The concept of organized public health and the role of public health agencies in society are constantly evolving to fit the times. The terrorist attacks on 9/11, the subsequent criminal spread of anthrax through the mail and the SARS epidemic in late 2002 emphasized the need to modernize the systems we rely upon to detect bioterrorist acts and emerging infectious diseases.

Even as the threat of bioterrorism persists, other issues of public concern have arisen. MRSA and other drug-resistant organisms proliferate, and the incidence of healthcare-associated infections has become intolerable. A creative, multifaceted team approach is essential to the development and implementation of infection control policies and procedures that will successfully address these challenges.

As the Los Angeles County Department of Public Health recognized the need to improve communications with providers in order to enhance local surveillance systems, staff members began devising ways to strengthen partnerships with hospitals. In November 2003, the department's Acute Communicable Disease Control program created the Hospital Outreach Unit Liaison Project. As part of the project, five public health nurses and their supervisor interface with the 103 licensed acute-care hospitals in Los Angeles County. Project goals are strengthening the department's communication with acute-care facilities, increasing traditional disease reporting, improving surveillance for unusual conditions, and assisting with infection control and prevention in hospitals and emergency departments.

A large part of enhancing preparedness for emerging infectious threats lies in bolstering current hospital infrastructure for infection control. Public health's greatest allies in hospitals are the infection control professionals. Mandated by California regulation and required by The Joint Commission, these professionals are responsible for coordinating the control, prevention and reporting of communicable diseases. The Hospital Outreach Unit Liaison Project has worked closely with infection control professionals on a wide range of issues, including SARS, pandemic influenza planning, healthcare-associated infection control, respiratory hygiene, hand-washing campaigns and disease reporting via the Internet.

In another program, more than three dozen hospital emergency departments in Los Angeles have partnered with our department's "syndromic surveillance" system to boost early detection of potentially significant public health problems. Liaison nurses follow up with emergency departments and infection control professionals to review patient records when statistical signals indicate unusual activity among emergency patients with any of several syndromic categories, including gastrointestinal, respiratory, neurologic and dermatological.

Another novel approach to surveillance involves daily review of all deaths reported to the coroner, or "coroner cases." Using data-mining techniques, the Hospital Outreach Unit selects cases to be followed closely by a liaison nurse until the coroner determines the final cause of death. By following up on these coroner cases over the past four years, public health staff has identified a number of important disease cases that would have been reported late or missed entirely.

The Hospital Outreach Unit and its nurses are integral components of a new public health paradigm that promotes collaboration with hospitals and infection control professionals to ensure the health and safety of medical staff and their patients while improving the county's surveillance systems. Acknowledgement of the professionals' critical role in the hospital environment has been long overdue. In 2007, the project's director, Dawn Terashita, MD, and supervisor, Sharon Sakamoto, RN, recognized the importance of the work done by infection control professionals by awarding certificates of appreciation.

As we start a new year and face a future filled with unknown health threats, our staff continues to increase our disease-detection capabilities and improve our partnerships with hospitals and those on the front lines. To read more about the Hospital Outreach Unit Liaison Project, visit www.lapublichealth.org/acd/HOU.htm.

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Dawn Terashita, MD, MPH, is the supervisor of the Hospital Outreach Unit in the Acute Communicable Disease Control program at the Los Angeles County Department of Public Health. Sharon Sakamoto, RN, MSN, MPH, CNS, is the supervisor of the Liaison Public Health Nurse Project in the Hospital Outreach Unit.