Table 3.

Evaluation results of HAI Network’s BSI Surveillance system attributes, India, 2022

Attribute	Indicator	Evidence collected	Assessment	Overall evaluation
Simplicity	Ease of collecting data	• Minimum 2 full-time surveillance staff • 80% staff spends > 2 h or more every day in collecting the 23 variables and the lab confirmation for case confirmation from paper-based reports	Time-consuming	Simple
	Ease of applying case definition	• 15/20 (75%) staff rate it as very easy or easy	Easy
	Ease of online reporting	• 18/20 (90%) rate it as very easy or easy • 10–15 min to submit one CRF, described as “user-friendly”	Easy
	Levels of reporting	• Two a) Local (hospital administration), and b) National (AIIMS, New Delhi)	Easy
Stability	Reliability	• All 40 staff surveyed are trained in protocol • All 21 sites reviewed collected denominator data on all days including weekends/holidays • All 21 sites reviewed have access to a 24 by 7 working laboratory • 16/21 sites reviewed have access to all positive cultures, required for classifying BSI type • 5/21 sites reviewed reported not having LIS/ HMIS, reported using manual registers • 15/21 (71%) sites review every positive culture at month-end to capture missing cases	Reliable	Stable if funding is available
	Availability	• Available from 2017 including during second wave of COVID-19 in India • Decreased reporting to 84/131 (64%) in ICUs and surveillance stopped in 22/39 (56%) sites seen briefly during April 2020	Available
	Sustainability	• 26/39 (67%) of the sites are funded by US CDC • Reporting decreased to 63/131 (48%) in the quarter 4, 2021 when funding was interrupted	Funding stability a concern
Acceptability	Willingness of stakeholders to participate	• Started with 20 ICUs in 2017 and has increased to 131 ICUs in 2019 • Hospital administration of all 10 hospitals interviewed accepts this system is required to control multi-drug resistant pathogens	High	Acceptable
	Proportion of physicians accepting feedback from the surveillance system	• 90% physicians surveyed starting a QI initiative in their ICU based on the feedback received from surveillance
Representativeness	Population representative of the participating hospital	• 32/58 (55%) of the febrile episodes reviewed had their blood cultured	Not representative	Not representative
Data Quality	Data validity	• 280/284 (98%) of CRFs reviewed have correctly applied the case definition	Valid	Data quality is good
	Data completeness	• 259/284 (91%) of CRFs have data filled in each data va without any missing details	Complete
Timeliness	Blood collection	• 27/61 (44%) of febrile episodes reviewed were cultured (blood collection) < 24 h of fever	Not timely	Blood culture collection and feedback to ICU physicians is not timely
	Reporting to network	• 36/39 (92%) sites reported data within 10 days of the reporting month	Timely
	Dissemination to key stakeholders	• 6/10 (60%) ICU physicians surveyed reported getting consistent monthly feedback • 13/14 (93%) quarterly reports shared by AIIMS with all key stakeholders within one month of the reporting quarter	Not timely Timely
	Detection of BSI outbreaks	• Sites not comfortable in sharing information regarding outbreaks detected in their hospitals, hence this information could not be captured • One outbreak of Burkholderia cepacia detected in the network using surveillance data and controlled (retrieved from published data)	–––
Sensitivity	True cases detected	• 26/26 (100%) cases reviewed during site visit were correctly identified	Sensitive	Sensitive
	Monitoring trends	• System can identify BSI trends from May 2017 to December 2021	Sensitive
	Early warning signals generated	• System has generated 684 ICU specific BSI rate alerts from May 2017 to December 2021 • Alerts are generated when ICU specific BSI rates are > 20 for that month	Sensitive
Positive Predictive Value	Proportion of true cases with confirmed BSI	• 26/26 (100%) cases reported as BSI for the months of November 2021 to March 2022 were reviewed and found to be true cases	Good	Good PPV
Usefulness	Monitoring trends Detecting outbreaks Improving IPC	• Quarterly trend analysis done for every quarter from Jan 2018 to Dec 2018 • Three outbreaks detected including one outbreak of Burkholderia cepacia using surveillance data and controlled (retrieved from published data) • 12/39 (31%) sites have completed/ongoing QI projects to improve BSI rates • 7/10 (70%) physicians surveyed reported having increased adherence to recommended Central Line insertion and maintenance practices following feedback from the system	Useful	Useful