Although infection continues to be a major cause of morbidity and mortality in neutropenic patients, newer strategies have resulted in a shorter duration of neutropenia. The prime risk to patients with short-duration neutropenia (defined as neutropenia of less than 14 days) is bacterial infection, which is reduced by the administration of prophylactic antibiotics, and possibly by the use of clean food, sterile water, and protection against transmission of organisms from healthcare workers' hands.

Even with a good surveillance program, nosocomial infections may be not recognized because of several reasons: absence of symptoms or prolonged incubation period (eg, viral bloodborne infections, tuberculosis); problems with the microbiological diagnosis, because adequate specimens may be difficult to obtain or special methods should be used (eg, fungal infections, virus, new agents); shorter hospital stays (eg, surgical-site infections); difficulty in distinguishing between nosocomial and community-acquired infections (eg, influenza); and failure to detect clinically relevant colonization (eg, multiresistant microorganisms). Because of the important potential consequences of occult nosocomial infections, specific surveillance programs should be designed to address these problems.

Hospitals in the process of building or renovating intensive-care units (ICUs) often establish multidisciplinary design teams. However, these teams rarely include infection control professionals. Because nosocomial infection is common in the ICU, design features can affect the risk of infection transmission, and outbreaks can occur during construction, this exclusion seems shortsighted. Infection control professionals are familiar with the relevant research, as well as the regulations and guidelines related to ICU design and infection control practices. Not only is their input essential to the design and construction of safe and effective units but their presence on the design team can allow the prospective collection of comparative data to turn the building project into a research project.