All Ontario hospitals are mandated by the Ministry of Health and Long Term Care to report the number and rate of certain new hospital acquired infections on their hospital websites.  Stevenson Memorial Hospital (Stevenson) welcomes the provincial government’s initiative to enhance public reporting of patient safety indicators.  We are committed to not only meeting this Ministry requirement, but will work with our new Board to report to our community other important measures of quality, safety and customer satisfaction. The Ministry will also be reporting this information for all hospitals on their website at www.ontario.ca/patientsafety .

The list of reportable patient safety indicators has continued to expand to include a broader range of patient safety indicators, although not all are applicable to Stevenson.   All Ministry required indicator reports are listed in this table.  Click on the Patient Safety Indicator below to view our most recent success:

Stevenson not eligible for reporting of other Ministry patient safety indicators such as the rate of Ventilator Associated Pneumonia (VAP), Central Line Infection (CLI), Surgical Site Infection Prevention (SSI) and the Hospital Standardized Mortality Ratio (HSMR) based on the volumes and types of patients that we treat.

How do we maintain/improve our hospital acquired infection rates?

Good hand hygiene, thorough environmental cleaning, staff education and constant monitoring are the keys to strong performance.  Stevenson has consolidated its Infection Prevention and Control Services with those of Southlake Regional Health Centre to ensure we are implementing best practices in Infection Prevention and Control. 

Stevenson actively analyzes all new cases of hospital acquired infection.  To decrease transmission of all infectious diseases in hospital, we are actively monitoring our compliance with best practices for Hand Hygiene and educating staff, physicians, volunteers and visitors in the importance of good hand washing technique.  Appropriate cleaning and disinfection methods are in place on all clinical units.  In addition, we ensure all patients with infectious diseases are placed and cared for in appropriate accommodations according to transmission based precautions.

Clostridium Difficile Associated Diarrhea (CDAD)

Clostridium Difficile, also known as C. difficile, is one of many types of bacteria that can be found in the environment and in feces (bowel movement). For over 30 years, it has been a known cause of health care-associated diarrhea. It occurs naturally in about 3-5% of the population, without causing symptoms or any health risk. 

Clostridium Difficile Associated Diarrhea (CDAD) - Diarrhea with laboratory confirmation of the presence of the C. difficile organism, or a diagnosis through endoscopic procedure or examination of a colon specimen by a pathologist

Nosocomial or Hospital Acquired CDAD - CDAD where symptoms were not present on admission or in the first 72 hours of hospitalization.

The use of antibiotics, such as in a healthcare environment, increases the chances of developing C. difficile diarrhea as it alters the normal level of good bacteria found in the intestines and colon.  Without the presence of the normal bowel bacteria, the C. difficile bacteria may start to grow and produce a toxin that can damage the bowel and lead to watery diarrhea, fever and abdominal pain or tenderness.  The effects of CDAD are usually mild.  In some severe cases, however, surgery may be needed, and in extreme cases CDAD may cause death.

How is the rate calculated?  

• New Cases: The total # of new hospital acquired cases each month.  Counts of 0 and counts of 5 or more are reported. 
• CDAD Rate:  The infection rate is calculated as a rate per 1,000 patient days. The “total patient days” represents the sum of the number of days during which services were provided to all inpatients during the given time period. It excludes children under the age or 1. The rate is calculated on a monthly basis and equals the total # of new Nosocomial CDAD cases times 1000 divided by the total # of inpatient days
• Based on Ministry guidelines, where the number of cases is zero or greater than 5 the number of cases will also be posted. If the case number is between 1 and 4 then the case number will be reported as <5.
  

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that lives on the skin and mucous membranes of healthy people and is resistant to certain types of antibiotics.  It can be spread by contact with hands or objects in the patient’s environment that have been contaminated with the germ. These infections may be minor but they can cause delayed healing or other complications.  A Nosocomial MRSA infection is one that developed during the hospital stay and was not present on admission.

What is Methicillin-resistant Staphylococcus aureus (MRSA Bacteremia) Infection?

A laboratory confirmed bloodstream infection with Methicillin-resistant Staphylococcus aureus (MRSA Bacteremia).  A blood stream infection is a single positive blood culture for MRSA.

How is the rate calculated?  

• New Cases: The total # of new hospital acquired bloodstream infection for each 3 month period.  Counts of 0 and counts of 5 or more are reported. 
• MRSA Bacteremia Rate:  The infection rate is calculated as a rate per 1,000 patient days. The “total patient days” represents the sum of the number of days during which services were provided to all inpatients during the given time period. The rate is calculated on a quarterly basis and equals the total # of new Nosocomial MRSA Bacteremia cases times 1000 divided by the total # of inpatient days.
• Based on Ministry guidelines, where the number of cases is zero or greater than 5 the number of cases will also be posted. If the case number is between 1 and 4 then the case number will be reported as <5.
  

Vancomycin-resistant Enterococci (VRE)

Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci.  In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE).  If a patient has an infection caused by VRE it may be more difficult to treat. A Nosocomial VRE infection is one that developed during the hospital stay and was not present on admission

What is Vancomycin-resistant Enterococcus (VRE Bacteremia) Infection?

A laboratory confirmed bloodstream infection with Vancomycin-resistant Enterococcus (VRE Bacteremia).  A blood stream infection is a single positive blood culture for VRE.

How is the rate calculated?  

• New Cases: The total # of new hospital acquired cases of bloodstream infection with VRE for each 3 month period.  Counts of 0 and counts of 5 or more are reported. 
• VRE Bacteremia Rate:  The infection rate is calculated as a rate per 1,000 patient days. The “total patient days” represents the sum of the number of days during which services were provided to all inpatients during the given time period. The rate is calculated on a quarterly basis and equals the total # of new Nosocomial VRE Bacteremia cases times 1000 divided by the total # of inpatient days.
• Based on Ministry guidelines, where the number of cases is zero or greater than 5 the number of cases will also be posted. If the case number is between 1 and 4 then the case number will be reported as <5.

Hand Hygiene Compliance

As the single most effective way to reduce the spread of infections, hand hygiene is an important practice for health care providers and patients alike.

Effective hand hygiene practices in hospitals plays a key role in improving patient and provider safety. It is a different way of thinking about safety and patient care and involves everyone in the hospital, including patients and health care providers.

To be clear, health care providers are washing their hands, and it is a practice that continues to improve as we learn more about hand hygiene best practices.  The key is to wash your hands at the right time and in the right way. 

How is the Hand Hygiene Audit completed?

Direct observation of hand hygiene practice is done by trained observers using the provincial audit tool.  An observation is based on 4 indications or ‘Four Moments’ for Hand Hygiene:

·        before initial patient/patient environment contact

·        before aseptic procedure

·        after body fluid exposure risk

·        after patient/patient environment contact

The observer conducts observations openly, recording only what they see, but the identity of the health care provider is kept confidential.  Compliance is recorded for all 4 indications for hand hygiene however the MOHLTC will not publicly report data on “before aseptic procedures” and “after body fluid exposure risk” as it is difficult for some hospitals to obtain a large enough sample size for these indications. 

How is the rate calculated?

It is a percentage based on the total number of times hand hygiene was performed divided by the total number of observations where hand hygiene was indicated.

Two rates are reported: before contact with the patient and/or their environment and after contact with the patient and/or their environment.

For more information on the Hand Hygiene indicator visit the Ministry’s website at: http://www.health.gov.on.ca/patient_safety/public/hh/hh_pub.html