Introduction

Description of indicator & value

• What does this indicator show?

  This indicator shows the number of patients newly diagnosed with hospital-associated Clostridium difficile Infection (CDI), divided by the number of patient days in that month, multiplied by 1,000. Patient days are the number of days spent in a hospital for all patients. This rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Case count is the number of patients with hospital-associated CDI during a calendar month.

  This website lists hospitals that were in outbreak during the reporting period. The public is encouraged to contact the specific hospital directly for additional information. Hospitals are strongly encouraged to post on their websites when their hospital has an outbreak, the exact units affected and when the outbreak is over.

• Why is this important to measure?

  C. difficile is a bacterium that can either live in the bowel, as part of normal bowel flora, without causing harm, or it can cause an infection (diarrhea, fever, abdominal pain).  Infection can occur when a person has been on antibiotics.  The antibiotics can upset the normal balance of the bowel, leading to Clostridium difficile Infection.The effects of CDI are usually mild, but sometimes can be severe. Symptoms range from mild diarrhea to high fever, abdominal cramping, abdominal pain and dehydration. In severe cases, surgery may be needed and in extreme cases CDI may cause death.

  Measuring, monitoring and reporting Clostridium difficile Infections is one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the number of patients newly diagnosed with hospital-associated MRSA bacteremia (bloodstream infection), divided by the number of patient days in that month, and multiplied by 1,000. Patient days are the number of days spent in a hospital for all patients. This rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Case count is the number of patients with hospital-associated MRSA bacteremia during the reporting period.

• Why is this important to measure?

  Staphylococcus aureus (S. aureus) is a type of bacteria that lives on the skin and mucous membranes of healthy people. When S. aureus develops resistance to certain antibiotics, it is called methicillin-resistant Staphylococcus aureus, or MRSA. MRSA can either live on the skin or mucous membranes (e.g. nose) of a person without causing harm (called colonization), or it can enter the body through artificial openings (e.g. wounds, IV lines) and cause infections like bloodstream infections. MRSA infections can be challenging to treat because the bacteria are resistant to some antibiotics.

  Measuring, monitoring and reporting MRSA bacteremia is one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the number of patients newly diagnosed with hospital-associated Vancomycin Resistant Enterococcus (VRE) bacteremia, divided by the number of patient days in that month, and multiplied by 1,000. Patient days are the number of days spent in a hospital for all patients. This rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Case count is the number of patients with hospital-associated VRE bacteremia during the reporting period.

• Why is this important to measure?

  Enterococci are bacteria that live in the gastrointestinal tract (bowels) of most individuals and generally do not cause harm. Vancomycin-Resistant Enterococci (VRE) are strains of the enterococci bacteria that are resistant to the antibiotic Vancomycin. VRE can either live in the bowel of a person without causing harm (called colonization), or it can enter the body through artificial openings (e.g. wounds, IV lines) and cause infections like blood stream infections. VRE infections can be challenging to treat because the bacteria can be resistant to some antibiotics.

  Measuring, monitoring and reporting VRE bacteremia is one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the total number of newly diagnosed Central Line-Associated Primary Bloodstream Infection (CLI) cases in the Intensive Care Unit (ICU) after at least 48 hours of being placed on a central line, divided by the number of central line days in that reporting period, and multiplied by 1,000. Central line days are the number of days spent on a central line for all patients in the ICU 18 years and older. Case count is the number of ICU patients 18 years and older diagnosed with CLI after at least 48 hours of being placed on a central line during the reporting period.

• Why is this important to measure?

  A central venous catheter (or “line”) is fed through a vein and provides access to major blood vessels (e.g. aorta, pulmonary artery). A typical intravenous line or IV is not considered a central line. These lines are inserted through artificial openings in the skin, which decreases the ability of the body to keep out bacteria. A Central-line primary bloodstream infection (CLI) occurs when bacteria get into the line and spread to the bloodstream causing infection.

  Measuring, monitoring and reporting rates of CLI are one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the total number of newly diagnosed Ventilator-Associated Pneumonia (VAP) cases in the Intensive Care Unit (ICU) after at least 48 hours of mechanical ventilation, divided by the number of ventilator days in that reporting period, and multiplied by 1,000. Ventilator days are the number of days spent on a ventilator for all patients in the ICU 18 years and older. Case count is the number of ICU patients 18 years and older diagnosed with VAP after at least 48 hours of being placed on a ventilator (occasionally or continuously).

• Why is this important to measure?

  Critically ill patients may require the assistance of a ventilator to breathe. When ventilated, microorganisms may get into the patient’s lungs causing pneumonia or ventilator-associated pneumonia (VAP).

  Measuring, monitoring and reporting rates of CLI are one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the total number of patients who received antibiotics within the appropriate time period prior to surgery divided by the total number of surgical patients during the reporting period, and multiplied by 100. Included are patients 18 years or older having primary hip or knee joint replacement surgery, including total, partial or hemiarthroplasty.

• Why is this important to measure?

  Surgical Site Infection can occur when germs enter the patient’s body through the surgical site. Surgical site infections can be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, including organs.

  One way to prevent surgical site infection is to give patients antibiotics 0 to 60 minutes (for usual antibiotics) or 0 to 120 minutes (for an antibiotic known as Vancomycin) before surgery.

  Measuring, monitoring and reporting rates of SSIs are one part of a comprehensive Infection Prevention and Control (IPAC) program. The information gathered can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the number of times that hand hygiene was performed before and after contact with the patient, or the patient environment, divided by the number of observed hand hygiene opportunities for before and after patient/patient environment contact, and multiplied by 100.

  As an example, hand hygiene was performed 60 times before patient/patient environment contact by all health care providers. There were 100 observed hand hygiene opportunities for before patient/patient environment contact for all health care providers. Therefore, the percent hand hygiene compliance for before patient/patient environment contact = (60/100)x 100 = 60% compliance rate.

• Why is this important to measure?

  Hand hygiene is the removal of visible soil or killing of microorganisms from the hands and may be accomplished using soap and running water or an alcohol-based hand rub. Bacteria that can cause infection can move from patient to patient on the hands of healthcare workers.

  A comprehensive hand hygiene program is part of any effective infection prevention and control (IPAC) program. Measuring hand hygiene compliance can assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.

Description of indicator & value

• What does this indicator show?

  This indicator shows the total number of surgeries in which all three phases of the Surgical Safety Checklist were performed divided by the total number of surgeries during the reporting period, multiplied by 100. Exclusions are minor surgical procedures that are done under local anaesthetic. Inclusions are surgical procedures such as: major surgery, day surgery, inpatient surgery, endoscopy, cytoscopy, bronchoscopy, colonoscopy, colposcopy, cataracts, dental procedures, C-sections, and emergency surgeries.

• Why is this important to measure?

  The Surgical Safety Checklist is a one-page list covering about 26 of the most common tasks and items that operating room teams carry out to ensure patient safety. The checklist was developed by the Canadian Patient Safety Institute as a tool to support patient care through professional preparation and teamwork. The consistent use of this checklist has been shown to reduce the rates of death and complications associated with surgical care.

Description of indicator & value

• What does this indicator show?

  The Hospital Standardized Mortality Ratio (HSMR) is a ratio of the actual number of in-hospital deaths in a region or hospital to the expected number based on the types of patients a region or hospital treats. The HSMR is calculated annually by the Canadian Institute for Health Information (CIHI) and the results can be found on their website.

  It is important to note that the HSMR takes into consideration many factors associated with the risk of dying, but it cannot adjust for every factor. As a result, the HSMR is intended to track a hospital’s mortality trend over time.

• Why is this important to measure?

  The HSMR is a performance indicator that can be used to track the overall change in mortality resulting from a broad range of factors, including changes in the quality and safety of care delivered. Ever since the HSMR measure was first developed and disseminated by CIHI, many hospitals and health providers across Canada have been using it as part of their ongoing efforts to improve care.