Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
Data Standardization and
Validation
Session DSV-042
12:30-1:30 p.m.
Accurately Predicting Risk of Central
Line-Associated Bloodstream Infection—Application
of Machine Learning to Predict and Minimize
Incidence of Central Line-Associated
Bloodstream Infection
Heather Schoonover, MN, ARNP, PHCNS-BC, Customer Success
Director, Health Catalyst; Kristen Kelley, MPH, CIC, CLC, Director,
Infection Prevention, Indiana University Health; Levi Thatcher,
PhD, Director of Data Science, Health Catalyst
BACKGROUND: Approximately 41,000 patients in the hospital and
37,000 patients receiving hemodialysis that have central lines end
up with a central line-associated blood stream infection (CLABSI).
Decreases in the incidence of CLABSI nationwide are slowing. Ac-
curately predicting risk for CLABSI could provide the ability to
intervene more quickly, decreasing the incidence of CLABSI. This
study sought to identify if machine learning could be utilized to ac-
curately predict which patients with a central line will develop a
CLABSI.
METHODS: A predictive model was developed using restrospective
data from the analytics platform and enterprise data warehouse.
Proposed input variables contributing to the development of in-
fection were identified. Two sample t-tests of input variables were
used against CLABSI result data to determine which variables should
be included. Preliminary models were developed using machine
learning algorithms, logistic regression, and random forest. Receiv-
er Operating Characteristic (ROC) curve was used to identify the best
performing model.
RESULTS: Initially, 40 variables were included. Sixteen variables ac-
counted for the most significant impact on CLABSI prediction,
additional variables did not improve accuracy. The random forest
algorithm used 2,000 decision trees, with four features in each de-
cision tree. This setup was used to train models on the 16 variables
on 70,218 retrospective cases of CLABSI. The ROC for the logistic re-
gression model was 0.79, and 0.87 for the random forest model,
resulting in selection of the random forest model for deployment.
The predictive model’s true-positive rate was 0.81 and the false-
positive rate was 0.16.
CONCLUSIONS: Machine learning can be used to develop predic-
tive risk models for CLABSI. This is incredibly important for practice,
as use of the predictive model provides clinicians the ability to
intervene for those patients at highest risk, particularly during
times when resources are challenged and there are barriers to
ensuring that each patient receives every CLABSI prevention
activity.
Session DSV-043
12:30-1:30 p.m.
An Innovative Approach to Evaluate Hospital and
System Improvements in Infection Prevention:
Development of a Dynamic Bacteremia Dashboard
Rebecca Battjes, MPH, Infection Preventionist, Ascension;
Lindsey Jones, Manager, Programs and Projects, Ascension;
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
S31
Clariecia Groves, MS, CHDA, Senior Clinical Data Analyst,
Ascension; Mohamad Fakih, MD, MPH, Senior Medical Director,
Ascension Center of Excellence for Antimicrobial Stewardship and
Infection Prevention, Ascension
BACKGROUND: Bacteremias, regardless of source, reflect invasive
infection from an at-risk patient population in inpatient health-
care settings. Hospital-onset (HO) bloodstream infection rates can
serve as proxy measures of both a hospital’s and a system’s infec-
tion prevention efforts. While central line-associated bacteremias
are tracked and reported nationally to the National Healthcare Safety
Network (NHSN), those attributable to other sources (abdominal,
urinary tract, respiratory and additional invasive devices) are not
regularly monitored.
METHODS: Positive blood culture data were extracted from a single
infection prevention surveillance system across 60 acute care hos-
pitals. NHSN MDRO (MRSA) Lab ID event definitions were applied
to categorize community (CO) versus HO type. Organisms in-
cluded were Escherichia coli, Klebsiella pneumoniae, Pseudomonas
aeruginosa, Staphylococcus aureus and all Candida species. CO and
HO bacteremia rates per 10,000 patient-days and CO-to-HO ratios
were calculated. Infection preventionists (IPs) performed validation,
comparing individual site’s microbiology data to the surveillance
system’s report.
RESULTS: A preliminary validation from one large hospital identi-
fied many report discrepancies, primarily due to culture result
inconsistencies and inaccurate report parameters. Seven additional
hospitals validated a corrected report and a dynamic dashboard was
created. Data can be viewed not only by onset, but also stratified by
bed size, single or multiple facilities, region, and/or organism. Ex-
amples of 12-month average HO bacteremia rates are provided. CO-
to-HO ratios are also calculated, and can be similarly deconstructed.
CONCLUSIONS: Building and validating a dynamic bacteremia dash-
board is an innovative approach to infection prevention beyond
traditional means. The report auto-generates monthly and re-
quires minimal maintenance. Unlike NHSN device-associated
definitions, bacteremia calculations are straightforward and objec-
tive. At a system level, the dashboard can drive quality improvement
and patient safety efforts. Locally, IPs can easily identify outbreaks
and unusual trends, not only in their own facilities, but also in the
community at-large.
Session DSV-044
12:30-1:30 p.m.
Contact Precautions for Colonized Methicillin-
Resistant Staphylococcus aureus (MRSA) and
Vancomycin-Resistant Enterococcus (VRE) Patients:
Are They Really Necessary?
Amanda Lester, MSN, RN, CNL, Infection Preventionist, Hartford
Healthcare; Tracy Corl, BSN, RN, Resource Center RN, William W.
Backus Hospital
BACKGROUND: There is little concrete evidence in the literature re-
garding whether contact precautions are necessary for patients
colonized with MRSA and/or VRE. Current practice at our organi-
zation was to isolate all patients with a history. It was felt that with
sufficient hand hygiene, contact precautions would not be neces-
sary for colonized patients. The purpose of this study was to
determine if the use of standard precautions versus contact pre-
cautions for patients colonized with MRSA and/or VRE increased