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Quality and safety in the literature: January 2020
  1. Jennifer Meddings1,2,3,
  2. Ashwin Gupta1,2,
  3. Nathan Houchens1,2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  3. 3 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer Meddings, Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; meddings{at}

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Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, while others will highlight unique publications from high-impact medical journals.

Key points

  • In a time-series analysis of institution-level rates of multidrug resistant organism colonisation and healthcare-associated infection, moving patients from a large hospital with mostly three-person and four-person ward-type rooms to a new hospital with exclusively single-patient rooms was associated with important changes. These included an immediate and sustained decrease in the rates of new colonisation with vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) as well as VRE infection, but no reduction in infection with MRSA or Clostridioides difficile. JAMA Intern Med. 19 August 2019.

  • In a multicentre, open-label, randomised controlled trial of patients diagnosed with exacerbations of chronic obstructive lung disease in the primary care setting, point-of-care testing of C-reactive protein to guide antibiotic prescribing resulted in fewer prescriptions and less patient-reported antibiotic use than the usual care group without evidence of harm. N Engl J Med. 11 July 2019.

  • In a multihospital, retrospective cohort study of adults hospitalised with pneumonia, the majority of patients received excess antibiotic therapy compared with guidelines, primarily at hospital discharge. Excess treatment was associated with higher rates of patient-reported adverse events. Ann Intern Med. 9 July 2019.


Infection prevention and antimicrobial stewardship programmes are rapidly evolving.1 2 Like many patient safety initiatives, these programmes initially focused on encouraging the individual healthcare provider to follow guidelines, primarily through education, hand hygiene feedback and restricting use of higher-risk antibiotics. However, more recently there is recognition that infection prevention and antimicrobial …

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