, the positive predictive value of the case-times of nosocomial infection was 9.62%, and the missing report rate was 84.24%. CONCLUSION The diagnostic efficiency and sensitivity of the early warning system are high at the whole hospital level, and it raises the efficiency of surveillance of the nosocomial infection cases, however, the accuracy was generally low, and the sensitivity varies significantly in departments and infection sites.