Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1,1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology— 4.9% and general surgery patients— 4.0%, and lowest among newborns—0.3% and pediatric patients—0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections; The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years. Two hundred thirty-six microorganisms were cultured from 175 of the infections. Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus were the most common gram-positive organisms. E. coli, Pseudomonas, Proteus, and Klebsiella were the most common gram-negative organisms cultured. The overall nosocomial infection incidence was much lower than reported rates for other groups of hospitals. These data have implications for the review and potential modification of complex guidelines and requirements for infection control in smaller rural hospitals.