Patient Safety Indicators

At Michael Garron Hospital (MGH), quality care and patient safety are top priorities. The hospital believes in being accountable and open with the community about its performance and the quality services they can expect. The health and safety of patients and staff is MGH’s first priority and it takes the prevention of infectious diseases very seriously.

Preventing the Spread of Hospital Acquired Infections

What are hospital-acquired infections?

Sometimes when patients are admitted to the hospital, they can get infections. These are called hospital-acquired infections. Hospital-acquired mean that the infection is identified 72 hours after admission to the hospital; or that the infection was present at the time of admission, but was related to a previous inpatient admission to a hospital within the last four weeks.

How does Michael Garron Hospital prevent the transmission of infections within a hospital setting?

• Screening for antibiotic resistant organisms - swabs are collected from your nose and rectum where these bacteria like to grow.
• Screening questions - patients are asked if they have recently been hospitalized, travelled or been ill.
• Monitor patients for signs and symptoms of infection and place patients exhibiting infections in additional precautions -  the additional precautions help prevent the transfer of infectious particles via healthcare staff and/or equipment.
• Electronic monitoring of hand hygiene rates - electric monitoring is conducted in various locations in MGH and provides real time results to unit leadership to advise on unit hand hygiene performance.
• Antimicrobial Stewardship - MGH’s nationally recognized Antimicrobial Stewardship team will review antibiotic orders to ensure the appropriate antibiotic is selected for the particular bacteria that is causing the infection. Selecting the wrong antibiotic could lead to prolonged treatment and even the development of resistance in the bacteria.

Patient Indicators and Reporting

C. difficile Infection (CDI)

Clostridium difficile (C. difficile) is a bacterium that causes mild to severe diarrhea and intestinal conditions and is the most frequent cause of infectious diarrhea in hospitals and long-term care facilities in Canada, as well as in other industrialized countries.

Some antibiotics (high dose or for prolonged period) can destroy a person's normal bacteria found in the gut, causing C. difficile bacteria to grow. When this occurs, the C. difficile bacteria produce toxins, which can damage the bowel and cause diarrhea. However, some people can have C. difficile bacteria present in their bowel and not show symptoms.

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces, and then touch their mouth. Healthcare workers can spread the bacteria to their patients if their hands are contaminated. For healthy people, C. difficile does not pose a health risk. The elderly and those with other illnesses or who are taking antibiotics are at a greater risk of infection. 

Cases
The number of new hospital acquired C. difficile infections will be reported on a monthly basis.

Infection Rate per 1,000 Patient Days
The C. difficile 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, over one year of age, during the given time period.

MGH Rates
MGH’s C. difficile infection rate for August 2020: 0.19

Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia

Methicillin-Resistant Staphylococcus aureus (MRSA) is a type of bacterium that is commonly found on the skin and in the noses of healthy people. Some are easily treatable while others are not. Bacterium that are resistant to the antibiotic methicillin are known as methicillin-resistant staphylococcus aureus or MRSA. If left untreated, MRSA infections may develop into serious, life-threatening complications such as infection of the bloodstream, bones and/or lungs (e.g., pneumonia). 

MRSA is primarily spread by skin-to-skin contact or through contact with items contaminated by the bacteria. Those with weakened immune systems and chronic illnesses are more susceptible to the infection and MRSA has been shown to spread easily in healthcare settings.

Cases
The number of new hospital acquired MRSA bloodstream infections will be reported on a quarterly basis.

Infection Rate per 1,000 Patient Days
The MRSA 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, over one year of age, during the given time period.

MGH Rates
MRSA rate for August 2020: 0.00

Vancomycin-resistant Enterococci (VRE) Bacteremia

Vancomycin-resistant enterococci (VRE) are strains of bacteria that are resistant to the antibiotic vancomycin. Enterococci are bacteria that live in the human intestine, in the urinary tract and are often found in the environment. Generally these bacteria do not cause illness; however when illness does occur it can usually be treated with antibiotics. Vancomycin is an antibiotic generally prescribed to treat serious infections caused by organisms that are resistant to other antibiotics such as penicillins.

It can spread from patient to patient when bacteria is carried on the hands of healthcare workers and occasionally through contact with contaminated equipment or other surfaces (e.g. toilet seats, bedrails, door handles, soiled linens, stethoscopes etc). VRE is very hardy. It can survive on hard surfaces for 7-10 days and on hands for hours.

Cases
The number of new hospital acquired VRE bloodstream infections will be reported on a quarterly basis.

Infection Rate per 1,000 Patient Days
The VRE 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, over one year of age, during the given time period.

MGH Rates
The VRE rate for August 2020: 0.00

Central Line Infections (CLI)

Central line-associated bloodstream infections (CLI) occur when germs (usually bacteria or viruses) enter the bloodstream through the central line. A central line is a tube that doctors often place in a large vein to give medication or fluids or to collect blood for medical tests. Central lines are different from regular intravenous (IV) lines because it accesses a major vein that is close to the heart and can remain in place for weeks or months and be much more likely to cause serious infection. Central lines are commonly used in intensive care units. Healthcare providers must follow a strict protocol when inserting such line to make sure the IV remains sterile and a CLI does not occur.

CLI Cases
Only central line associated blood stream infections that occur 48 hours or more after insertion and in a hospitalized ICU patient are being publicly reported.

CLI Rate per 1,000 Central Line Days
The CLI rate is the number of ICU patients (18 years and older) with a new CLI per 1,000 central line days. Central line days are the total number of days a central line was used in ICU patients who are 18 years and older

MGH Rates
The CLI rate for quarter one of the 2018/2019 fiscal year (April - June): 0.0

Ventilator-Associated Pneumonia (VAP)

Ventilator-associated pneumonia (VAP) is a lung infection (pneumonia) that develops in a patient who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient's mouth or nose, or through a hole in the front of the neck (tracheostomy or endotracheal tube). An infection may occur if germs enter through the tube and get into the patient's lungs.

VAP Cases
Includes only VAPs that develop 48 hours after the patient was placed on a ventilator in ICU. Includes only ICU patients, 18 year and older, who are mechanically ventilated.

VAP Rate
The VAP rate is the number of ICU patients (18 years and older) with new VAP per 1,000 ventilator days. Ventilator days are the number of days spent on a ventilator for all patients in the ICU 18 years and older.

MGH Rates
VAP rate for August 2020: 0.00

Hospital Standardized Mortality Ratio (HSMR) 

The Hospital standardized mortality ratio (HSMR) is an important measure designed to improve patient safety and quality of care in hospitals by tracking mortality. It is calculated by comparing observed versus expected deaths. Observed deaths are actual deaths in the hospital and expected deaths are the overall Canadian mortality in the reference year.

The HSMR adjusts for factors that affect in-hospital mortality rates, such as patient age, sex, diagnosis and admission status. In last two years, Michael Garron Hospital (MGH) remarkably improved its HSMR score.

HSMR is used to track a hospital’s mortality over time and it allows our hospital to measure and monitor progress in quality of care. The Canadian Institute for Health Information (CIHI) measures HSMR for all qualified hospitals in Canada. Below are HSMR scores calculated by CIHI for MGH.

Fiscal Year	HSMR	HSMR 95% CI
2019 - 2020	81	73 - 90
2018 - 2019	78	70 - 87
2017 - 2018	63	42 - 91
2016 - 2017	65	58.3 - 73.2
2015 - 2016	71	63 - 79

Notes:
95% CI = 95 percent confidence interval.
The fiscal year 2009–2010 baseline HSMR of 100.

How should HSMR be interpreted?

An HSMR equal to 100 suggests that there is no difference between the hospital’s mortality rate and the overall average rate; An HSMR greater than 100 suggests that the local mortality rate is higher than the overall average; An HSMR less than 100 suggests that the local mortality rate is lower than the overall average. It is important to note that HSMR is not designed for comparisons between hospitals; it is intended to track a hospital’s trend over time.

Hand Hygiene Compliance

Hand hygiene refers to the removal of visible soil and the removal or killing of microorganisms from the hands. This may be accomplished using soap and running water, or by using  alcohol-based hand rub.  Alcohol based hand rub is the preferred method of hand hygiene when hands are not visibly soiled. The single most common way of transferring health care associated infections (HAI) is by the hands of health care workers. Health care workers' hands may become colonized with the infectious bacteria after contact with patients, or after handling specimens, and contaminated materials or equipment. 

MGH Rates
As fiscal year 2019/2020:

• Percent compliance before patient contact: 67.90%
• Percent compliance after patient contact: 68%

Surgical Site Infection Prevention

Surgical site infections (SSI) can increase mortality, rates of readmission and length of stay. Appropriate prophylactic antibiotic use is a key measure of reliable perioperative care.

MGH regularly monitors the percentage of primary hip and knee surgical cases with appropriate antibiotic administration.

MGH Rates
The SSI prevention rate for August 2020 is 100.00%.

Surgical Safety Checklist Compliance

The surgical safety checklist is a tool used to verify compliance with processes in the operating room to ensure patient safety. The surgical checklist compliance indicator is a measure of the percentage of surgeries in which the checklist was carried out in completion. For 100% compliance, all three phases, briefing, time out and debriefing, must be completed.

MGH Rates
For Jan-June 2020, MGH had a surgical safety checklist compliance rate of 100%.