Surveillance of Nosocomial Infections in Icus: Is Postdischarge Surveillance Indispensable?

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Abstract
Objective:: To determine how many infections are missed if the postdischarge surveillance (PDS) follow-up of intensive care unit (ICU) patients that is required by the National Nosocomial Infection Surveillance System method is not done. Design:: ICU patients were followed up and surveillance results with PDS (gold standard) and without PDS were compared. Setting:: Surgical or interdisciplinary ICUs in eight German acute-care hospitals. Patients:: All 1,857 patients within a 6-month period in the participating ICUs (a total of 9,129 ICU-patient–days). Results:: Without PDS, 45 urinary tract infections (UTIs) were diagnosed, compared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischarge follow-up was performed. Three nosocomial pneumonias (4%) and one bloodstream infection (8%) also were missed if surveillance was carried out without PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated NIs were missed if no follow-up was done. Conclusions:: Since it is very time-consuming to follow patients after their transfer from the ICU, we do not perform a postdischarge follow-up of patients in the course of routine surveillance.