The epidemiology of the acquisition of bacteria in hospitals: a study using data from hospital information systems
Bibliographic record
Abstract
Health-care associated infections (HAI) cause significant mortality and morbidity for many hospitalized patients and increase the cost of patient care. The incidence of HAI is particularly high in intensive-care units (ICU), affecting about 30% of ICU patients. The growing implementation and capabilities of hospital information systems provide vast amounts of information that could be used to control HAI, but these resources remain underused for this application. The goals of this thesis were 1) to explore how data from these information systems can be used to enable efficient surveillance of all bacteria types, and 2) to explore the potential of these data to inform infection control efforts by studying bacteria acquisition.The goals were met in a series of three studies. The 'admission discharge transfer' information system was used to define a cohort of 65,124 patients admitted to two university hospitals (the Montreal General Hospital (MGH) and Royal Victoria Hospital (RVH)) over 2000-2005. Data from the laboratory information system were extracted, linked, grouped and analyzed. The first study demonstrates an approach to deriving population-level information about HAI from data held in hospital information systems and presents prevalence, rates, and time trends of bacteria and antibiotic resistance.The subsequent studies focus on the 19,343 hospital admissions with ICU stays. The second study evaluates the impact of a physical intervention: the re-opening of the MGH ICU in a new location with all private rooms, on bacterial acquisition rates. A substantially reduced rate of acquisition of infectious organisms following the intervention was found. Finally, the third study assesses the risk that a patient will acquire MRSA or C.difficile from a previous bed occupant who was positive for these bacteria. An increased risk for exposed patients in the RVH was found. At the MGH the risk for exposed patients was elevated only before the intervention to private rooms.This thesis describes and shows how routinely collected electronic data from hospital information systems can be used to derive updated information on rates of organisms and susceptibility to antimicrobials, study infection control intervention, and support an individual assessment of the infection risk of a patient.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".