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.

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.

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.

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.

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.

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.

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. 

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.

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.

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.

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