多重抗藥性菌株資訊自動化監測與應用

Surveillance System for Smart Management of Multidrug-resistant Organisms

林慧姬(Hui-Chi Lin) ； 曾意儒(Yi-Ju Tseng) ； 陳明源(Ming-Yuan Chen) ； 盛望徽(Wang-Huei Sheng) ； 陳宜君(Yee-Chun Chen) ； 張上淳(Shan-Chwen Chang)

《感染控制雜誌》 23卷6期 (2013/12) Pp. 290-299

https://doi.org/10.6526/ICJ.201312_23(6).0002

摘要

The emergence and spread of multidrug-resistant organisms (MDROs) have caused significant challenges for infection control personnel. To resolve this problem, the WHO has made antimicrobial resistance an organization-wide priority and the focus of the 2011 World Health Day. Information technology is expected to improve efficiency in automated surveillance and infection control (1-8). The present study developed a Web-based MDRO surveillance and outbreak detection information system from electronic microbiological data at a 2200-bed major teaching hospital in Taiwan. The accuracy of MDRO detection was 63.9%±26.4% by infection control personnel; the system was 100% (P ＜ .001). The optimal UCL for MDRO outbreak detection was the upper 90% confidence interval (CI) using germ criterion with clustering (area under ROC curve [AUC], 0.93). This study demonstrates that an internet-based MDRO surveillance and outbreak detection information system provides useful information to facilitate the timely targeting of the correct unit by infection control personnel for appropriate intervention. The proportion of contact precautions among incident patients increased after implementation of the system (16.5% versus 82.2%, P = .001). Time lag of contact isolation (hours) improved after implementation of the system (307.8 versus 18.1, P = .001). In such a system, visualization methods are also important for clearly presenting the proximity of time and space and species of MDRO, and for facilitating data-driven decision-making. Implementing this system could, therefore, improve patient safety as well as the quality of medical care in a hospital.

關鍵字

資訊自動化監測 ； 多重抗藥性菌株

並列摘要

The emergence and spread of multidrug-resistant organisms (MDROs) have caused significant challenges for infection control personnel. To resolve this problem, the WHO has made antimicrobial resistance an organization-wide priority and the focus of the 2011 World Health Day. Information technology is expected to improve efficiency in automated surveillance and infection control (1-8). The present study developed a Web-based MDRO surveillance and outbreak detection information system from electronic microbiological data at a 2200-bed major teaching hospital in Taiwan. The accuracy of MDRO detection was 63.9%±26.4% by infection control personnel; the system was 100% (P ＜ .001). The optimal UCL for MDRO outbreak detection was the upper 90% confidence interval (CI) using germ criterion with clustering (area under ROC curve [AUC], 0.93). This study demonstrates that an internet-based MDRO surveillance and outbreak detection information system provides useful information to facilitate the timely targeting of the correct unit by infection control personnel for appropriate intervention. The proportion of contact precautions among incident patients increased after implementation of the system (16.5% versus 82.2%, P = .001). Time lag of contact isolation (hours) improved after implementation of the system (307.8 versus 18.1, P = .001). In such a system, visualization methods are also important for clearly presenting the proximity of time and space and species of MDRO, and for facilitating data-driven decision-making. Implementing this system could, therefore, improve patient safety as well as the quality of medical care in a hospital.

並列關鍵字

Automatic surveillance ； multidrug-resistant organisms