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The evolving art and science of hospital epidemiology.

The study of hospital-acquired infections is a new discipline in the young science of medicine. Although there have been important recognition and interest for centuries in the fates of patients housed in institutions for medical care [1, 2], it is only in recent decades that the field of nosocomial infection as such has been generally accepted. The important forces operative in the development of modern hospital epidemiology and infection control included the recognition of the need to control clusters of diarrheal diseases in hospitals in the 1940s [3], the widespread emergence of nosocomial infections caused by Staphylococcus aureus in the 1950s [4], the major initiation, in 1970, of the Centers for Disease Control for surveillance and control of disease [5], and subsequent institutional requirements of the Joint Commission for the Accreditation of Hospitals (JCAH) [6]. From 1970 to 1985, a number of studies have confirmed the 5%-10% attack rate of infections during hospitalization [7, 8], the high, r',25%, attributable mortality for nosocomial infections of the bloodstream [9-12], and the average fiveto 10day added hospital stay directly related to nosocomial infections at various anatomical sites [13-16]. It is clear that even by the most conservative estimates, the consequences of the two to four million hospital-acquired infections occurring in the United States annually represent a leading cause of death and an economic burden of three to ten billion dollars [17, 18]. A renewed interest in the outcome of nosocomial infections has followed the introduction