Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) was implemented in Rio de Janeiro and Uberlândia University Hospitals, which had different policies on use of mupirocin. One hundred fourteen multiresistant MRSA strains were isolated from 62 patients. Mupirocin resistance was observed in 63% of strains in Rio de Janeiro, where there was extensive use of topical mupirocin, and 6.1% in Uberlândia, where its use was rare.

Over the past decade, the incidence of hospital-acquired bloodstream infections caused by Candida strains has risen, while the implicated species have changed. Candida tropicalis, Candida parapsilosis, and Candida glabrata all have increased in incidence. Data from the Centers for Disease Control and Prevention reveal that, between 1980 and 1990, Candida emerged as the sixth most common nosocomial pathogen (7.2.%) and was the fourth most common pathogen in nosocomial bloodstream infections, surpassed only by coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. The incidence of candidemia is dramatically higher in high-risk critical-care units: 25% of cases occur in surgical intensive-care units (ICUs) versus 25% in bone marrow transplantation units, 20% in medical ICUs, 20% in general medical wards, and 10% in oncology-hematology units. Burns and gastrointestinal surgery predispose to nosocomial candidemia. Independent risk factors include prior therapy with multiple antibiotics, isolation of Candida from sites other than blood, and prior hemodialysis. Crude mortality exceeds 55% and is associated with older age and concomitant renal failure, hepatic failure, acute respiratory diseases, or postoperative shock. In addition to extreme vigilance for early recognition of Candida sepsis in critically ill surgical patients, the high risk for candidemia probably necessitates fungal surveillance cultures and initiation of preemptive antifungal therapy in high-risk surgical patients.

As a follow-up to a 1992 study of respiratory isolation, we studied compliance with recommendations for respiratory isolation through smokestick testing (1993) and surveys (1994). Effective negative pressure was demonstrated in 80 of 156 rooms and was associated with the presence of anterooms (P<.001). The proportion of surveyed hospitals periodically testing isolation rooms increased from 0% (1992) to 30% (1993) to 100% (1994; P<.001).

This article describes the basic framework for developing a tuberculosis (TB) control program. We suggest how to assess the risk of TB in a healthcare delivery setting, how to prioritize control measures based on their effectiveness, and how to meet current regulatory requirements. In addition, we discuss some problematic issues, examples of how other hospitals have confronted these issues, and where to obtain additional information on nosocomial TB.