Two decades have elapsed since the first detailed studies were undertaken to determine which factors were associated with an increased incidence of life-threatening sepsis during the treatment of leukemia and lymphoma. The state of granulocytopenia is now acknowledged to be the major factor predisposing to infection and accordingly, attention has focused on the merits of preventive measures applied during this risk period. A tremendous effort has been invested in the evaluation of different protocols and there is little doubt that major advances have been made even though a simultaneous improvement in survival rates as a result of more intensive chemotherapy has not always been in evidence. While it is appropriate to initiate prophylaxis before the treatment of most adult acute leukemias and for marrow transplantation, the reduced duration and severity of granulocytopenia during chemotherapy for both childhood acute leukemia and lymphoma generally obviate the need for this approach.

Progress in the development of potent broad-spectrum antibiotics coupled with better clinical awareness of the value of early treatment, as well as changing practices in supportive care have each contributed to the recent pattern of infection that has been observed. In addition, the impact of new technologies, as illustrated by recent innovative applications of bone marrow transplantation, further underlines the need to reappraise current infection control procedures.

Although soiled linen has been identified as a source of large numbers of pathogenic microorganisms, the risk of actual disease transmission appears negligible. Rather than rigid rules and regulations, hygienic and commonsense storage and processing of clean and soiled linen are recommended. Guidelines for laundry construction and operation for health care facilities have been published.

Between 1972 and 1973, Britt and colleagues conducted 1-day infection prevalence surveys in 18 hospitals each with fewer than 75 beds and all located in the rural intermountain west. The lessons learned from that study were incorporated into a book chapter entitled “Infection Control in Small Hospitals” by Dr. Britt. Since that study no substantial nor systematic review of nosocomial infections in small community or rural hospitals has been reported. A recent editorial in Infection Control posed four questions that still needed to be answered for the smaller (less than 100-bed) hospital:

1. Given the statistical realities of small hospitals, what types of surveillance methods—periodic prevalence surveys, general surveillance, focused surveillance, etc.—are the most reliable? Are any of them necessary?

2. Which of the many infection control practices recommended by the CDC, the Joint Commission on Accreditation of Hospitals, and others are applicable to small hospitals?

3. What resource sharing of existing expertise, from larger hospitals, health departments, groups such as the Association of Practitioners of Infection Control and the Society of Hospital Epidemiologists of America, and others can be developed for smaller hospitals in cost effective and realistic ways?

4. Should smaller hospitals be required to have the same type of multidisciplinary infection control committees required of larger hospitals or can the responsibilities of the committee be delegated to a smaller group such as one nurse and one staff physician?

The purpose of this report is to provide detailed infection control information obtained from 15 hospitals located in rural areas of Southwestern Wisconsin. This article will focus on data derived from an initial comprehensive prevalence survey that replicated the Britt study in the Wisconsin sites in 1983. Additional data were derived from ongoing bi-monthly prevalence studies done over 6 consecutive months in each of the 15 rural hospitals. Data from 6 months of ongoing comprehensive surveillance from each of the 15 hospitals and final conclusions from the project will be the subject of a subsequent paper.