Patient Safety Indicators

When a patient requires long-term access to medication or fluids through an intravenous route, a central line or catheter is put into a large vein in the neck, chest or groin. A central line infection (CLI), in which bacteria grow in the line and spreads to the patient’s blood stream, may occur. The bacteria can come from a variety of places (e.g., skin, wounds, environment, etc.), though they most often come from the patient’s skin. CLI are treated with antibiotics.

Seriously ill patients on the Critical Care Unit are more likely to developing infections because of their severe illness and compromised immune systems.

The Ministry of Health has asked that CLI rates in Critical Care Units or Intensive Care Units (ICUs), be publicly reported on a quarterly basis because this is where the majority of patients have central lines.

At the HPHA only our Stratford General Hospital site has a Critical Care Unit.

Prevention of Central Line Infections

Our health care team follows best practices on how to prevent bacteria from entering into a central line. This includes:

• Proper handwashing techniques. Everyone who touches the central line must wash their hands with soap and water or use alcohol-based hand rub.
• Wearing appropriate Personal Protective Equipment (PPE) including a mask, gloves and hair covering when putting in the line. The patient should be covered with a sterile drape with a small hole where the line goes in.
• Cleaning the patient’s skin with "chlorhexidine" (a disinfectant and antiseptic) when the line is put in.
• Choosing the most appropriate vein to insert the line.
• Checking the line every day for infection.
• Replacing the line as needed
• Removing the line as soon as it is no longer needed.

Clostridium difficile is a common bacterium that is found in the environment and occurs naturally in some people. When C. difficile damages the bowel and causes diarrhea, it is known as a Clostridium difficile infection (CDI).

C. difficile can grow and cause infection when antibiotics kill the ‘good’ bacteria in the intestine. As the C. difficile grows, it produces toxins which can damage the bowel and cause watery diarrhea and abdominal pain. Risk factors for developing CDI include a history of antibiotic usage, prolonged hospitalization, increased age and serious underlying illness.

At HPHA, we closely monitor and track our infection rates. Every case of CDI that is diagnosed within the hospital is investigated. The rate at HPHA hospital sites at times appears to indicate a problem although is most often a reflection of a small number of cases with a low volume of patients.

Clinton Public Hospital

St. Marys Memorial Hospital

Seaforth Community Hospital

Stratford General Hospital

HPHA Combined Rate

Preventing the spread of C. difficile

The following special precautions are taken for patients with C. difficile

• Private rooms are utilized if available
• Signage is placed on the door of the room to remind all who enter of special precautions, such as gowns and gloves.
• Visitors and staff must wash their hands with soap and water when entering and leaving the room.
• Shared spaces, such as lounges, cafes, gift shops, etc. should not be visited.
• Patients should practice proper hand hygiene – washing their hands with soap and water after using the bathroom and before leaving their room.
• After the patient is transferred, discharged or removed from C.difficile isolation precautions, the room is completely emptied. Curtains are removed and all unused items are disposed of. The room is double-cleaned using a bleach solution.

Hand hygiene is the single most effective way to prevent infections.

Research indicates that hand hygiene reduces the risk of healthcare-associated infections, length of hospital stays and readmissions. It is fundamental to all our patient safety initiatives, and a cornerstone of our infection control and prevention efforts at HPHA. Hand Hygiene will continue to be a key priority of all our patient safety and quality initiatives.

Hospitals across Ontario are required to audit and report their hand hygiene compliance rates annually on two indicators, Before Initial Patient or Patient Environment Contact, and, After Patient or Patient Environment Contact.

HPHA Hand Hygiene Compliance Rates

• At HPHA, we have alcohol-based hand sanitizers close to where health care providers care for patients. This makes it very convenient for staff to sanitize their hands prior to giving patient care.
• Hand sanitizers are also found at each patient's bedside. It is important that all patients wash their hands when leaving their room to go to other departments within the facility. Examples would be going for a test such as an x-ray or participating in physiotherapy in the gym.
• Hand sanitizers are also at the entrance to the hospitals and patient care areas. All visitors to our facilities are asked to wash their hands as they enter and exit the hospital, as well as when they enter and leave patient rooms, as this will also help to stop the spread of germs to our patients.

The Hospital Standardized Mortality Ratio (HSMR) is calculated as a ratio of the actual number of deaths to the expected number of deaths among patients in the hospital. The HSMR is adjusted for factors affecting mortality such as age, sex and length of stay in the hospital.

Interpreting the HSMR

• 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.

The following outlines the Huron Perth Healthcare Alliance's performance in recent years:

Staphylococcus aureus is a bacterium that lives on the skin and mucous membranes of healthy people. Occasionally these bacteria can cause an infection. When S. aureus develops resistance to certain antibiotics, the resulting infection is known as methicillin-resistant Staphylococcus aureus, or MRSA.

Many bacteria live on and in the body without causing disease/infection. This is called colonization. Colonization does not require treatment. These same bacteria, under the right conditions, can cause disease. This is an infection.

MRSA is spread from one person to another by contact. MRSA can live on hands and on objects in the environment for long periods of time. Regular hand cleaning with soap and water or alcohol-based hand sanitizer is the best way to prevent the spread of MRSA.

Rates of New Hospital Acquired MRSA Blood Stream Infections at HPHA

Clinton Public Hospital

St. Marys Memorial Hospital

Seaforth Community Hospital 

Stratford General Hospital 

HPHA Combined Rate 

A surgical safety checklist (SSCL) is a patient safety communication tool that is used by our surgical team (nurses, surgeons, anesthesiologists, and others) to discuss important details about each surgical case.

The checklist is used before, during and after surgery to help the team verify and review medical history and any special requirements that may be needed for each individual case.

Information included in the checklist section is as follows:

• Verify with the patient their name and procedure to be done
• Allergy Check
• Medications Check
• Operation site, side and procedure
• Lab tests, X-rays

The “Time Out” Phase

• Patient position
• Operating site, side and procedure
• Antibiotics check

The Debriefing Phase

• Surgeon reviews and confirms with the surgical team important details regarding the patient’s risk factors and surgery performed
• Nurse reviews correct counts of items involved in procedure

SSCL Compliance Rates at HPHA

The SSCL is considered “performed” when the designated checklist coordinator confirms that surgical team members have implemented and/or addressed all of the necessary tasks and items in each of the three phases: briefing, time out and debriefing.

The SSCL compliance indicator measures the degree to which all three phases of the checklist were performed correctly and appropriately for each surgical patient. All three steps must be fully completed during all surgeries to achieve a rating of 100%

Note: surgeries are only performed at our Clinton Public Hospital and Stratford General Hospital sites.

Clinton Public Hospital

Stratford General Hospital

One of the ways to prevent surgical site infections (SSI) to give patients a preventive dose of antibiotics just before the surgical incision is made. The timing of this antibiotic administration is crucial as there is a designated ‘window’ of time for starting and finishing the antibiotic infusion before the surgical incision.

The Ontario Ministry of Health has chosen the antibiotic use and timing ‘best practice’ for hip and knee joint replacement surgeries as the first SSI-Prevention Indicator which Ontario hospitals are required to publicly report.

Surgical Site Infection (SSI) Prevention Rate at HPHA

The SSI–Prevention rate reported is the percentage of time our patients (18 years of age or older) receive antibiotics within the appropriate time period before their hip or knee joint replacement surgery.

Note: Hip and knee joint replacement surgeries are only performed at our Stratford General Hospital site

Hips

Knees

VRE is a strain of Enterococcus bacteria, which has become resistant to many of the antibiotics normally used to treat this infection. These bacteria usually live in the bowel and can sometimes cause infection.

VRE can live on skin or in the environment for long periods of time. People with VRE can spread it to others when they forget to wash their hands after using the washroom. It can also be spread by unwashed hands after direct contact with patients or the contaminated environment. Regular hand cleaning with soap and water or alcohol-based hand sanitizer is the best way to prevent the spread of VRE.

Bacteremia is a bloodstream infection caused by the presence of bacteria in the bloodstream. Risk factors for VRE bacteremia include having a weakened immune system, a prolonged hospital stay due to a critical illness and having received many antibiotics.

Rates of New Hospital Acquired VRE Bloodstream Infections at HPHA

Clinton Public Hospital

St. Marys Memorial Hospital

Seaforth Community Hospital

Stratford General Hospital

HPHA Combined Rate

Ventilator Associated Pneumonia (VAP) is a serious lung infection that may occur specifically in patients in a Critical Care Unit, who need assistance breathing with a mechanical ventilator, for more than 48 hours. A ventilator is an external mechanical breathing device that is connected to the patient via a breathing tube.

Ventilator Associated Pneumonia can develop in patients for many reasons. Patients who are on a ventilator are very sick and are more prone to infection. Since they are relying on an external machine to breathe, the patient’s normal ability to cough, yawn, and breathe deeply are reduced. They may also have a depressed immune system, making them more prone to infection.

VAP is caused by a bacterial infection in the lungs and is treated using antibiotics.

Rates of Ventilator Associated Pneumonia at HPHA

The number of VAP cases and rates are being publicly reported on a quarterly basis by each eligible hospital site.

Note: The Stratford General Hospital site of the HPHA is the only site with a Critical Care Unit.

Stratford General Hospital

Preventing VAP

At HPHA, our healthcare teams use a set of ‘best practices’ to help prevent VAP. These include:

• Practicing proper hand hygiene techniques.
• Raising the head of the patient’s bed so the patient is in a partially upright position.
• Considering chest X-ray if patient develops a fever or has an increased white blood cell count (which may be indicative of an infection)
• Discontinuing mechanical ventilation as soon as possible when patients can breathe on their own.