Partners in safety: implementing a community-based patient safety advisory council.

CONTEXT: A recommended strategy for improving patient safety is patient-centered care, with the patient and provider functioning as partners to achieve health care goals. OBJECTIVE: To implement a community-based advisory council where patients and providers can collaboratively develop interventions for safe medication use in the outpatient setting. DESIGN, SETTING, PARTICIPANTS: A descriptive study of the process used to implement a patient-provider advisory council in Walworth County, Wisconsin in 2005-2006. Participants included patients and health care professionals from Aurora Health Care and the community. Using formative research and community-based participatory programs, the Council developed medication safety interventions. MAIN OUTCOME MEASURE(S): Establishment of a community-based patient-provider council; development of interventions to improve medication safety in the outpatient setting. RESULTS: The Walworth County Patient Safety Council was established in November 2005, with 11 patient and 12 provider representatives. The Council identified and developed multiple interventions for patients and health care providers. CONCLUSIONS: A community-based advisory council is an effective partnership model where patients, providers, and their community can collaboratively develop strategies for improving medication safety. As interventions are disseminated in Walworth County, their effectiveness on medication safety outcomes will be evaluated.

An outbreak of Legionnaires disease associated with a decorative water wall fountain in a hospital.

OBJECTIVE: To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring. DESIGN AND SETTING: Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital. PATIENTS: Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010. METHODS: Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel. RESULTS: Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough. CONCLUSION: This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.

Clinical effectiveness and cost benefit of universal versus targeted methicillin-resistant Staphylococcus aureus screening upon admission in hospitals.

OBJECTIVE: To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections. DESIGN: Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses. SETTING: Two community hospitals in Wisconsin. PATIENTS: Consecutive sample of 15,049 adult admissions from April 2009 to July 2010. INTERVENTIONS: MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals. RESULTS: Universal screening was associated with an increase in admission screening of 43.58 percentage points (P< .01), an increase in MRSA detection of 2.95 percentage points (P< .01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P< .01). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection. CONCLUSION: Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.