EPIDEMIOLOGY, THERAPY AND COSTS OF NOSOCOMIAL INFECTION

In the current climate of cost containment and quality control, nosoco mial infection is a worrisome adverse event in hospital care. Hospital ised patients require care for increasingly severe illnesses, and are therefore more susceptible to infection, especially by opportunistic m icro-organisms. It is thus necessary to accurately assess and adjust f or the severity of the underlying illness in studies of risk factors i nvolved in nosocomial infections. The appearance of new diagnostic and therapeutic techniques provides novel opportunities for infection con trol and represents a constant challenge to hospital systems. The cont inuous selection of resistant flora, together with the identification of new pathogens, calls for a reconsideration of hospital policies reg arding the dispensation of antibiotics. Epidemiological surveillance c ontinues to be the most important aspect of attempts to monitor infect ion control programmes, and to identify changes in risk factors that m ay increase the infection rate. Among the major challenges now facing the infection control practitioner is the use of nosocomial infection rates as an indicator of quality of care. Awareness of infection stati stics would serve as a stimulus to the prevention and control of infec tion, but would be useless if not accompanied by adequate systems to g uarantee the comparability of data from different studies and centres. Suitably sensitive and specific surveillance systems should be develo ped, and the use of site-specific and procedure-specific infection rat es adjusted for the patient's intrinsic risk should be encouraged.