HGMH takes your care and your safety very seriously, and we are committed to transparency.  on a monthly basis, beginning in september 2008, we will be reporting our C. difficile infection rates on our website.

As of December 31st 2008 we will also be reporting rates of:

   * Methicillin-resistant Staphylococcus (MRSA)
   * Vancomycin-Resistant Enterococci (VRE)
   
 Beginning in April 2009 the following indicators will be reporting on:
 
   * Hand hygiene compliance among health-care providers

If you have any questions about the information below or about our hospital's infection prevention and control program, please contact Joann Beckstead, R.N., C.I.C., Infection Prevention and Control Practitioner, by email at jbeckstead@hgmh.on.ca  or by telephone at 613-525-2222 ext. 4114.

Our Rates

C. Difficile Rate:
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 during the given time period.  The rate is calculated as follows:

Number of new hospital acquired case of C. difficile
in our facility x 1000
__________________________________________________
 
Total number of patient days (for one month)

For smaller sites:
C.difficile infection rate may vary from month to month: the smaller the site, the greater the rates will vary-this is because a change in even one case in a small site will cause the rate to up or down considerably.

Clostridium Difficile 2008-2009 statistics for HGMH

Indicator	Reporting  Period	Rate per 1,000 patient days	Case Count	*Outbreak
Clostridium difficile Associated Disease (CDAD)	January 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	February 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	March 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	April 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	May 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	June 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	July 2010	0	0	No
Clostridium difficile Associated Disease (CDAD)	August 2010	1	1.2	No
Clostridium difficile Associated Disease (CDAD)	September 2010
Clostridium difficile Associated Disease (CDAD)	October 2010
Clostridium difficile Associated Disease (CDAD)	November 2010
Clostridium difficile Associated Disease (CDAD)	December 2010

Measuring Clostridium difficile ( C. difficile) rates
HGMH posts its infection rates online on a monthly basis.  On this website, you can find informatin about hospital-acquired infection rates for C. difficile.

What are hospital-acquired infections?
Sometimes when patients are admitted to the hospital, they can get infections.  These are called hospital-acquired infections.  In the case of C. difficile, this may mean that symptoms began 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to that hospital within the last four weeks.  

What is C. difficile?
C. difficile (Clostridium difficile) is a bacteria.  C. difficile can be a part of the normal bacteria in the large intestine and is one of the many bacteria that can be found in stool (a bowel movment).

A C.difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing the C. difficile bacteria to grow and produce toxin.  The toxin produced can damage the bowel and cause diarrhrea. C. difficile is one example of a hospital-acquired infection and is one of the most common infections found in hospitals and long-term care facilities.  C. difficile has been a known cause of health care associated diarrhea for about 30 years.

Who is at risk for C. difficile?
Healthy people are not usually susceptible to C. difficile. Seniors, and people who have other illnesses or conditions being treated with antibiotics and certain other stomach medications, are at greater risk of an infection from C. difficile.

What are the symptoms of C. difficile?
The usual symptoms are mild but can be severe.  Main symptoms are watery diarrhea, fever, abdominal pain/tendernes.  In some cases there may not be diarrhea.  Blood may or may not be present in the stools.

How do you get C. difficile?
When a person has C. difficile, the germs in the stool can soil surfaces such as toilets, handles, bedpans, or commode chairs.  When touching these items, your hands can become soiled.  If you then touch your mouth, you can swalloow the germ.  Your soiled hands can spread germs that survive for a long time on other surfaces if not properly cleaned.

The spread of C. dificile occurs due to inadequate hand hygiene and environmental cleaning; therefore, proper control is achieved through consistent hand hygiene and thorough cleaning of the patient environment.  Good hand hygiene i.e. washing hands thoroughly and often is the single-most effective way to prevent the spread of infectious diseases like C. difficile.

At HGMH we are committed to promoting hand hygiene for patient care.  We provide access to alcohol-based hand products as well as soap and water throughout the facility for staff, patients and visitors to use.  We have a process to audit the hand hygiene of staff members and provide feedback.  We follow the advice and practices in the Ontario "Just Clean Your Hands" campaign to help us provide best practices in hand hygiene in caring for our patients.

How is C. difficile diagnosed?
C. difficile is usually diagnosed by sending a specimen of diarrhea to the laboratory where it is tested for the presence of C. difficile toxin.

How is C. difficile treated?
Treatment depends on how sick you are.  People with mild symptoms may not need treatment.  For more severe disease, antibiotics are required. 

What precautions are used to prevent the spread of C. difficile in the hospital?
If you are in the hospital and have. C. difficile diarrhea, you will be put on precautions until you are free from diarrhea for at least two days.  Your activites outside the room may be restricted. All health care staff who enter your room will wear a gown and gloves. Everyone MUST clean their hands when leaving you room.

How does HGMH control the spread of C. difficile?
In order to prevent the spread of C. difficile, we engage our houskeeping team to ensure that they are following the best practices for cleaning in situations where patients are identified with C. difficile.  As well, we are strongly encouraging our staff to enhance their hand hygiene practices.  We ensure that patients who are suspected or proven to have C. difficile receive appropriate treatment as soon as possible.  Once diarrhea has stopped in a patient with C. difficile, there is a much lower risk of contamination that might cause further cases. 

Does HGMH track C. difficile cases?
Looking closely at the C. difficile cases is an important step in making sure you are safe.  This is called surveillance, and it allows us to know whether there is a problem in the hospital and to understand how big the problem is.  We track all C. difficile cases in our hospital, and as soon as any case is identified, we bring in the resources needed to stop the possibility that it might spread to others.

What is HGMH doing to improve patient safety?
We have a patient safety program in the hospital to make sure that all practices are at the highest level possible to keep you safe. This includes:
* ensuring that our houskeeping practices are in line with the best 
   practices in healthcare.
* following the "Just Clean Your Hands" program for excellence in hand
   hygiene.
* conducting audits on various practices to verify that patient care is
   as safe as possible.    
* implementing programs such as "fall prevention", "medication 
   safety" and "Safer Healthcare Now" initiatives.



What is a C. Difficile outbreak?
Definitions shave been developed to assist hospitals and public health units in determining when there is an outbreak.

Outbreak: Six or more new nosocomial cases of C. difficile infection within a 30-day period on a single ward or unit.

Hospital Acquired Infection: Infection acquired during the delivery of health care within a particular health care facility.  See also, Nosocomial.

Infection Risk: The probability that a patient/client will acquire an infection based on the characteristics of the individual, the inherent risks associated with a procedure, or other factors that might put the individual at risk for a health care-associated infection.

Nosocomial Infection: Infection acquired during the delivery of health care within a particular health care facility.  See also. Hospital-Acquired Infection.  

Surveillance: The systematic ongoing collection, collation and analysis of data with timely dissemination of information to those who require it in order to take action.

Cluster: Three or more new nosocomial cases of C. difficile infection associated with a single ward or unit within a seven-day period.

(From the Provincial Infectious Disease Advisory Committee)

MRSA Rate
The method of calculation of the MRSA bacteremia infection rate for the reporting period is:

Number of nosocomial patients with laboratory identification of MRSA bacteremia x 1000
__________________________________________________


  Total number of patient days (for one month)

Where the numerator is the total number of newly identified cases for MRSA bacteremia assoicated with the reporting facility, for the reporting period.  The denominator is the total number of in-patient days for the reporting period.  There are no exclusion criteria.

Indicator	Reporting Period	Rate per 1,000 patient days	Case Count
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	September - November 2008	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	January - March 2009	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	April - June 2009	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	July - September 2009	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	October - December 2009	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	January - March 2010	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	April - June 2010	0	0
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	July - September 2010
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia	October - December 2010

VRE Rate
The method of calculation of the VRE bacteremia infection rate for the reporting period is:
 

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

__________________________________________________

                                

Total number of patient days (for one month)

Indicator	Reporting     Period	Rate per   1,000 patient days	Case Count
Vancomycin-resistant enterococci (VRE) bacteremia	September - November 2008	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	January - March 2009	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	April - June  2009	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	July - September     2009	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	October - December  2009	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	January - March 2010	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	April - June 2010	0	0
Vancomycin-resistant enterococci (VRE) bacteremia	July - September 2010
Vancomycin-resistant enterococci (VRE) bacteremia	October - December 2010

Where the numerator is the total number of newly identfied cases for VRE bacteremia associated with the reporting facility, for the reporting period.  The denominator is the total number of in-patient days for the reporting period.  There are no exclusion criteria.

Hospitals should be posting the quarterly MRSA and VRE bacteremia rates.

Information for Patients and Families
Glengarry Memorial Hospital takes your care and your safety very seriously and we are extremely committed to transparency.  On a quarterly basis, beginning in December, we will be reporting our infection rates on our website.

If you have any questions about the information below or about our hospital's infection prevention and control program please contact Infection Prevention and Control Practioner Joann Beckstead, R.N., C.I.C. at 613-525-2222 ext .4114.

Measuring Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococci (VRE) rates.
Glengarry Memorial Hospital posts its infection rates online on a quarterly basis.  On this website, you can find information about hospital-acquired infection rates for MRSA and VRE.

What does hospital acquired mean?
Sometimes when patients are admitted to the hospital, they can get infections.  This is a hospital-acquired infection.  In the case of either MRSA or VRE, this may mean that symptoms begin 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to that hospital within the last 4 weeks.

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. cloxacillins and cephalosporins.  MRSA are strains of S. aureus that have an MIC to oxacillin of  greater than or equal to 4 mcg/ml. or contain the mecA gene coding for penicilin binding protein 2a (PBP 2a).

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 bateria 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 greater than or equal to 32 mcg/ml. They contain resistance genes VAN-A or VAN-B

What are the risk factors for MRSA?
Risk factors for MRSA acquisition include invasive procedures, prior treatment with antibiotics, prolonged hospital stay, stay in an intensive care or  burn unit, surgical wound infection and a close proximity to a colonized person.  MRSA can also be transmitted from mother to child through breast milk.

What are the risk factors for VRE?
Risk factors for VRE include severity of unerlying illness, presence of invasive devices, prior colonization with VRE, antibiotic use and length of hospital stay.

How is MRSA transmitted?
The single most important mode of transmission of MRSA in a health care setting is via transiently colonized hands of health care workers who acquire it from contact with coloinzed or infected patients, or after handling contaminated material or equipment.  The unrecognized colonized patient presents a particular risk for transmission to other patients.


How is VRE transmitted?
The single most important mode of transmission of VRE in a health care setting is via transiently colonized hands of health care workers who acquire it from contact with colonized or infected patients, or after handling contaminated material or equipment.  The unrecognized colonized patient presents a particular risk for transmission to other patients.

How are MRSA and VRE diagnosed?
If you meet the criteria for the screening protocol, the nurse will take swabs of your nose and rectum and any broken areas of your skin.  This testing allows us to find carriers quickly and prevent spread to other patients.  The results will be reported to your physician.

How are MRSA and VRE treated?
Many bacteria live on and in the body without causing disease/infection.  This is colonization.  Colonization does not require treatment.  These same bateria under the right conditions can cause disease. This is infection.  MRSA can colonize in the nose, the skin and the respiratory tract.  It can cause infection in the respiratory tract, in surgical sites and in the blood.  Treatment depends on how sick patients are with the disease.

What precautions are used to prevent the spread of both MRSA and VRE in the hospital?
If you are found to carry MRSA or VRE, you will be placed in a single room and put under special Infection Control precautions.  This is to ensure that the germs cannot spread to other patients.  Your medical care that you require will not be affected.

What Glengarry Memorial Hospital is doing to improve patient safety:

* Hand hygiene program with increased access to alcohol gel

* Screening patients on admission for silent carriage of resistant       organisms

* Use of single rooms, (when possible) masks, gowns, and gloves to   control  transmision

* Increased housekeeping resources

* Education and awareness campaigns for patients and health care    providers

Hand Hygiene Compliance
    

Hand Hygiene

• Hand hygiene is a key issue for our hospital, and our hospital has mobilized resources to enhance patient and health care provider safety through improved hand hygiene within our organization.

• Patient safety remains the most important priority for our hospital; this involves ensuring that patients are not at risk for contracting health care-associated infections.

• We know that good hand hygiene is the single most effective way to reduce the risk of health care-associated infections.

• Hand washing is something we all do, but it's also something that we want to continue to do better - i.e., at the right times and the right way, etc.

• 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.

• We have sound infection control programs in place and are committed to using standardized patient safety data and public reporting to drive further improvements.

• Last March, 100% of Ontario hospitals participated in the government's Just Clean Your Hands training program - an evidence-based, multi-faceted hand hygiene program to support hand hygiene improvement in hospitals.

• We are working to create a culture of patient safety involves everyone - health care administration, health care professionals, and, of course, patients and families.

• The dedicated health professionals who work in this hospital are committed to providing the best possible care to our patients.

• Public reporting on patient safety indicators is an important and positive step forward.
  
• Our hospital strongly supports the provincial government's new public reporting regime because we believe it will inspire improved performance, enhance patient safety, and strengthen the public's confidence in Ontario's hospitals.

• The public reporting of hand hygiene compliance rates is another, helpful measure to ensure the care provided to our patients is even safer, and improves over time.
  
• The public reporting of hand hygiene compliance rates is not intended to serve as a a comparator measure among hospitals. It is, above all else, about reducing the occurences of health care-associated infections.
  
  Hand Hygiene Compliance Rates  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          x100

# 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.)

Our hand hygiene rate at HGMH is 86%  

(ii)  hand hygiene after patient/patient environment contact by 
      combined health care provider type (e.g., nurses, allied health
      professionals, physicians, etc.)

Our hand hygiene rate at HGMH is 92%  

Hand Hygiene  Indication	Post Education 2009	Annual Reporting 2010
Before initial   patient/patient  environment contact	52%	86%
After patient/patient  environment contact	56%	92%

Information for Patients and Families

Patient safety remains the most important priority for Hôpital Glengarry Memorial Hospital and this involves ensuring that patients are not at risk for contracting healthcare-associated infections.

We have a number of practices in place to help prevent and control infections, including a comprehensive hand hygiene program. As of April 30, 2009, all Ontario hospitals are required to annually post their hand hygiene compliance rates to further promote accountability and transparency within the health system.

If you have any questions about the information below or about our hospital's infection prevention and control program, please contact J. Beckstead 613-525-2222 ext. 4114.

What are health care-associated infections?

Sometimes when patients are admitted to the hospital, they can get infections. These are called health care-associated infections.

How will the public reporting of hand hygiene compliance affect compliance among health care professionals?

There are many factors that will improve hand hygiene compliance. Mandatory public reporting is one element. Certainly the increasing recent attention on the issue as well as the provincial government's multifaceted hand hygiene program called Just Clean Your Hands are important to ensuring effective hand hygiene at the right times.

Why is hand hygiene so important?

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.

What Hôpital Glengarry Memorial Hospital  is doing to improve patient safety?

Our Initiatives 
 

• HGMH has senior and middle management support and commitment to make hand hygiene an organizational priority.
• A multidisciplinary hand hygiene group was formed to facilitate the "Just Clean Your Hands Program".
• Point of Care Access to Alcohol-Based Hand Rub was provided with staff input into product and placement.
• A hand care program was developed to assist staff that has hand/skin problems.
• Provincial Infectious Disease Advisory Committee (PIDAC) Best Practices for Hand Hygiene In all Health care Settings are followed.
• The Ministry Of Health and Long Term Care" Four Moments for Hand Hygiene" have been in-serviced to all health care employees.
• Ongoing monitoring for compliance and performance indicators is performed through auditing and infection surveillance and feedback is given to health care providers.
• Patient/family/visitors are educated on the importance of hand hygiene. Educational brochures are given to all patients on admission and are available for family and visitors explaining our Hand Hygiene Program at HGMH.
• Hand Hygiene Champions have been chosen from all departments to be leaders and positive role models for hand hygiene practices. Our champions provide on the spot feed back on hand hygiene practices to healthcare providers.
• Visual workplace reminders for the importance of hand hygiene and the "Four Moments" have been placed throughout the hospital.

What can patients do to help improve their own safety?

Hand hygiene involves everyone in the hospital, including patients. Hand cleaning is one of the best ways you and your health care team can prevent the spread of many infections. Patients and their visitors should also practice good hand hygiene before and after entering patient rooms.

More patient-specific information is available at www.ontario.ca/patientsafety and www.oha.com/patientsafetytips.