Endogenous infections such as candidiasis can be minimized by oral fluconazole prophylaxis, although oral or intravenous amphotericin, or itraconazole, are suitable for certain patients. Exogenous fungal infections most commonly are transmitted by the airborne route, but the benefits of high-efficiency particulate air-filtered room air probably are diminishing as broad-spectrum prophylaxis against Aspergillus species and other fungi improves. However, high-risk environmental sources such as construction work always must be avoided near neutropenic patients. Reactivation of quiescent pulmonary Aspergillus infection can be prevented by surgical resection during remission, or by systemic amphotericin prophylaxis during subsequent neutropenic episodes.

Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P<.001). Eightyseven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.

All methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from colonized or infected patients in a 625-bed public teaching hospital during an epidemic, and for 3 years thereafter, underwent susceptibility testing to mupirocin. Mupirocin resistance among MRSA increased markedly over this period (1990, 2.7%; 1991, 8.0%; 1992, 61.5%; 1993, 65%) in association with increased use of mupirocin ointment as an adjunct to infection control measures.

Approximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of these infections are $558 to $593 for each urinary tract infection, $2,734 for each surgical site infection, $3,061 to $40,000 for each bloodstream infection, and $4,947 for each pneumonia. Even minimally effective infection control programs are cost-effective. In countries with prospective payment systems based on diagnosis-related groups, hospitals lose from $583 to $4,886 for each nosocomial infection. As administrators focus on cost containment, increased support should be given to infection control programs so that preventable nosocomial infections and their associated expenditures can be averted.