Handwashing policies in place in virtually every hospital in Ontario, but monitoring hand hygiene remains a challenge

    New report examines patient safety measures in Ontario hospitals

    OTTAWA, Oct. 30 /CNW Telbec/ - According to a new analysis from the
Canadian Institute for Health Information (CIHI), 99% of the 103 Ontario
hospitals participating in a 2008 patient safety survey reported that they had
a formal hand hygiene policy in place, and just more than one-third of these
(38%) established an auditing process to ensure that proper handwashing
procedures are being followed. Hand hygiene is recognized in Canada and
internationally as a top patient safety priority measure in preventing the
spread of infections, and auditing is a key component in ensuring observance
of hand hygiene policies.
    Community hospitals were the most likely facility type to have a formal
mechanism in place for auditing hand hygiene practices (47%), followed by
teaching hospitals (35%) and small hospitals (19%). Among hospitals without
formal inspection procedures, more than half (59%) reported that one will be
developed in 2008, with full implementation planned for 2009.
    "In recent years, limiting the spread of hospital-acquired infection has
become a major focus of patient safety campaigns across the country," says
Dr. Michael Gardam, Medical Director at the University Health Network in
Toronto. "The results of this survey offer a rare chance to see how these
campaigns are changing the culture of Ontario's hospitals and creating a safer
environment for patients."

    Appointing experts in creating safe surroundings

    Many Ontario hospitals have implemented hospital infection control
programs, appointing professionals with infection prevention and control
training and expertise. These professionals work with an organization to
prevent health care-acquired infections by educating staff, planning and
implementing infection control practices and evaluating existing policies and
procedures. In 2008, 80% of hospitals reported having either a certified
infection control practitioner (ICP) or a physician/doctoral professional
trained in infection control as part of their infection control program.
Successful programs emphasize the importance of having both, and the survey
showed this was the case in 42% of participating hospitals.
    The presence of infection control experts varied by hospital type; all
teaching hospitals reported that their program included a physician or
doctoral professional trained in infection control, compared to 56% of
community hospitals and 26% of small hospitals. A greater proportion of
teaching hospitals reported that they have an ICP certified by the
Certification Board of Infection Control as part of their infection control
program compared to community and small hospitals.

    Infection surveillance programs

    Many studies show that active surveillance of hospital-acquired
infections can help contain their spread. Of hospitals participating in the
survey, 98% reported that they routinely track cases of nosocomial
(hospital-acquired) infections within their hospital. Approximately three out
of four hospitals (74%) reported that they most commonly use hospital-wide
surveillance to routinely monitor the incidence of nosocomial infections,
compared to targeted surveillance of specific areas of the hospital. These
results varied by hospital type: small and community hospitals largely use
hospital-wide surveillance (84% and 78%, respectively), whereas teaching
hospitals use hospital-wide (47%) and targeted surveillance (53%) equally.
    Almost all hospitals indicated that they reported the incidence of
"super-bug" infections, either internally or publicly. At the time the survey
was completed, 96% of hospitals indicated reporting for methicillin-resistant
Staphylococcus aureus (MRSA), 95% for vancomycin-resistant enterococci (VRE)
and 95% for Clostridium difficile (C-difficile). New mandatory reporting
legislation enacted by the Ontario Ministry of Health and Long-Term Care means
that as of September 26, 2008, public reporting of all C-difficile cases is
mandatory in Ontario health care facilities. VRE and MRSA cases will be
reported publicly by December 30, 2008.
    "Nobody wants patients to become more unwell while being treated in
hospital," says Dr. Indra Pulcins, Director of Health Reports and Analysis at
CIHI. "Better information on current infection control practices and policies,
as well as information about the incidence of hospital-acquired infections,
will provide further direction for the development of new procedures into the

    Reusing single use medical devices

    The appropriate use of reusable medical equipment can be critical in
preventing hospital-acquired infections. Medical devices labelled by the
manufacturer as single use are meant to be discarded after one use. In
Ontario, some single use medical devices are allowed to be used more than once
if reprocessing (sterilization) is done by a licensed operator. While the
majority of Ontario acute care hospitals (87%) do not reuse these devices, the
survey found that of the hospitals that permit reuse of the devices following
sterilization, teaching hospitals are the most likely to do so (29%) compared
to community hospitals (12%) and small hospitals (4%).

      Hand hygiene auditing involves:

      - Monitoring and documenting adherence to hand hygiene policies by
      - Providing feedback to personnel regarding performance
      - Monitoring volume of alcohol-based hand rub/detergent used for
        handwashing or hand antisepsis
      - Increased monitoring when infection outbreaks occur

      J. M. Boyce and D. Pittet, "Guideline for Hand Hygiene in Health-Care
      Settings: Recommendations of the Healthcare Infection Control
      Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand
      Hygiene Task Force," Infection Control and Hospital Epidemiology 23,
      12 Suppl (2002): pp. S3-40.

    About CIHI

    The Canadian Institute for Health Information (CIHI) collects and analyzes
information on health and health care in Canada and makes it publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.

    The report, as well as the following figures, is available from CIHI's
    website at www.cihi.ca.

    Figure 1  Percentage of Hospitals With a Fully Implemented Formal
              Mechanism for Auditing Hand Hygiene Practices, Among Hospitals
              With a Hand Hygiene Policy, by Hospital Type (Figure 1 in the

    Figure 2  Percentage of Hospitals Reporting That Their Infection Control
              Program Includes a Certified ICP, a Physician or Doctoral
              Professional Trained in Infection Control, or Both, by Hospital
              Type (Figure 3 in the analysis)

    Figure 3  Percentage of Hospitals Using Hospital-Wide or Targeted
              Surveillance to Routinely Monitor the Incidence of Nosocomial
              Infections, Among Hospitals With a Surveillance Method, by
              Surveillance Type and Hospital Type (Figure 4 in the analysis)

    Figure 4  Percentage of Hospitals That Report Permitting Reuse of Single
              Use Medical Devices With Sterilization, by Hospital Type
              (Figure 7 in the analysis)

For further information:

For further information: Media contacts: Leona Hollingsworth, (613)
241-7860 ext. 4140, Cell: (613) 612-3914, lhollingsworth@cihi.ca; Jennie
Hoekstra, (613) 241-7860 ext. 4331, Cell: (613) 725-4097, jhoekstra@cihi.ca

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