Nosocomial, or hospital-acquired, infections (more appropriately called health care–associated infections) are today by far the most common complications affecting hospitalized patients. Indeed, the Harvard Medical Practice Study II found that a single type of nosocomial infection — surgical-wound infection — constituted the second-largest category of adverse events.¹ Long considered the greatest risk that the hospital environment poses to patients,² nosocomial infections abruptly became the province of public health officers at the time of a nationwide epidemic of hospital-based staphylococcal infections, in 1957 and 1958.³ Since then, the study and control of nosocomial infections have been profoundly shaped by the discipline of public health, with its emphasis on surveillance and epidemiologic methods. These infections are not only the most common types of adverse events in health care; they may also be the most studied. Currently, between 5 and 10 percent of patients admitted to acute care hospitals acquire one or more infections, and the risks have steadily increased during recent decades (Table 1).^4,5 These adverse events affect approximately 2 million patients each year in the United States, result in some 90,000 deaths, and add an estimated $4.5 to $5.7 billion per year to the costs of patient care.^6,7 Infection control is therefore a critical component of patient safety. In this article I describe the common ground shared by these two disciplines. I also discuss the major problems in infection control, approaches to their solutions, the role of the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention (CDC) as a model, and the need for renewed commitment to and innovations in infection control to help ensure patient safety.
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