AlertsNet is the Thuringian prospective population-based registry for the surveillance of nosocomial bloodstream infections and antibiotic resistances as well as for the improvement of guidance compliant blood culture diagnostics.
A state-wide surveillance system for blood culture diagnostics antibiotic resistance monitoring will be established. The network will comprise stationary institutions (hospitals and rehabilitation facilities), as well as all microbiological laboratories in the Free State of Thuringia. This will create a reference to the population as a whole and, for the first time in Germany, produce data that is representative of the community for a population of more than 2.3 million people. An electronic reporting system will be developed that gathers reports on blood culture testing in a timely manner. The reporting system will also collect selected clinical details of patients with nosocomial blood stream infections (primary and secondary sepsis) in order to determine the extent to which mortality and morbidity are caused by antimicrobial resistance. The reporting system will enable the data to be fed back to participating institutions, so that short-term interventions for the benefit and improvement of quality will be possible. As an accompanying study during this step in the process, a standardized survey will be conducted in which staff are asked about the practice of blood culture testing in their hospitals, as this will allow observed differences to be classified more effectively. At the same time, the results of this survey will be incorporated in the development of the intervention.
Further development of indicators for quality assurance in blood culture testing
Adjusted reference values for the indicators are to be developed, as these will enable the indicator values in specific institutions to be interpreted. The reference values for incidence rates of blood culture sets that are drawn will be validated on the basis of an empirical analysis of the association between incidence rate and sepsis mortality in the participating institutions. The utilisation of quality assurance indicators, however, requires that characteristics of the specific institution are also included.
Exemplary test of the use of the indicators to improve the quality of health care
On the basis of the indicators, institutions with low values will be selected for a training intervention. An expected improvement in the values of the indicators will demonstrate the usefulness of surveillance (including educational measures) as a measure for quality assurance and for improving the quality of health care.