Infectious diseases in small hospitals. Prevalence of infections and adequacy of microbiology services.

In a 1-day prevalence survey nosocomial infections were found in 7.2% and community acquired infections in 20.4% of 525 patients hospitalized in 18 small hospitals. Pneumonia was the reason for admission in 11% of patients in small hospitals. The patterns of nosocomial infections and antibiotic usage in small hospitals are similar to those found in large hospitals. The adequacy of bacteriologic services was assessed using a process audit technique. The routine approach to common bacteriologic specimens and antibiotic disk susceptibility tests was frequently inadequate. Approaches used in large hospitals for the control of nosocomial infection and the performance of bacteriology tests were not practical for most small hospitals. Specific research into methods for doing clinically adequate bacteriology and approaches for the control of nosocomial infection in the small hospital setting are needed.