Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections

OBJECTIVES. To assess the surveillance coverage obtained with Centers for Disease Control and Prevention (CDC)-recommended surveillance of healthcare-associated infections (HAIs), which is focused on intensive care units ( ICUs) and emphasizes device-related infections (ie, those associated with central venous catheters, ventilators, and/or urinary catheters), compared with the surveillance coverage achieved by comprehensive hospitalwide surveillance. In addition, we assessed whether the infection rates in step-down units more resemble those in wards or ICUs. METHODS. Review of prospectively obtained, comprehensive hospitalwide surveillance data from 2004 through 2005 for an acute care tertiary care hospital with approximately 700 beds. Surveillance data was obtained by trained infection control professionals using standard CDC criteria for HAIs. RESULTS. CDC-recommended ICU surveillance for catheter-related bloodstream infection ( BSI) and ventilator-associated pneumonia would have detected only 87 (21.4%) of 407 catheter-related BSIs and only 66 (37.9%) of 174 respiratory tract infections that occurred in the medical and surgical services. Only 31 (34.8%) of 89 infections caused by methicillin-resistant Staphylococcus aureus and 7(31.8%) of 22 infections caused by vancomycin-resistant Enterococcus occurred in our adult ICUs. CONCLUSIONS. Rates of HAIs were highest in the ICUs, intermediate in step-down units, and lowest in the wards. The rates of infections in the step-down units were more similar to those in the wards than to those in the ICUs. To prevent HAIs, more comprehensive surveillance may be indicated.