Surveillance of nosocomial infections in ICUs: Is postdischarge surveillance indispensable?

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 i s not done. DESIGN: ICU patients were followed up and surveillance results with PDS (go ld standard) and without PDS were compared. SETTING: Surgical or interdisciplinary ICUs in eight German acute-care hosp itals. PATIENTS: AU 1,857 patients within a 6-month period in the participating IC Us (a total of 9,129 ICU-patient-days). RESULTS: Without PDS, 45 urinary tract infections (UTIs) were diagnosed, co mpared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischa rge follow-up was performed. Three nosocomial pneumonias (4%) and one blood stream infection (8%) also were missed if surveillance was carried out with out PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated N Is 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 pati ents in the course of routine surveillance.