Nosocomial infection. A continuing problem.

Bacteremia, urinary tract infection, and respiratory infection account for over 60% of all nosocomial infections. The incidence of nosocomial bacteremia is low, but about 25% of patients with Gram-negative bacteremia die from it. Many cases of nosocomial bacteremia result from contamination of intravenous (IV) infusion systems. If an underlying source of infection cannot be found in a patient with fever and an indwelling IV catheter, the infusion set should be removed immediately. Urinary tract infection is the most common nosocomial infection. It is often associated with urinary tract instrumentation and is frequently preventable. Lower respiratory tract infection is a major cause of morbidity and prolonged hospitalization; it is sometimes preventable by careful management of respiratory therapy equipment. When infection occurs, treatment should be started with large doses of broad-spectrum antibiotics until results of culture can point the way to more specific therapy. Every hospital should have an active patient surveillance system and a strong infection-control program. If a problem with nosocomial infection cannot be resolved within the hospital, the local or state health department should be contacted for assistance.