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Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection.

In a prospective study, we determined that severity of underlying disease at time of admission indicates medical patients at unusual risk of nosocomial infection. The nosocomial infection rate was 23.6% in patients with fatal underlying disease, 9.6% in those with ultimately fatal disease, and 2.1% in those with nonfatal disease. After an awareness program that promoted the use of established methods for prevention of nosocomial infections was established, there was a decline of overall incidence of endemic nosocomial infections from 9.2% to 4.8% (P less than .001) within an eight-month period. With subsequent discontinuation of the program, the infection rate rose to 8.1%. Reinstitution of the program resulted in a decline to 5.2% (P = .05).