Nosocomial transmission of Shiga toxin-producing Escherichia coli O157 to two patients and three nurses is described. The index case presented with rectal bleeding rather than diarrhoea, and additional infection control measures were therefore only instituted after detection of the organism. Of the nurses, two were asymptomatic and detected on a screening programme of all staff in contact with the affected patients. Two patients died, one from Clostridium perfringens bacteraemia. The use by staff of full protective gowns for handling patients from their first onset of diarrhoea is recommended, rather than plastic aprons. Interest from the media was intense, despite the small number of patients and staff affected, and early preparations for media enquiries should be made in such episodes.