Nosocomial LRI in Adult Intensive Care Unit Patients Surveillance Definition

Summary: Chart reveiw based surveillance is conducted on all Adult ICU patients who have been on a ventilator for > 3days. On Neurosciences units (NCCU/NPCU) patients who have been on the unit for greater than 3 days will be under surveillance.

Eligible Patients

All Adult ICU patients who have been ventilated for more than 72 hours. All Adult Neurosciences patients who have been admitted for more than 72 hours.

Surveillance Definition of Infection

NOSOCOMIAL LRI can be diagnosed clinical, or at autopsy

Clinically a case must meet the following criteria; all of which are detected within 72 hours of one another:

• Temperature > 38.5° C or hypothermia < 36° C or elevated WBC
• Chest radiograph or CT with new infiltrate, consolidation, or cavitation with onset more than 72 hours after admission to an intensive care unit; or a progressive infiltrate associated with a new pathogen that was not present on admission to the intensive care unit.
• Production of purulent sputum or change in character of the sputum associated with the onset of fever and chest radiograph changes as defined above.

Autopsy diagnosis If autopsy results do not confirm a questionnable diagnosis of pneumonia, the case will not be counted as nosocomial.

Surveillance Mechanism
Nosocomial LRI (as defined above) developing in patients transferred from an intensive care unit will be documented as ICU related if onset occurs within 72 hours after transfer. Persons transferred from the intensive care unit and readmitted less than 24 hours later will be considered to have a continuous ICU stay for surveillance purposes.