Infection control in El Salvador: the Hospital Rosales experience.

We describe circumstances at the Hospital Rosales, located in San Salvador, El Salvador, and some salient observations from an infection control program begun in 1978. Findings include overuse of antibiotics, especially of penicillin and chloramphenicol; a predominance of gram-negative rod infections, especially Pseudomonas aeruginosa; a relative infrequency of Staphylococcus aureus infections; an apparent doubling of the mean duration of hospitalization for patients with nosocomial infections compared with other patients (22.1 days versus 11.0 days); documentation and partial correction of deficiencies in aseptic and antiseptic practices; an outbreak of Pseudomonas aeruginosa endophthalmitis traced to the hospital's factory for the manufacturing of intravenous fluids; and attitudinal problems such as the care of patients with rabies on open wards. Prevalence surveys conducted during 1981 and 1986 suggest a dramatic increase in the recent incidence of surgical wound infection (44% upsilon 28%, P less than 0.001). This latter observation suggests a direct relationship between infection rates and the hardships imposed by poverty and civil war.