The contemporary infection control program, whether independent or fully integrated into a hospital-wide quality assurance (QA) program, has a very broad scope including surveillance, outbreak management, education, policy/procedure development, environmental/construction surveillance, program evaluation and research (Table). The greatest problem organizing an infection control program has been identified as integration of its components so as to establish supervision and feedback among its participants, with the purpose of achieving steady progress.

Programs have historically been “centralized” with the hospital epidemiologist, infection control practitioner and hospital infection control committee responsible directly or indirectly for the maintenance of the system.’

One of the more important aspects of nosocomial infections is that they often are caused by bacterial strains resistant to many antimicrobial agents. Despite over 50 years in the development and use of a wide variety of antibiotics, bacterial resistance mechanisms have not been defeated and are playing an increasingly important role in the therapy of infections.

The mechanisms of bacterial resistance, moreover, are constantly changing, but our understanding of these resistance mechanisms at a molecular level is rapidly increasing.” Yet importantly, a detailed knowledge and understanding of the genetic basis for bacterial resistance is of great importance for the proper evaluation and control of nosocomial infections caused by resistant pathogens. The purpose of this discussion is to provide insights into the genetic basis for bacterial resistance and to describe some newer mechanisms of bacterial resistance that influence the therapeutic approach to nosocomial infections.

I generally associate the “product commentary” section of this journal with such things as urethral catheters, vascular access devices and antiseptic solutions. Hence, the invitation to write about surgical wound surveillance seemed at first inappropriate. However, the gathering storm over who will supervise wound surveillance involves our own unique product: infection control data. My task is to address concerns common to all business enterprises:

▪ What is the demand?

▪ What does the consumer want?

▪ Who should be the chief executive officer?

▪ What should be our current strategy?

More than 70 years ago, it was shown that making surgeons aware of infection rates can lower their incidence.’ It is now customary to cite a series of studies suggesting that surgeon-specific rate reporting lowers the incidence of postoperative wound infection. First, Cruse and Foord correlated this practice with a lowering of the infection rate from 2.6% to 0.6%. Next, Condon et al. and then Olson et al. reported similar successes. Finally, data from the Centers for Disease Control's SENIC project indicated that two factors clearly correlated with reduced wound infection rates: 1) strong surveillance and control programs; and 2) the presence of an effective infection control physician.” Having both elements in place reduced the infection rate by 41% or 35% for low-risk or high-risk patients, respectively. Having surveillance alone reduced the infection rate by 19% for low-risk patients and 20% for high-risk patients. These findings made the case for wound surveillance seem ironclad.