Patient Safety Reports: More information about the hospital’s Hand-Hygiene and other Patient Safety Indicators.

PATIENT SAFETY REPORTS

Ontario Hospitals are now required to publicly report their rates of hospital acquired c-difficile rates, MRSA rates, VRE rates and the Hospital’s Standardized Mortality Ratio (HSMR).  It is our pleasure to dedicate this section of the LDMH Web-Site to providing those reports and Central Line Infections and Hand-Hygiene Compliance Rate updates every month.  Patient Safety is a major corporate priority for LDMH and we are pleased to share the results of our work with our community.  We take pride in providing high quality, safe patient care and want to ensure you have the utmost confidence in us. 

For more information about these Patient Safety Indicators click on the links below:

• LDMH – Patient Safety Action Plan
  • Find out more information about what LDMH is doing to protect patient safety
• HOW to protect yourselves and your loved ones while in hospital
  • Important tips for how you can help

   

HAND HYGIENE COMPLIANCE RATE

Hand hygiene is an important practice for health care providers and has a significant impact on reducing the spread of infections in hospitals. Hand hygiene is a different way of thinking about safety and patient care and involves everyone in the hospital, including patients and health care providers.  Effective hand hygiene practices in hospitals play a key role in improving patient and provider safety, and in preventing the spread of health care-associated infections. To be clear, health care providers are washing their hands. What the provincial audit tool does is help ensure that they are washing them the right way at the right times.

For more information about these Patient Safety Indicators click on the links below:

Hand-Washing Instructions

Proper Water Free Hand-washing Instructions

Frequently Asked Questions

Hand-Washing FAQs

C-Difficile

What is C-difficile?

C-difficile is one of the many types of bacteria that can be found in feces and has been known as a cause of health care associated diarrhea for about 30 years.

For more information about these Patient Safety Indicators click on the links below:

• C-Difficile – important facts
  • Find out more about these infections

MRSA Bacteremia

What is Methicillin-resistant Staphylococcus aureus (MRSA)?

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain or all types of the beta-lactam classes of antibiotics such as penicillins, penicillinase-resistant penicillins (e.g. cloxacillin) and cephalosporins. MRSA are strains of S. aureus that have an MIC to oxacillin of ≥ 4 mcg/ml. or contain the mecA gene coding for penicillin binding protein 2a (PBP 2a).

VRE Bacteremia

What is 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). VRE have a minimal inhibitory concentration (MIC) to vancomycin of ≥ 32 mcg/ml. They contain the resistance genes VAN-A or VAN-B.

For more information about these Patient Safety Indicators click on the links below:

•  MRSA and VRE – important facts
  • Find out more about these infections

HSMR

What is the Hospital Standardized Mortality Ratio (HSMR)?

The HSMR is an important new measure that can help support efforts to improve patient safety and quality of care in Canadian hospitals. The HSMR compares the actual number of deaths in a hospital with the average Canadian experience, after adjusting for several factors that may affect in-hospital mortality rates, such as the age, sex, diagnoses and admission status of patients. The ratio provides a starting point to assess mortality rates and identify areas for improvement, which may help to reduce hospital deaths from adverse events.

For more information about these Patient Safety Indicators click on the links below:

• HSMR – Information for the Public

What is a Central-Line Associated Blood Stream Infection (CLI-BSI)?

When a patient requires long-term access to medication or fluids through an IV, a central line is put in place. A central line blood stream infection can occur when bacteria and/or fungi enters the blood stream, causing a patient to become sick. The bacteria can come from a variety of places (e.g., skin, wounds, environment, etc.), though it most often comes from the patient’s skin.

Hospitals follow best practices on how to prevent bacteria from entering into a central line. Patients in the ICU often require a central line since they are seriously ill, and will require a lot of medication, for a long period of time.

For more information about these Patient Safety Indicators click on the links below:

• Central-Line Infections - FAQ about CLIs

What is a Ventilator Associated Pneumonia (VAP)?

For our public reporting purposes, ventilator associated pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in an intensive care unit (ICU), requiring, external mechanical breathing support (a ventilator) intermittently or continuously, through a breathing tube for more than 48 hours.

HOW ARE THE RATES CALCULATED?

Hand Hygiene Rate

 Ontario hospitals are posting their hand hygiene compliance rates as percentages for time periods identified by the Ministry of Health and Long-Term Care, using the following formula:

    # of times hand hygiene performed         x 100

    # of observed hand hygiene indications  

These percentages also reflect:

   (i) hand hygiene before initial patient/patient environment contact by combined health care

        provider type (e.g., nurses, allied health professionals, physicians, etc.)

  (ii) hand hygiene after patient/patient environment contact by combined health care provider

       type (e.g., nurses, allied health professionals, physicians, etc.)

Hospitals are to collect at least 200 observations for every 100 in patient beds.

To ensure statistically valid data for smaller hospitals, or hospitals with fewer in-patient beds a minimum of 50 observed opportunities for hand hygiene will need to be collected.

The goal of public reporting hand hygiene compliance is to achieve an overall assessment of whether compliance rates are improving. It is normal for rates to vary from hospital to hospital.

C-difficile Rate

The c-difficile rate is calculated as follows:

Number of new cases X 1000

    Number of Patient Days

MRSA Rate

The method of calculation of the MRSA infection rate for the reporting period (on a quarterly basis) is:

Number of nosocomial patients with laboratory identification of MRSA bacteraemia x 1000

          Total number of patient days

 VRE Rate

The method of calculation of the VRE infection rate for the reporting period (on a quarterly basis) is:

Number of nosocomial patients with laboratory identification of VRE bacteraemia x 1000

           Total number of patient days

HSMR Rate

The method to calculate the hospital’s HSMR is:

                                                          Observed Deaths       x 100

                                                          Predicted Deaths

Central-Line Infection Rate (CLI)

All hospitals with ICUs required to report into the Critical Care Information System (CCIS) – a centralized data collection system where hospitals report a variety of critical care information – must publicly report the CLI indicator data. These hospitals are considered “eligible” for CLI-BSI reporting. 

These Ontario hospitals are posting their quarterly CLI rate and case count for those infections acquired in their facility, using the following formula:

              total # of ICU related BSIs after 48 hours of central line placement   x 1000

              total # of central line days for ICU patients 18 years and older

Ventilator Associated Pneumonia (VAP) Rate

Ontario hospitals with ICUs are posting their quarterly VAP rate and case count for those infections acquired in their facility, using the following formula:

         Total # of ICU cases of VAP after 48 hours of mechanical ventilation___  X 1000

         Total # of ventilator days for ICU patients 18 years and older

IMPORTANT NOTE: In smaller hospitals, such as LDMH, rates will vary greatly, from month to month, because a change in even one case in a small facility will cause the rate to go up or down considerably.

To find out more about patient safety you may visit the Ministry web site at www.ontario.ca/patientsafety

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