<p>Developing a Registry of Healthcare-Associated Infections at Intensive Care Units in West China: Study Rationale and Patient Characteristics</p>

Abstract

PurposeLimited evidence is available to support the management of healthcare-associated infections (HAIs) in intensive care units (ICUs). Establishing a registry with complete and accurate information is urgently needed. The West China Hospital system has the most complete and largest data system for HAI in the ICU setting in China. By linking a multidimensional database, we developed a registry of HAI in ICU.MethodsThe ICU-HAI registry was established using a multi-source database that included electronic medical record (EMR), ICU system and ICU-HAI system in the West China Hospital healthcare system. Patients who were admitted to ICUs between 1 April 2015 and 30 March 2018 were included and data were extracted based on pre-designed, standardized data forms. We achieved the linkage of the three databases using a unique patient identification code, and cleaned the data based on standardized variable dictionaries and cleaning rules. We evaluated the quality of the registry through data verification and assessment of the quality of key variables.ResultsIn total, 23, 062 patients were included. The ICU mortality and hospital mortality were 5.4% and 5.5% respectively. A total of 855 patients developed ICU-HAIs, 1540 patients developed ventilator-associated events (VAE), and 171 patients developed possible ventilator-associated pneumonia (PVAP). Quality assessment showed that the accuracy of data extraction and linkage was 100%. Furthermore, 98% of all patients had at least one important laboratory tests performed, and the median number of tests performed was 4 to 5 per admission.ConclusionA unique registry for HAIs in the ICU setting was successfully established, which contains complete and accurate information for all patients in the ICU. The registry, linked from multiple data sources, provides unique research insights into the management of HAIs in the ICU setting in China.

The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

“…We carried out an observational study using an established ICU-HAI registry. A detailed description of this registry has been published elsewhere [ 37 ]. In brief, this registry consisted of three databases including an EMR system, an ICU system, and an ICU-HAI monitoring system.…”

“…Three infection control practitioners judged the type of VAE for each suspected case. The accuracy of PVAP was previously validated to be 96.2% [ 37 ]. In this study, we defined: (1) VAC-plus (all patients with VAC, including those who also fulfilled criteria for IVAC and PVAP); (2) IVAC-plus (all patients who met the IVAC criteria, including those with PVAP); and (3) PVAP.…”

“…Patient characteristics were extracted, including demographic characteristics (age, sex); ICU type; chronic comorbidities (hypertension, diabetes, cardiovascular disease, malignant tumor, chronic lung disease, liver failure, renal failure, and heart failure); acute comorbidities at ICU admission [gastrointestinal bleeding, shock, pneumonia, and acute respiratory distress syndrome (ARDS)]; APACHE II score; surgery (cardiac or cranial surgery); intubation sites; tracheostomy; time of admission and discharge; time on MV; time of VAE occurrence; and VAE type. The chronic comorbidities were identified through the International Classification of Diseases, 10th edition (ICD-10), and the completeness and accuracy were 99% and 88%, respectively [ 37 ]. For acute comorbidities presented at ICU admission, which were stored in transferred summary as unstructured formats, test mining was used to identify related information.…”

Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project

“…Healthcare-associated infections (HAIs) are the most frequent adverse outcome occurring when patients stay in hospital wards, especially in intensive care units (ICUs) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Due to their impact on patients’ morbidity and mortality, as well as on antimicrobial resistance and assistance healthcare costs, these infections represent a major concern for public health [ 5 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Indeed, patients admitted to ICUs generally had a worse clinical prognosis, including prolonged hospital stays, sepsis and mortality [ 19 ]. Particularly, mortality in ICUs is two time higher among infected patients than those not infected [ 6 , 8 ]. This in turn depends on several patients’ factor such as the use of invasive procedures, their severity, type of infection, therapy, and microorganisms’ characteristics, including clonal spread [ 19 , 20 , 21 , 22 ].…”