Bloodstream infections (BSIs) are common in hemodialysis patients, causing substantial morbidity and mortality. The National Healthcare Safety Network (NHSN) provides infrastructure for BSI surveillance for outpatient hemodialysis patients; reporting relies upon manual data collection that can be time-consuming. Development of streamlined reporting methods is critical for sustained NHSN use. We evaluated BSI data generated using automated surveillance based on electronic health record (EHR) data compared to manual surveillance.
METHODS:
Manual and automated BSI surveillance, based on NHSN methods, were performed between January to June 2012 in 13 outpatient dialysis centers belonging to a single dialysis organization. For the manual method, staff from the Tennessee Department of Health identified BSI cases by review of dialysis center medical records and records from known healthcare encounters. For the automated method, CDC staff identified BSI cases from EHR data extracted by dialysis organization staff. The number of BSIs and rates per 100 patient-months identified by each method were compared, and discrepancies investigated.
RESULTS: Manual surveillance identified 68 BSI cases; 24 of which were identified via automated surveillance. Automated BSI rates were lower than manual in 12 dialysis centers, as was the overall BSI rate (0.57 vs 1.62; p<0.001). Under-ascertainment by automated surveillance was primarily attributed to the absence of information on positive blood culture from the day of or day after hospital admission.
CONCLUSIONS:
BSI rates from automated surveillance are lower than for manual surveillance, with under ascertainment primarily due to exclusion of positive blood cultures drawn on the day of or day after patient hospitalization. Communication of positive blood culture results between hospitals and outpatient dialysis centers should be improved. Best practices for transmitting these results need to be identified.