Cost reduction is a major focus of healthcare in the United States (US) and throughout the world. US hospitals are merging and downsizing staff as a major effort in cost containment. Specialty care teams such as nutrition support, IV therapy, and infection control, have been early prey to downsizing or elimination by administrators who perceive these programs as dispensible amenities. This will most likely prove to be counterproductive and excessively costly. In 1994, the US Agency for Healthcare Policy and Research published The National Bill for Diseases Treated in the U. S. Hospitals, which listed medical complications from the use of a device or procedure for diagnosis or treatment among the top ten most costly health-related problems in the US, at an annual cost of $3.1 billion. An extraordinary number of medical devices are used in the delivery of parenteral and enteral nutrition. Both modalities carry significant risk for costly complications related to the associated medical device. The incidence of central venous catheter (CVC) complications alone is estimated at well over 10%. The consequences of adverse events with vascular catheters and enteral feeding devices can be life-threatening. Patients may survive elaborate, high-tech surgical procedures after trauma or lifethreatening illnesses only to later suffer or die as a result of insufficient knowledge of prevention or treatment of medical device-related complications, or failure of the device itself. Patients surviving such adverse events may be left with profound abnormalities such as neurological impairment, disfigurement, loss of limb, or permanent loss of venous access sites; all negative outcomes which result in extended length of hospital stay and inordinate costs. Another costly and unfortunate outcome of device-related adverse events is malpractice litigation, not typically a line-item in a hospital’s or agency’s budget. Following are examples of recent legal cases where large sums were awarded for patients who suffered or died from such events.

To be a nurse involves the assumption of ethical responsibility in all areas of practice. Infection control practice is a nursing specialty which exemplifies two ethical issues: the nurse's duty or moral obligation for patient advocacy and the right of patients to safe care. Individual moral responsibility is an important issue for the nurse epidemiologist because epidemiologic fact-finding provides information that may present ethical problems as well as suggest solutions. This paper discusses ethical dilemmas arising in infection control practice, as illustrated by three actual situations.In the course of practice, questions may arise concerning the ethical responsibilities of a nurse epidemiologist to provide facts that may be used in cases of dispute. This discussion shall be limited to institutionally acquired or nosocomial infections.