Mastitis pathogens and antibiotic resistance in beef cows in Switzerland.

INTRODUCTION: Mastitis in beef cows has not been studied as extensively as mastitis in dairy cows, and data from Switzerland are lacking. Various studies have shown a similar pathogen spectrum as in dairy cows, which could not be confirmed in this study. To gather initial data from Switzerland, milk samples from 297 lactating beef cows from 31 herds from the Engadin Valley in the Canton of Grisons were examined bacteriologically. At least one major or minor mastitis pathogen was recovered from at least one individual-quarter or composite sample from 33 % of all cows. The most common major mastitis pathogens were Staphylococcus aureus (8,4 % of cows), Pasteurella multocida (4,1 %), Streptococcus uberis (2 %) and Streptococcus dysgalactiae (1,7 %). Sixteen percent of the cows had at least one blind quarter, but only 32 % of these had been previously detected by the owners. In the second part of the study, milk samples from beef cows with mastitis were examined bacteriologically; the cows originated from various parts of Switzerland and had been presented for veterinary treatment. Pasteurella multocida (22 %) and Staphylococcus aureus (21 %) were the most common pathogens isolated. Antibiograms using microtitration and disk diffusion testing were generated for the Staphylococcus aureus, Pasteurella multocida and Streptococcus uberis strains from both parts of the study. Fifty-six percent of the Staphylococcus aureus strains were resistant to penicillin G. Our results showed that bacteriological examination of a milk sample aids in the diagnosis and allows specific treatment of mastitis in beef cows; this may be further improved with antibacterial susceptibility testing. Our preliminary data for the resistance patterns of mastitis pathogens in beef cows will facilitate evidence-based treatment strategies.

INTRODUCTION: Les mammites chez les vaches mères n'ont pas été étudiées de manière aussi approfondie que chez les vaches laitières et les données concernant la Suisse font défaut. Diverses études ont montré un spectre pathogène similaire à celui des vaches laitières, ce qui n'a pas pu être confirmé dans cette étude. Pour rassembler les premières données en Suisse, des échantillons de lait de 297 vaches mères provenant de 31 troupeaux de la vallée de l'Engadine dans le canton des Grisons ont été examinés bactério- logiquement. Au moins un agent pathogène majeur ou mineur de mammite a été retrouvé dans au moins un quartier ou dans un échantillon composite chez 33 % de toutes les vaches. Les agents pathogènes majeurs de mammite les plus courants étaient Staphylococcus aureus (8,4 % des vaches), Pasteurella multocida (4,1 %), Streptococcus uberis (2 %) et Streptococcus dysgalactiae (1,7 %). Seize pour cent des vaches avaient au moins un quartier sec mais cela n'avait été détectés auparavant par les propriétaires que dans seulement 32 % des cas. Dans la deuxième partie de l'étude, des échantillons de lait provenant de vaches mères atteintes de mammites ont été examinés sur le plan bactériologique; les vaches provenaient de diverses régions de Suisse et avaient été présentées pour un traitement vétérinaire. Pasteurella multocida (22 %) et Staphylococcus aureus (21 %) étaient les agents pathogènes les plus fréquemment isolés. Des antibiogrammes utilisant des tests de microtitration et de diffusion sur disque ont été générés pour les souches de Staphylococcus aureus, Pasteurella multocida et Streptococcus uberis des deux parties de l'étude. Cinquante-six pour cent des souches de Staphylococcus aureus étaient résistantes à la pénicilline G. Nos résultats montrent que l'examen bactériologique d'un échantillon de lait facilite le diagnostic et permet un traitement spécifique des mammites chez les vaches mères; ceci peut être encore amélioré par des tests de sensibilité aux antibactériens. Nos données préliminaires sur les profils de résistance des agents pathogènes de mammites chez les vaches de boucherie faciliteront les stratégies de traitement fondées sur des faits.

[CIRRNET® - learning from errors, a success story]. / CIRRNET® - Aus Fehlern lernen, eine Erfolgsgeschichte.

CIRRNET® is the network of local error-reporting systems of the Swiss Patient Safety Foundation. The network has been running since 2006 together with the Swiss Society for Anaesthesiology and Resuscitation (SGAR), and network participants currently include 39 healthcare institutions from all four different language regions of Switzerland. Further institutions can join at any time. Local error reports in CIRRNET® are bundled at a supraregional level, categorised in accordance with the WHO classification, and analysed by medical experts. The CIRRNET® database offers a solid pool of data with error reports from a wide range of medical specialist's areas and provides the basis for identifying relevant problem areas in patient safety. These problem areas are then processed in cooperation with specialists with extremely varied areas of expertise, and recommendations for avoiding these errors are developed by changing care processes (Quick-Alerts®). Having been approved by medical associations and professional medical societies, Quick-Alerts® are widely supported and well accepted in professional circles. The CIRRNET® database also enables any affiliated CIRRNET® participant to access all error reports in the 'closed user area' of the CIRRNET® homepage and to use these error reports for in-house training. A healthcare institution does not have to make every mistake itself - it can learn from the errors of others, compare notes with other healthcare institutions, and use existing knowledge to advance its own patient safety.

["Second victim" - error, crises and how to get out of it]. / "Second victim" - Umgang mit der Krise nach dem Fehler.

Medical errors do not only harm patients ("first victims"). Almost all health care professionals become a so-called "second victim" once in their career by being involved in a medical error. Studies show that error involvement can have a tremendous impact on health care workers leading to burnout, depression and professional crisis. Moreover persons involved in errors show a decline in job performance and jeopardize therefore patient safety. Blaming the person is one of the typical psychological reactions after an error happened as the attribution theory tells. The self-esteem gets stabilized if we can put blame on someone and pick out a scapegoat. But standing alone makes the emotional situation even worse. A vicious circle can evolve with tragic effect for the individual and negative implications for patient safety and the health care setting.

Women's experiences with low-risk singleton in-hospital delivery in Switzerland.

OBJECTIVE: To assess maternal and neonatal clinical short-term outcomes and women's experiences with singleton low-risk in-hospital deliveries in a routine care setting. METHODS: In 13 community hospitals in the Cantons of Zurich (10), St. Gallen (2) and Schwyz (1), participating in the "Canton of Zurich Outcomes Project", trained hospital staff recorded clinical outcome data. Patients completed a questionnaire at the end of the hospital stay. Over two measurement cycles, 3395 eligible women entered the study and 2079 (61%) returned the questionnaire. RESULTS: Sixty-seven percent of women had spontaneous and 11% had assisted vaginal deliveries, 12% delivered by emergency, and 10% by elective Caesarean section. The episiotomy rate in vaginal deliveries was 46% (95% CI 44-48%). Ten percent of neonates had umbilical cord artery pH < or =7.15 (95% CI 9-11%) and Apgar scores at five minutes were < or = 7 in 3% (95% CI 2.5-3.6%). Reporting negative experiences with hospital care and an insufficient state of knowledge at discharge were strongly associated with mode of delivery. The top three issues new mothers were most likely to report about feeling little or not informed about were postpartum pelvic floor exercises (22%), management of vaginal bleedings (12%), and alternatives of infant feeding (10%). CONCLUSION: In a setting of routine care poor short-term outcomes were rare in women giving birth in hospitals, and neonates and most mothers were discharged with a level of information that at least ensured a smooth transition to follow-up maternal care. Poor clinical results and patient-reported negative experiences concentrate in few individuals. Restrictive approaches that reduce the frequency of instrumental vaginal delivery, and routine episiotomy remain an important objective for quality improvement.

[The LORAS Project and quality assurance. In four years from input- to outcome-oriented financing in public health. 1: The LORAS Project]. / Das Projekt LORAS und Qualitätssicherung. In vier Jahren von Input- zu Outcomeorientierter Finanzierung im Gesundheitswesen. Teil 1: Das LORAS Projekt.

This series of three articles is a summary of the operations, findings and results of the hospital reform projects in the Canton of Zurich, termed LORAS. With the aid of the LORAS project within four years Zurich hospitals have been transformed. Whereas they used to adhere to input-oriented covering of deficits they now operate with outcome-oriented prospective financing of output. Part 1 describes the whole Project. Part 2 focuses on the development of outcome-measurement. Part 3 finally describes the implementation of the outcome-measurement in the canton of Zurich.

[The LORAS project and quality assurance. In four years from input- to outcome-oriented financing in public health. 2: LORAS project outcome parts 1 & 98]. / Das Projekt LORAS und Qualitätssicherung. In vier Jahren von Input- zu Outcomeorientierter Finanzierung im Gesundheitswesen. Teil 2: Loras-Teilprojekte Outcome 1 & 98.

This series of three articles is a summary of the operations, findings and results of the hospital reform projects in the Canton of Zurich, termed LORAS. With the aid of the LORAS project within four years Zurich hospitals have been transformed. Whereas they used to adhere to input-oriented covering of deficits they now operate with outcome-oriented prospective financing of output. Part 1 describes the whole project. Part 2 focuses on the development of outcome-measurement. Part 3 finally describes the implementation of the outcome-measurement in the canton of Zurich.