Spain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.

Mathematical means have suggested that the surgical team is at particular risk of acquiring HIV (or other bloodborne viruses) from a source patient. To reduce this risk, it is mandatory to avoid accidental injuries during operative procedures. The surgeon must handle tissues with instruments and must minimize finger use. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time. Instruments should not be handled blindly, but instead should be accompanied by eye and verbal contact. We find these changes in surgical technique are necessary for present and future generations of surgeons.

We report nosocomial infection with Vibrio cholerae 01, in four seriously ill individuals and one infant in Guatemala. Nosocomial cholera occurs in developing countries in Latin America and should be suspected in hospitalized patients with diarrhea, especially during community outbreaks, in order to institute appropriate diagnostic, therapeutic, and control measures.

Medical researchers often are faced with the challenge of estimating the total number of cases in a population based on incomplete samples. Because of a lack of explicit methods for determining if all cases have been counted, indirect methods for estimating the abundance of disease have been developed. Capture-recapture models are an indirect method of estimating population sizes that have been employed in recent epidemiological studies. These methods, derived from techniques developed for studies of animal abundance, estimate the true population size by evaluating the degree of overlap among incomplete lists of cases from existing data sources. Although intuitively appealing, the successful application of these methods is dependent upon a clear understanding of the biology of the disorder involved, the dynamics of the reference population, and the assumptions and robustness of the specific models used. Failure to address these issues can lead to inaccurate and sometimes misleading results. This article describes some of the strengths and limitations of recapture techniques and provides the reader with a foundation from which to explore the methods in further detail.

The role of the hospital epidemiologist has changed substantially over the last 30 years as medical care has become more complex. The hospital epidemiologist needs training in methods for sur veillance, prevention, and control of nosocomial infections. The hospital epidemiologist also must know how to apply these methods to other areas, including the epidemiology of noninfectious adverse out-comes of medical care. Training in hospital epidemiology should be a defined part of every infectious disease fellowship training program. Ancillary and additional training is available from several sources.