Patient safety is our number one priority at Hamilton Health Sciences. A big part of that commitment is routinely monitoring and improving our performance on indicators of patient safety such as hospital-acquired infections, readmissions to hospital, unexpected deaths, deaths following major surgery, in-hospital sepsis, obstetric trauma (with instrument), low-risk caesarean sections, and hip fracture surgery occurring within 48 hours.
By tracking these indicators, we can identify where issues exist and take the necessary measures to improve. Performance for these indicators is available on the Health Quality Ontario (HQO) and Canadian Institute for Health Information (CIHI) websites.
Antibiotic-Resistant Bloodstream Infections in Hospital Patients
Sometimes when patients are admitted to the hospital, they can get infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a hospital-acquired infection. It is a type of bacteria that is resistant to certain or all types of antibiotics.
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 bacteria 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).
This indicator measures the rate and number of new cases of hospital-acquired bloodstream infections caused by Methicillin-Resistant Staphylococcus aureus (MRSA) or Vancomycin-Resistant Enterococcus (VRE). The rate is expressed as the number of new cases per 1,000 inpatient days (days hospital beds were occupied by patients) during the reporting period. A lower rate and a lower number of cases are better.
Central line bloodstream infections (CLI)
CLI occurs when a central venous catheter (or “line”) placed into a patient’s vein gets infected. This happens when bacteria grow in the line and spread to the patient’s blood stream.
Clostridium difficile infections (CDI)
Clostridium difficile (C. difficile) is a spore-forming bacteria that is present in the environment and can affect up to 3-5% of adults in the community without causing symptoms. C. difficile has been a known cause of healthcare-associated diarrhea for about 30 years. C. difficile can be picked up on the hands from exposure in the environment, and can get into the stomach once the mouth is touched, or if food is handled and then swallowed.
Hand hygiene
The single most common way of transferring health care-associated infections in a health care setting is on the hands of health care providers. Health care providers move from patient to patient and room to room while providing care and working in the patient environment. This movement provides many opportunities for the transmission of organisms on hands that can cause infections. Monitoring hand hygiene practices is vital to improving rates and, in turn, reducing health care-associated infections.
Hospital standardized mortality ratio
This indicator of health care quality measures whether the number of deaths at a hospital is higher or lower than you would expect, based on the average experience of Canadian hospitals. When tracked over time, this measure can indicate whether hospitals have been successful in reducing patient deaths and improving care. This indicator examines the ratio of the actual number of in-hospital deaths in a region or hospital to the number that would have been expected based on the types of patients a region or hospital treats. The HSMR is calculated by dividing the actual number of in-hospital deaths by the expected number of in-hospital deaths, for conditions accounting for about 80% of inpatient mortality. A lower HSMR is better. The measure is adjusted for some of the differences in the types of patients a hospital sees. For example, more deaths would be expected in a hospital that cares for severe trauma patients than in one that focuses on maternity care. The HSMR is most useful to follow a hospital’s performance over time.
Surgical safety checklist (SSCL)
The Surgical Safety Checklist promotes communication and teamwork and furthers the organization’s patient safety efforts. This tool, which is mandatory in all Ontario hospitals, is designed to get Operating Room teams talking about the procedure that they are about to perform. The SSCL has been shown to reduce the rates of death and complications among patients. Hospitals are required to publicly report their compliance rates with these protocols.
Surgical site infections (SSI)
Surgical site infections occur when harmful germs enter a patient’s body through the surgical site (any cut the surgeon makes in the skin to perform the operation). Infections happen because germs are everywhere. One of the ways to prevent surgical site infections is by giving patients an antibiotic.
Ventilator associated pneumonia (VAP)
VAP is defined as pneumonia (a serious lung infection) that can occur in patients (specifically intensive care unit patients) who need assistance breathing with a mechanical ventilator (machine to assist breathing) for at least 48 hours.