Skip to main content

Advertisement

SpringerLink
Log in

From Cues to Nudge: A Knowledge-Based Framework for Surveillance of Healthcare-Associated Infections

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

We propose an integrated semantic web framework consisting of formal ontologies, web services, a reasoner and a rule engine that together recommend appropriate level of patient-care based on the defined semantic rules and guidelines. The classification of healthcare-associated infections within the HAIKU (Hospital Acquired Infections – Knowledge in Use) framework enables hospitals to consistently follow the standards along with their routine clinical practice and diagnosis coding to improve quality of care and patient safety. The HAI ontology (HAIO) groups over thousands of codes into a consistent hierarchy of concepts, along with relationships and axioms to capture knowledge on hospital-associated infections and complications with focus on the big four types, surgical site infections (SSIs), catheter-associated urinary tract infection (CAUTI); hospital-acquired pneumonia, and blood stream infection. By employing statistical inferencing in our study we use a set of heuristics to define the rule axioms to improve the SSI case detection. We also demonstrate how the occurrence of an SSI is identified using semantic e-triggers. The e-triggers will be used to improve our risk assessment of post-operative surgical site infections (SSIs) for patients undergoing certain type of surgeries (e.g., coronary artery bypass graft surgery (CABG)).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Notes

  1. International Classification of Diseases, Version 9

  2. HL7 Reference Information Model: www.hl7.org/implement/standards/rim.cfm

  3. The Foundational Model of Anatomy Ontology: sig.biostr.washington.edu/projects/fm/AboutFM.html

  4. Chemical Entities of Biological Interest (ChEBI): https://www.ebi.ac.uk/chebi/

  5. http://protege.stanford.edu/

  6. The Resource Description Framework (RDF): www.w3.org/RDF/

References

  1. Douglas Scott II, R., The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. 2009 CDC Report: www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf.

  2. Klevens, R. M., Edwards, J. R., Richards, C. L., Jr., Horan, T. C., Gaynes, R. P., Pollock, D. A., and Cardo, D. M., Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 122(2):160–6, 2007.

    PubMed  PubMed Central  Google Scholar 

  3. Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., et al., Multistate point-prevalence survey of health care-associated infections. New England Journal of Medicine 370(13):1198–208, 2014.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Scott, R. D., The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention; 2009.

  5. Gravel, D., Taylor, G., Ofner, M., Johnston, L., Loeb, M., Roth, V. R., et al., Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. Journal of Hospital Infection 66(3):243–8, 2007.

    Article  PubMed  CAS  Google Scholar 

  6. Horan, T. C., Andrus, M., and Dudeck, M. A., CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control 36(5):309–32, 2008.

    Article  PubMed  Google Scholar 

  7. Magill, S. S., et al., Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville. Florida. Infect Control Hosp Epidemiol 33(3):283–91, 2012.

    Article  PubMed  Google Scholar 

  8. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., and Jarvis, W. R., Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 20(4):250–78, 1999. quiz 279–80.

    Article  PubMed  CAS  Google Scholar 

  9. Lee, J. T., Precision, accuracy, clarity, meaning. Surg Infect (Larchmt) 8(1):1–4, 2007.

    Article  Google Scholar 

  10. Shaban-Nejad, A., Rose, G. W., Okhmatovskaia, A., Riazanov, A., Baker, C. J. O., Tamblyn, T., Forster, A. J., and Buckeridge, D. L., Knowledge-based Surveillance for Preventing Postoperative Surgical Site Infection. In proc. of MIE 2011, Studies in Health Technology and Informatics, IOS Press, 145–149.11, 2011.

  11. Gill, C. J., and Gill, G. C., Nightingale in Scutari: Her legacy reexamined. Clinical infectious diseases 40(12):1799–805, 2005.

    Article  PubMed  Google Scholar 

  12. Boyce, J. M., and Pittet, D., Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. American journal of infection control 30(8):S1–S46, 2002.

    Article  PubMed  Google Scholar 

  13. Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada. Hand hygiene practices in healthcare settings. Ottawa, Ontario: Canadian Electronic Library, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2012; 2012.

  14. Rutala, W. A., Weber, D. J., Centers for Disease Control., Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control (US), 2008.

  15. Centre for Communicable Diseases and Infection Control (Canada), Public Health Agency of Canada, Routine practices and additional precautions for preventing the transmission of infection in healthcare settings. Ottawa, Ontario: Canadian Electronic Library, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2012, 2012.

  16. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., and Jarvis, W. R., Guideline for prevention of surgical site infection, 1999. American journal of infection control 27(2):97–134, 1999.

    Article  PubMed  CAS  Google Scholar 

  17. Healthcare Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention, Guidelines for preventing health-care-associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Respiratory care 49(8):926, 2004.

    Google Scholar 

  18. O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., et al., Guidelines for the prevention of intravascular catheter-related infections. Clinical infectious diseases 52(9):e162–e193, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Canadian Electronic Library, Clostridium Difficile Infection - Infection Prevention and Control Guidance for Management in Acute Care Settings. Public Health Agency of Canada. Canadian Electronic Library. Canadian Health Research Collection, 2012.

  20. Gould, C., Umscheid, C., Agarwal, R., Kuntz, G., Pegues, D., and Healthcare Infection Control Practices Advisory Committee, Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31(4):319–26, 2010.

    Article  PubMed  Google Scholar 

  21. Haley, R. W., Culver, D. H., White, J. W., Morgan, W. M., Emori, T. G., Munn, V. P., et al., The efficacy of infection surveillance and control progams in preventing nosocomial infections in US Hospitals. American Journal of Epidemiology 121(2):182–205, 1985.

    PubMed  CAS  Google Scholar 

  22. Leth, R. A., and Møller, J. K., Surveillance of hospital-acquired infections based on electronic hospital registries. J. of Hospital Infection 62:71–79, 2006.

    Article  CAS  Google Scholar 

  23. Sands, K., Vineyard, G., Livingston, J., Christiansen, C., and Platt, R., Efficient identification of postdischarge surgical site infections: Use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis 179(2):434–441, 1999.

    Article  PubMed  CAS  Google Scholar 

  24. Surgical Site Infection (SSI) Event, Procedure-Associated Module, Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). Accessed on October 20, 2014. Available from: http://www.cdc.gov/nhsn/CPTcodes/ssi-cpt.html, 2014.

  25. Ducel, G., Fabry, J., Nicolle, L. (eds.) Prevention of hospital-acquired infections: A practical guide. 2nd edition, World Health Organization (WHO), 2002. http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf.

  26. Gruber, T. R., A translation approach to portable ontology specifications. Knowl. Acquis. 5:199–220, 1993.

    Article  Google Scholar 

  27. Stevens, R., Goble, C. A., and Bechhofer, S., Ontology-based knowledge representation for bioinformatics. Brief Bioinform 1(4):398–414, 2000.

    Article  PubMed  CAS  Google Scholar 

  28. Rose G. W. Use of an Electronic Data Warehouse to Enhance Cardiac Surgical Site Infection Surveillance at a Large Canadian Centre. MSc Thesis, University of Ottawa, 2009.

  29. Donnelly, K., SNOMED-CT: The advanced terminology and coding system for eHealth. Stud. Health Technol. Inform. 121:279–290, 2006.

    PubMed  Google Scholar 

  30. Dumontier, M., Baker, C. J., Baran, J., Callahan, A., Chepelev, L., Cruz-Toledo, J., Del Rio, N. R., Duck, G., Furlong, L. I., Keath, N., Klassen, D., McCusker, J. P., Queralt-Rosinach, N., Samwald, M., Villanueva-Rosales, N., Wilkinson, M. D., and Hoehndorf, R., The Semanticscience Integrated Ontology (SIO) for biomedical research and knowledge discovery. J Biomed Semantics 5(1):14, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  31. W3C OWL Working Group, OWL 2 Web Ontology Language. Available online: www.w3.org/TR/owl2-overview/ (accessed on 30 May 2015).

  32. Wilkinson, M., McCarthy, L., Vandervalk, B., Withers, D., Kawas, E., and Samadian, S., SADI, SHARE, and the in silico scientific method. BMC Bioinformatics 11(Suppl 12):S7, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Riazanov, A., Klein, A., Shaban-Nejad, A., Rose, G. W., Forster, A. J., Buckeridge, D. L., and Baker, C. J., Semantic querying of relational data for clinical intelligence: A semantic web services-based approach. J Biomed Semantics 4(1):9, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Berners-Lee, T., Connolly, D., Kagal, L., Scharf, Y., and Hendler, J., N3Logic: A logical framework for the World Wide Web. Theory and Practice of Logic Programming 8(3):249–269, 2008.

    Article  Google Scholar 

  35. Boley, H., A RIF-Style semantics for RuleML-integrated positional-slotted, object-applicative rules. In Proc. RuleML 2011, Vol. 6826 of LNCS. Springer; pp. 194–211, 2011.

  36. Cristofolini, M., Worlitzsch, D., Wienke, A., Silber, R. E., and Borneff-Lipp, M., Surgical site infections after coronary artery bypass graft surgery: Incidence, perioperative hospital stay, readmissions, and revision surgeries. Infection 40:397–404, 2012.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The Canadian Foundation for Innovation (CFI), the Canadian Institutes of Health Research (CIHR), the Natural Sciences & Engineering Council of Canada (NSERC), and Canadian Network for the Advancement of Research, Industry and Education (CANARIE) provide funding for this research.

Author information

Authors and Affiliations

  1. School of Public Health, University of California at Berkeley, 50 University Hall, 94720-7360, Berkeley, CA, USA

    Arash Shaban-Nejad

  2. Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada

    Arash Shaban-Nejad, Hiroshi Mamiya, Christopher J. O. Baker, Robyn Tamblyn & David L. Buckeridge

  3. IPSNP Computing Inc, Suite 1000, 44 Chipman Hill, Station A, PO Box 7289, Saint John, NB, E2L 4S6, Canada

    Alexandre Riazanov

  4. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Alan J. Forster

  5. Department of Computer Science, University of New Brunswick, Saint John, NB, Canada

    Christopher J. O. Baker

Authors
  1. Arash Shaban-Nejad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Mamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Riazanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alan J. Forster
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher J. O. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robyn Tamblyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David L. Buckeridge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arash Shaban-Nejad.

Additional information

This article is part of the Topical Collection on Systems-Level Quality Improvement

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shaban-Nejad, A., Mamiya, H., Riazanov, A. et al. From Cues to Nudge: A Knowledge-Based Framework for Surveillance of Healthcare-Associated Infections. J Med Syst 40, 23 (2016). https://doi.org/10.1007/s10916-015-0364-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10916-015-0364-6

Keywords

Search

Navigation