Fully Automated Surveillance of Healthcare-Associated Infections with MONI-ICUA Breakthrough in Clinical Infection Surveillance
16 March 2011
accepted: 21 July 2011
16 December 2017 (online)
Objective: Expert surveillance of healthcare-associated infections (HCAIs) is a key parameter for good clinical practice, especially in intensive care medicine. Assessment of clinical entities such as HCAIs is a time-consuming task for highly trained experts. Such are neither available nor affordable in sufficient numbers for continuous surveillance services. Intelligent information technology (IT) tools are in urgent demand.
Methods: MONI-ICU (monitoring of nosocomial infections in intensive care units (ICUs)) has been developed methodologically and practically in a stepwise manner and is a reliable surveillance IT tool for clinical experts. It uses information from the patient data management systems in the ICUs, the laboratory information system, and the administrative hospital information system of the Vienna General Hospital as well as medical expert knowledge on infection criteria applied in a multilevel approach which includes fuzzy logic rules.
Results: We describe the use of this system in clinical routine and compare the results generated automatically by MONI-ICU with those generated in parallel by trained surveillance staff using patient chart reviews and other available information (“gold standard”). A total of 99 ICU patient admissions representing 1007 patient days were analyzed. MONI-ICU identified correctly the presence of an HCAI condition in 28/31 cases (sensitivity, 90.3%) and their absence in 68/68 of the non-HCAI cases (specificity, 100%), the latter meaning that MONI-ICU produced no “false alarms”. The 3 missed cases were due to correctable technical errors. The time taken for conventional surveillance at the 52 ward visits was 82.5 hours. MONI-ICU analysis of the same patient cases, including careful review of the generated results, required only 12.5 hours (15.2%).
Conclusion: Provided structured and sufficient information on clinical findings is online available, MONI-ICU provides an almost real-time view of clinical indicators for HCAI – at the cost of almost no additional time on the part of surveillance staff or clinicians.
- 1 Haley RW, Culver DH, White JW. The effect of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121: 182-205.
- 2 Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: An overview of published reports. J Hosp Infect 2003; 54: 258-266.
- 3 Council of the European Union.. Council Recommendation on patient safety, including the prevention and control of healthcare associated infections. 2947th Employment, Social Policy, Health and Consumer Affairs Council meeting Luxembourg: 9 June 2009
- 4 Klompas M, Yokoe DS. Automated surveillance of health care-associated infections. Clinical Infectious Diseases 2009; 48: 1268-1275.
- 5 Chizzali-Bonfadin C, Adlassnig KP, Koller W. MONI: An intelligent database and monitoring system for surveillance of nosocomial infections. In: Greenes RA, Peterson HE, and Pratti DE. eds. MEDINFO’95: Part 2. Edmonton, Alberta, Canada: International Medical Informatics Association; Healthcare Computing and Communications Canada 1995: 1684.
- 6 Assadian O, Adlassnig KP, Rappelsberger A, Koller W. MONI –an intelligent infection surveillance software package. In: Adlassnig KP. ed. Intelligent Systems in Patient Care. Wien: Österreichische Computer Gesellschaft; 2001: 49-56.
- 7 Adlassnig KP, Blacky A, Koller W. Artificial-intelligence-based hospital-acquired infection control. Stud Health Technol Inform 2009; 149: 103-110.
- 8 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332.
- 9 Hospital in Europe Link for Infection Control through Surveillance (HELICS).. Surveillance of nosocomial infections in intensive care units. Protocol Version 6.1, September 2004, Project commissioned by the EC/ DG SANCO/F/4, Agreement Reference number: VS/1999/5235 (99CVF4–025), 2004; 1–51; http://helics. univ-lyon1.fr.
- 10 European Centers for Disease Prevention and Control (ECDC): European Surveillance of Healthcare associated Infections in Intensive Care Units.. HAIICU Protocol v1.01, December 2010
- 11 Adlassnig KP, Blacky A, Koller W. Fuzzy-based nosocomial infection control. In: Nikravesh M, Kacprzyk J, Zadeh LA. eds. Forging new frontiers: Fuzzy pioneers II –studies in fuzziness and soft computing. 2008. 218 343-350.
- 12 Adlassnig KP, Rappelsberger A. Medical knowledge packages and their integration into health-care information systems and the world wide web. In: Andersen SK, Klein GO, Schulz S, Aarts J, Mazzoleni MC. eds. eHealth beyond the horizon –get IT there. Proceedings of the 21st International Congress of the European Federation for Medical Informatics (MIE 2008). 2008: 121-126.
- 13 Health Level 7.. The arden syntax for medical logic systems, Version 2.7. Ann Arbor, MI: Health Level Seven, Inc.,; 2008
- 14 Hripscak G. Writing arden syntax medical logic modules. Comput Biol Med 1994; 24: 331-363.