Ontario Reports Four New Patient Safety Indicators



    McGuinty Government An International Leader in Public Reporting

    TORONTO, April 30 /CNW/ -

    NEWS

    Ontario is leading the way in North America with today's launch of
province-wide public reporting of hand-hygiene compliance rates - one part of
a comprehensive plan to create an unprecedented level of transparency in
Ontario's hospitals.
    The province has begun public reporting of hand hygiene compliance among
health care providers in hospitals in addition to rates of central line
infections (CLIs), ventilator-associated pneumonia (VAP) and surgical site
infection (SSI) prevention.
    In total, Ontario is now publicly reporting eight patient safety
indicators which can be found by visiting www.ontario.ca/patientsafety
(http://www.health.gov.on.ca/patient_safety/).

    
    The initial results show that:

    -  62.16 per cent of health care providers perform hand hygiene before
       initial patient or patient environment contact and after patient or
       patient environment contact
    -  The number of central line infection (CLI) cases that developed in the
       ICUs of Ontario's hospitals was 106. The CLI rate was 1.56 per 1000
       central line days.
    -  The number of ventilator-associated pneumonia (VAP) cases that
       developed in the ICUs of Ontario's hospitals was 176. The VAP rate was
       3.51 per 1000 ventilator days
    -  85.19 per cent of primary hip/knee joint replacement surgical patients
       received antibiotics within the appropriate time period before the
       surgery.
    

    In 2007, the government pilot tested the hand hygiene compliance
reporting program in 10 hospitals. Once hospitals started tracking and
reporting compliance rates, hand hygiene increased steadily at each of the
test sites.

    QUOTES

    "Our government knows that 'if you can track it, you can improve it,'
which is why these new patient safety indicators are so important. This public
reporting enables hospitals to monitor these rates so that the highest
standards of practice and most effective infection prevention and control
measures can be put in place."
    - David Caplan, Minister of Health and Long-Term Care

    "The initial compliance numbers clearly show that hand hygiene in our
hospitals needs to be improved - in some cases dramatically. I know hospitals
and health care providers across the province are ready and willing to make
improvements and provide patients with the high level of care they expect and
deserve."
    - Dr. Michael Baker, Executive Lead, Patient Safety, Ministry of Health 
and Long-Term Care

    
    QUICK FACTS

    -  Proper hand hygiene is the single most effective way of reducing
       health care associated infections.
    -  One year ago, Ontario launched Just Clean Your Hands - an
       evidence-based, multi-faceted program that provides a model for proper
       hand hygiene practice in hospitals.
    

    LEARN MORE

    Learn more about Ontario's Patient Safety Initiative and hospital
reporting (http://www.health.gov.on.ca/patient_safety/).
    Learn more about Ontario's hand hygiene initiative Just Clean Your Hands
(http://www.justcleanyourhands.ca/.)
    Read the announcement (http://www.justcleanyourhands.ca/) on the full
public reporting of eight patient safety indicators.

    
    Backgrounders:

    -  Reporting of CLI, VAP and SSI-Prevention Rates in Hospitals
    -  Reporting of Hand Hygiene Rates in Hospitals
    -  Jurisdictional Comparison of Patient Safety Indicators

    Fact Sheets
    -  Building capacity to increase patient safety

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                                                      ontario.ca/health-news
                                                      Disponible en français


    BACKGROUNDER
    -------------------------------------------------------------------------

                  REPORTING HAND HYGIENE RATES IN HOSPITALS
    

    Beginning today, Ontario is publishing hand hygiene compliance rates of
all hospitals on the Ministry of Health and Long-Term Care's public website.
Proper hand hygiene is the single most effective way of reducing health care
associated infections.
    Improving hand hygiene compliance requires a culture change, which takes
time. International research and experience in Ontario hospitals has
demonstrated that it takes more than a single intervention to change hand
hygiene behaviour - public reporting is one of many interventions being
implemented in Ontario hospitals.
    One year ago, Ontario launched Just Clean Your Hands
(http://www.justcleanyourhands.ca/) - an evidence-based, multi-faceted program
that provides a model for proper hand hygiene practice in hospitals. The
program - which has been recognized by the World Health Organization
(http://www.who.int/gpsc/national_campaigns/campaign_examples/en/) - involves
staff training and education, point-of-care intervention through the
availability of hand sanitizers, behaviour monitoring and evaluation.

    About this reporting tool

    As part of its ongoing patient safety initiative, Ontario is requiring
all hospitals to monitor and report hand hygiene compliance rates in their
facilities so the most appropriate infection prevention and control measures
can be put in place. Hospitals will use this information to ensure they're
maintaining the highest possible standards of patient safety.

    
    About this data

    There are four indications (moments) of hand hygiene:
    -  Before initial patient or patient environment contact
    -  Before aseptic procedure(*)
    -  After body fluid exposure risk
    -  After patient or patient environment contact
    

    The ministry is reporting the combined compliance rate of two
indications: before initial patient or patient environment contact and after
patient or patient environment contact.

    (*)An aseptic procedure could include: a) touching/manipulating a body site
that should be protected against infections (e.g., wound care including
dressing change and wound assessment); b) manipulating an invasive device that
could result in infection of a body area (e.g. priming intravenous infusion
set, inserting spike into opening of IV bag, flushing line, adjusting
intravenous site, administering medication through IV port, changing IV
tubing)

    How this data is collected

    Hand hygiene is audited through direct observations using a standard
provincial audit tool. A trained observer conducts observations openly,
without interfering with the ongoing work, and keeps the identity of the
health care providers confidential. Each observation session is 20 minutes
allowing the observer to capture multiple indications for hand hygiene.
    The number of observation sessions required will depend on the number of
in patient beds. For example, to ensure statistically valid data, a hospital
with 100 beds will observe at least 200 opportunities. The minimum number of
observed opportunities is 50 for any hospital with 25 beds or less.
    The hospital is able to audit their staff at any time during the calendar
year. However, it must report the minimum number of observed opportunities
required for their hospital site based on the number of in patient beds.
Observed opportunities are captured with observation sessions that vary across
time (i.e. day of the week and time of day) and place (i.e. ward/unit) within
the hospital.
    Hand hygiene results of the audits are posted annually.

    How to interpret the data

    The data presented on the ministry website is best used to measure
individual hospital performance over time. It can also be used to ask informed
questions to hospital representatives about their infection prevention and
control program. It is not intended to be the only source of information for
making decisions about hospital care nor should it be used to make
generalizations about the overall quality of care provided by hospitals.
    Trends in rates will be posted on the Ministry of Health and Long-Term
Care's website when enough data is available.

    How is the data presented?

    Data is presented in tables by hospital site. The data presented on the
ministry's website has been confirmed by the hospitals and is also being
reported on the hospitals' websites.
    Hospitals are grouped by hospital type to facilitate more relevant
comparisons. The hospital types are:

    
    -  Large Community
    -  Small Community
    -  Mental Health
    -  Acute Teaching
    -  Complex Continuing Care & Rehabilitation

    The provincial rate is determined by aggregating the data for all
hospitals in Ontario.

    2008 - 2009 data

    For the period covering 2008-2009:
    -  62.16 per cent of health care providers performed hand hygiene before
       initial patient or patient environment contact and after patient or
       patient environment contact.

    For public inquiries call ServiceOntario, INFOline at 1-866-532-3161
    (Toll-free in Ontario only)
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                                                      ontario.ca/health-news
                                                      Disponible en français


    BACKGROUNDER
    -------------------------------------------------------------------------

         REPORTING OF CLI, VAP AND SSI-PREVENTION RATES IN HOSPITALS
    

    As part of its ongoing patient safety initiative, Ontario is now
requiring all hospitals to monitor and publicly report central line infections
(CLI), ventilator-associated pneumonia (VAP) and surgical site infection (SSI)
prevention rates in their facilities so the most appropriate infection
prevention and control measures can be put in place. The rates will be
published on the Ministry of Health and Long-Term Care's public website.
    Public reporting of these additional indicators represents a significant
tool for hospitals to use to monitor their performance and determine what
measures they need to take to strengthen infection prevention and control in
their facilities. Hospitals will use this information to ensure they're
maintaining the highest possible standards of patient safety.

    Central Line Associated Bloodstream Infections (CLI)

    CLI occur when a central venous catheter (or "line") placed into a
patient's vein gets infected. This happens when bacteria grow in the line and
spreads to the patient's bloodstream. Patients require a central line when
blood, fluid replacement and/or nutrition need to be given to them
intravenously. Central lines also allow health care providers to monitor fluid
status and make determinations about the heart and blood.
    The CLI rate is determined by adding up the total number of newly
diagnosed CLI cases in the ICU after at least 48 hours of central line
placement. This number is divided by the number of central line days in the
reporting period and multiplied by 1,000. Central line days are the total
number of days a central line was used in ICU patients 18 years and older.
    This measure will be reported quarterly.

    Ventilator-Associated Pneumonia (VAP)

    VAP is defined as pneumonia (a serious lung infection) that can occur in
patients (specifically ICU patients) who need assistance breathing with a
mechanical ventilator for at least 48 hours.
    The VAP rate is determined by the total number of newly diagnosed VAP
cases in the ICU after at least 48 hours of mechanical ventilation. This
number is divided by the number of ventilator days in the reporting period and
multiplied by 1,000. Ventilator days are the number of days spent on a
ventilator for all patients in the ICU 18 years and older.
    This measure will be reported quarterly.

    Surgical Site Infection (SSI) Prevention

    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 - on the skin,
in the air and on things individuals touch. Most infections are caused by
germs found on and in a patient's body.
    The SSI-prevention rate is determined by the number of hip/knee joint
replacement surgery patients who received antibiotics within 60 or 120 minutes
of skin incision (depending on the antibiotic) divided by the total number of
patients during the reporting period who had a primary knee/ hip total joint
replacement surgical procedure, multiplied by 100.
    This measure will be reported quarterly; however, for the first reporting
period, SSI-prevention rates will comprise of March 2009 data.

    How to interpret the data

    When interpreting the data it's important to understand that many
differences exist from hospital to hospital which could affect their case
counts and rates. These include:

    
    -  Size of the hospital
    -  Complexity of the services offered
    -  Type of patient population served
    

    Trends in rates will be posted on the Ministry of Health and Long-Term
Care's website when enough data is available. Fluctuations in rates across
reporting periods are better interpreted when rates from different periods are
taken into account.
    The data presented on the ministry website is best used to measure
individual hospital performance over time. It can also be used to ask informed
questions to hospital representatives about their infection prevention and
control program. It's not intended to be the only source of information for
making decisions about hospital care nor is it information for generalizing
about the overall quality of care provided by hospitals.

    How is the data presented?

    Data is presented in tables by hospital site. Included in the tables is
data on the number of new hospital-acquired cases as well as the rate by
quarter. The data presented on the ministry's website has been confirmed by
the hospitals and is also being reported on the hospitals' websites.
    Hospitals are grouped by type to facilitate more relevant comparisons.
The hospital types are:

    
    -  Large Community
    -  Small Community
    -  Mental Health
    -  Acute Teaching
    -  Complex Continuing Care & Rehabilitation
    

    These hospital types take into consideration differences in hospital size
and patient case mix, factors which can make a significant difference in
average rates.
    The provincial rate is determined by aggregating the data for all
hospitals in Ontario.

    
    January to March, 2009 data

    For the period covering January, February and March 2009, there were:
    -  106 cases of central line infections found among the hospital sites in
       Ontario with ICUs. The provincial rate was 1.56 per 1,000 central line
       days.
    -  176 cases of ventilator associated pneumonia found among the hospital
       sites in Ontario with ICUs. The provincial rate was 3.51 per 1,000
       ventilator days.

    For the period covering March 2009:
    -  85.19 per cent of hip/knee joint replacement surgery cases were given
       antibiotics within the appropriate length of time before a skin
       incision was made.

    For public inquiries call ServiceOntario, INFOline at 1-866-532-3161
    (Toll-free in Ontario only)
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                                                      ontario.ca/health-news
                                                      Disponible en français


    BACKGROUNDER
    -------------------------------------------------------------------------

           JURISDICTIONAL COMPARISON OF PATIENT SAFETY INDICATORS
    

    The United States reports information on central line infections (CLI),
ventilator-associated pneumonia (VAP) and surgical site infection (SSI)
prevention. Ontario is the only jurisdiction in North America to publicly
report hand hygiene compliance for hospital staff.
    Comparisons of this information are difficult because of differences in
case reporting, surveillance coverage and reporting timeframe.

    
    -------------------------------------------------------------------------
    Jurisdiction    Indicator             Indicator results
    -------------------------------------------------------------------------
    Ontario         CLI        106 cases
                               1.56 per 1000 central venous line days (CLD)
                  -----------------------------------------------------------
                    VAP        176 cases
                               3.51 per 1000 mechanically invasive
                               ventilation days
                  -----------------------------------------------------------
                    SSI        85.19% - Knee/Hip surgery
                  -----------------------------------------------------------
                    Hand       62.16% - combined rate including before
                    Hygiene    initial patient/patient environment contact
                               and after patient/patient environment contact
    -------------------------------------------------------------------------
    United          CLI        Medical/Surgical ICU - 2.2 per 1000 CLD
    States                     Coronary ICU - 2.8 per 1000 CLD
                  -----------------------------------------------------------
                    VAP        Between 81-384 cases depending on type of
                               hospital site; rate ranges from 2.5 to 12.3
                               1000 mechanically invasive ventilation days
                  -----------------------------------------------------------
                    SSI        84.8%
                  -----------------------------------------------------------
                    Hand
                    Hygiene    No comparison
    -------------------------------------------------------------------------

    For public inquiries call ServiceOntario, INFOline at 1-866-532-3161
    (Toll-free in Ontario only)

    Media Contacts:  Steve Erwin, Minister's Office, 416-326-3986
    Mark Nesbitt, Ministry of Health and Long-Term Care, 416-314-6197
    -------------------------------------------------------------------------
                                                      ontario.ca/health-news
                                                      Disponible en français

    FACT SHEET


           INCREASING PATIENT SAFETY: ONTARIO'S ONGOING INITIATIVES
    -------------------------------------------------------------------------
    

    The Ontario government has taken a number of steps to strengthen
infection prevention and control in health care institutions. These
initiatives include:

    
    Publicly Reporting Eight Patient Safety Indicators

    The Ontario government has introduced full public reporting on eight
patient safety indicators.

    -------------------------------------------------------------------------
    Patient Safety Indicator                                   Start Date of
                                                            Public Reporting
    -------------------------------------------------------------------------
    Clostridium difficile (C. difficile) associated disease   Sept. 26, 2008
    infection rates
    -------------------------------------------------------------------------
    Methicillin-resistant Staphylococcus aureus (MRSA)         Dec. 30, 2008
    bacteraemia infection rates
    -------------------------------------------------------------------------
    Vancomycin-resistant Enterococci (VRE) bacteraemia         Dec. 30, 2008
    infection rates
    -------------------------------------------------------------------------
    Hospital Standardized Mortality Ratio (HSMR)               Dec. 30, 2008
    - mortality rates
    -------------------------------------------------------------------------
    Rates of ventilator-associated pneumonia                  April 30, 2009
    -------------------------------------------------------------------------
    Rates of central line infections                          April 30, 2009
    -------------------------------------------------------------------------
    Surgical site infection prevention                        April 30, 2009
    -------------------------------------------------------------------------
    Hand hygiene compliance among health care providers       April 30, 2009
    -------------------------------------------------------------------------
    

    Appointing an Executive Lead - Patient Safety

    Dr. Michael Baker has been appointed Executive Lead - Patient Safety to
oversee the government's patient safety agenda.

    Requiring Hospitals to Report Outbreaks

    Hospitals are now required to immediately report Clostridium
difficile-associated disease (CDAD) outbreaks to their local public health
units. This gives Medical Officers of Health the information they need to
monitor and respond to emergent outbreaks.

    Launching Hand Hygiene Programs

    A multi-faceted hand hygiene program for all Ontario hospitals - called
(Just Clean Your Hands http://www.justcleanyourhands.ca/) - was launched in
March 2008. The government developed tools and materials, an audit process to
measure hand hygiene compliance and evaluate the program's impact and a
website for easy access to information and a place for hospitals to share
lessons learned. The government, in partnership with the Ontario Hospital
Association, has also provided hospitals with train-the-trainer sessions.
Hospitals will be required to publicly report on hand hygiene compliance by
April 30, 2009.
    Proper hand hygiene, through the use of alcohol-based hand rub or soap
and water, is the single most effective way of reducing the spread of
infections.
    The government pilot tested the program in 10 hospitals in 2007 with hand
hygiene compliance increasing steadily in each of the test sites.
    The government has sponsored an Ontario Hospital Association Clean Hands
Protect Lives (http://webx.newswire.ca/click/?id=dea60b14747f7e6) program
which is specifically designed to educate health care patients about the
importance of effective hand hygiene.
    Through Clean Hands Protect Lives, Ontario hospitals have received
posters and useful educational printed materials for distribution to patients
such as pamphlets and "How to Clean" pocket cards.

    Implementing Regional Infection Control Networks

    Fourteen Regional Infection Control Networks (RICNs) have been created
across the province to promote the best approaches to infection prevention and
control. This includes promoting consistent infection prevention and control
policies and surveillance practices.
    Development of the networks has brought together infection prevention and
control expertise from all health care settings, including hospitals, public
health, community care and long-term care homes.

    Funding Infection Prevention and Control Practitioners

    The government has provided funding for 166 infection prevention and
control practitioners (ICPs) in hospitals across the province. An ICP is
typically a health care professional who has specialized training and
expertise in infection prevention and control. The ICP works with all
departments in the organization to prevent health care-acquired infections
through: planning, implementing, evaluating and providing feedback on current
practices. They also educate health care staff on infection prevention and
control, conduct surveillance and provide expert consultation as needed.

    Educating Front-Line Health Care Providers

    In partnership with infection prevention and control experts and other
stakeholders, an extensive education program for infection prevention and
control professionals in acute care facilities has been developed by the
government. The program provides current, evidence-based educational modules
for acute care front-line health care professionals. The first three modules
have been released for health care staff in acute care settings, including
hand hygiene, chain of infection, and Routine Practices.

    Creating Infection Control Resource Teams

    Ontario has created Infection Control Resource Teams (ICRTs) to provide
rapid, on-site assistance with outbreak investigation and management in
hospitals. The teams, established through the Ontario Agency for Health
Protection and Promotion (http://www.oahpp.ca/) (OAHPP), are assembled and
deployed to provide expert advice and to support facilities and local public
health units in outbreak situations when the Chief Medical Officer of Health
determines that a need exists.

    Improving Effective Use of Antibiotics

    The OAHPP is working with the Institute for Safe Medication Practices
Canada (ISMP Canada) and infectious disease experts to support hospitals in
the most effective use of antibiotics. Careful attention to the most effective
use of antibiotics is important, because they are of great benefit in treating
infections, but they also increase the risk of infection due to C. difficile
and other antibiotic resistant organisms.
    The Ontario Ministry of Health and Long-Term Care has funded ISMP Canada
to improve medication safety in hospitals through the Medication Safety
Support Service (MSSS) since 2002. The Service assists Ontario hospitals,
long-term care homes, and community pharmacies to implement strategies and
safeguards for the prevention of patient injury from medication use. The
ministry is working with ISMP on multiple fronts including operating room
medication safety.

    
    For public inquiries call ServiceOntario, INFOline at 1-866-532-3161
    (Toll-free in Ontario only)
    -------------------------------------------------------------------------
                                                      ontario.ca/health-news
                                                      Disponible en français
    




For further information:

For further information: Steve Erwin, Minister's Office, (416) 326-3986;
Andrew Morrison, Ministry of Health and Long-Term Care, (416) 314-6197

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