Improving Patient Safety In Hospitals

    McGuinty Government Invests In Infection Control Measures

    TORONTO, Sept. 26 /CNW/ -


    Ontario is boosting patient safety measures by creating infection control
resource teams, funding 66 more infection prevention and control practitioners
in hospitals and local health units, and supporting more effective antibiotic
    The announcement comes as C. difficile rates are being publicly reported
for the first time ever in Ontario. Rates must be posted on the websites of
all Ontario hospitals and the Ministry of Health and Long-Term Care's public
website, creating an unprecedented level of transparency.
    Public reporting will enable hospitals to monitor C. difficile rates in
their facilities so that the most appropriate infection control measures and
highest possible standards of patient safety can be put in place.
    Numbers for August 2008 show that there were 319 cases of C. difficile
associated disease found among the 228 hospital sites in Ontario. The
provincial C. difficile rate was 0.39 per 1,000 patient days.
    This is the first time hospitals have been required to publicly report,
and it will take time to establish trends. C. difficile rates may vary
    The Ontario Agency for Health Protection and Promotion is also working
with the Institute for Safe Medication Practices Canada and infectious disease
expert Dr. Allison McGeer to support hospitals in the most effective use of
antibiotics. This work is important because prolonged exposure to certain
classes of antibiotics presents a real risk for C. difficile associated
disease to emerge.


    "We're improving patient safety as part of our commitment to ensure the
highest standards of care for hospital patients in Ontario," said Health and
Long-Term Care Minister David Caplan. "We're taking the steps needed to more
effectively control infectious diseases in hospitals."

    "The infection control initiatives announced today will help us to be
prepared as new information becomes available on infection rates through the
full reporting of C. difficile and the other patient safety indicators," said
Dr. Michael Baker, executive lead, Patient Safety, Ministry of Health and
Long-Term Care.

    "We are pleased to establish infection control resource teams that will
work with the ministry, local public health units and hospitals to provide
on-the-ground expertise that will help front-line health care workers deal
effectively with infectious diseases," said Dr. Vivek Goel, president and CEO
of the Ontario Agency for Health Protection and Promotion.

    "Ontario's hospitals strongly support collecting and publicly reporting
patient safety data that will contribute to the continuous improvement of
health care in hospitals," said Ontario Hospital Association Board Chair Mark
Rochon. "This data, reported on a consistent, province-wide basis, will be an
important element in our efforts to improve patient safety."

    "The Quality Healthcare Network welcomes the creation of infection
control resource teams and the addition of more infection prevention and
control practitioners on the ground. We believe these investments bring
critically-needed resources to the front lines. It demonstrates the
government's commitment to improving patient safety in our hospitals," said
Cynthia Majewski, executive director of the Quality Healthcare Network and
Ontario lead for Safer Healthcare Now.


    -   In addition to today's announcement, Ontario has previously funded
        136 infection prevention and control practitioners (ICPs) in
        hospitals and another 180 infection control staff in public health
    -   Altogether, Ontario has now provided funding for 166 hospital ICPs -
        one ICP for every 100 hospital beds. This represents the best ICP to
        hospital bed ratio in North America.
    -   ICPs are health care professionals with specialized training and
        expertise in infection prevention and control;
    -   Infection control resource teams (ICRTs) will provide rapid, on-site
        assistance during an infectious disease outbreak when the Chief
        Medical Officer of Health determines that a need exists;
    -   ICRTs will be assembled, managed and deployed by the Ontario Agency
        for Health Protection and Promotion;
    -   Good hand hygiene is the single most effective way to prevent the
        spread of infectious diseases like C. difficile.


    Learn more about Ontario's Patient Safety Initiative and hospital
reporting (

    Learn more about Ontario's hand hygiene initiative Just Clean Your Hands

    Read more about infection control resource teams, infection prevention
and control practitioners, hospital design and infection control, reporting C.
difficile in hospitals and C. difficile reporting in other jurisdictions

    Read the announcement
( the full public
reporting of eight patient safety indicators.

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

                                                      Disponible en français


                       INFECTION CONTROL RE

SOURCE TEAMS Ontario is creating 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, would be assembled and deployed to support facilities and local public health units in outbreak situations when the Chief Medical Officer of Health determines that a need exists. Expertise Based on the specific needs of the facilities, the teams may consist of health care professionals with the following expertise: - Experienced physician who specializes in infection control/microbiology; - Experienced senior infection prevention and control practitioner; - Epidemiologist familiar with health care associated infections; - Experienced environmental services/housekeeping lead; - Public health expert experienced in outbreak management. Role The ICRT will act as an expert consulting group to the hospital, and as a support to any investigation that may be underway. It will operate as part of the hospital's outbreak management team. The team will also work with the local public health unit, the regional infection control network and the hospital to improve local infection control capacity. At the end of the outbreak, the ICRT will debrief the hospital's outbreak management team and prepare a report about the outbreak. A final report, with recommendations, will be made available to the Ministry of Health and Long-Term Care, the Ontario Agency for Health Protection and Promotion, the Local Integration Health Network (LHIN), local public health unit and the hospital. Existing Local Capacity The teams will build on three existing levels of infection control capacity. This includes: Hospitals --------- - Infection prevention and control practitioners; - Laboratory resources; - Infectious disease physician/medical microbiologist. Public health units ------------------- - Medical officer of health/associate medical officer of health; - Communicable disease staff - including public health inspectors and public health nurses; - Epidemiologists. Regional Infection Control Networks ----------------------------------- - There are 14 networks set up across the province promoting consistent surveillance practices, and infection prevention and control policies; - Each network has a coordinator, network consultant and part-time medical coordinator. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only) ------------------------------------------------------------------------- Disponible en français BACKGROUNDER ------------------------------------------------------------------------- INFECTION PREVENTION AND CONTROL PRACTITIONERS An infection prevention and control practitioner (ICP) is a health care professional with specialized training and expertise in infection prevention and control. The ICP works with all hospital departments to prevent health care-associated infections. They also educate health care staff on infection prevention and control, conduct surveillance and provide expert consultation as needed. Following today's announcement, the government has now provided funding for 166 hospital ICPs across the province since 2004/05, which is a total investment of over $13 million. Ontario has provided funding for one ICP for every 100 hospital beds. This is the best ratio in North America. Listed below is a chart showing the hospital ICP positions funded since 2004/05: ------------------------------------------------------------------------- HOSPITAL NAME Funding 04/08 Funding 08/09 ------------------------------------------------------------------------- Hôpital Alexandra (Ingersoll) 0,5 ------------------------------------------------------------------------- Alexandra Hospital (Ingersoll) 0.5 ------------------------------------------------------------------------- Almonte General Hospital (Almonte) 0.5 ------------------------------------------------------------------------- Arnprior and District Memorial Hospital Corporation (Arnprior) 0.5 ------------------------------------------------------------------------- Atikokan General Hospital (Atikokan) 0.5 ------------------------------------------------------------------------- Baycrest Centre for Geriatric Care (Toronto) 1 0.5 ------------------------------------------------------------------------- Bloorview MacMillan Children's Centre (Toronto) 0.5 ------------------------------------------------------------------------- Bluewater Health (Sarnia) 2 0.5 ------------------------------------------------------------------------- Brant Community Health Care System (Brantford) 2 0.5 ------------------------------------------------------------------------- Bridgepoint Hospital (Toronto) 2.5 0.5 ------------------------------------------------------------------------- Brockville General Hospital 0.5 ------------------------------------------------------------------------- Cambridge Memorial Hospital (Cambridge) 1 ------------------------------------------------------------------------- Campbellford Memorial Hospital (Cambellford) 0.5 ------------------------------------------------------------------------- Centre for Addiction and Mental Health (Toronto) 3 0.5 ------------------------------------------------------------------------- Chatham Kent Health Alliance 2 ------------------------------------------------------------------------- Collingwood General and Marine Hospital (Collingwood) 0.5 ------------------------------------------------------------------------- Cornwall Community Hospital (Cornwall) 1 ------------------------------------------------------------------------- The Credit Valley Hospital (Mississauga) 2 0.5 ------------------------------------------------------------------------- Deep River and District Hospital (Deep River) 0.5 ------------------------------------------------------------------------- Dryden Regional Health Centre (Dryden) 0.5 ------------------------------------------------------------------------- Espanola General Hospital (Espanola) 0.5 ------------------------------------------------------------------------- Glengarry Memorial Hospital (Alexandria) 0.5 ------------------------------------------------------------------------- Grand River Hospital Corporation (Kitchener) 2.5 0.5 ------------------------------------------------------------------------- Grey Bruce Health Services (Owen Sound) 1 ------------------------------------------------------------------------- Groves Memorial Community Hospital (Fergus) 0.5 ------------------------------------------------------------------------- Guelph General Hospital (Guelph) 0.5 ------------------------------------------------------------------------- Headwaters Health Care Centre (Orangeville) 0.5 ------------------------------------------------------------------------- Haliburton Highlands Health Services Corporation (Haliburton) 0.5 ------------------------------------------------------------------------- Halton Healthcare Services Corporation (Oakville) 1.5 1 ------------------------------------------------------------------------- Hamilton Health Sciences Corporation (Hamilton) 2 1 ------------------------------------------------------------------------- Hanover and District Hospital (Hanover) 0.5 ------------------------------------------------------------------------- Homewood Health Centre (Guelph) 2 ------------------------------------------------------------------------- Hôpital General de Hawkesbury & District General Hospital Inc. (Hawkesbury) 0.5 ------------------------------------------------------------------------- Hôpital Montfort Hospital (Ottawa) 1 ------------------------------------------------------------------------- Hôpital Notre-Dame Hospital (Hearst) 0.5 ------------------------------------------------------------------------- Hôpital Regional de Sudbury Regional Hospital (Sudbury) 2 1 ------------------------------------------------------------------------- Hotel-Dieu Grace Hospital (Windsor) 2 ------------------------------------------------------------------------- Hotel Dieu Shaver Health & Rehabilitation Centre (St Catharines) 1 ------------------------------------------------------------------------- Humber River Regional Hospital (Toronto) 1 1 ------------------------------------------------------------------------- Muskoka - East Parry Sound (Huntsville / Bracebridge) 1 0.5 ------------------------------------------------------------------------- Huron Perth Hospital Alliance (Seaforth, Stratford, Clinton and St. Mary's) 1 0.5 ------------------------------------------------------------------------- Joseph Brant Memorial Hospital (Burlington) 2 ------------------------------------------------------------------------- Kingston General Hospital (Kingston) 1 ------------------------------------------------------------------------- Lady Dunn Health Centre (Wawa) 0.5 ------------------------------------------------------------------------- Lake of the Woods District Hospital (Kenora) 0.5 ------------------------------------------------------------------------- Lakeridge Health Corporation (Oshawa) 1 1 ------------------------------------------------------------------------- Leamington District Memorial Hospital (Leamington) 0.5 ------------------------------------------------------------------------- Listowel & Wingham Hospital Alliance (Listowel and Wingham) 0.5 ------------------------------------------------------------------------- London Health Sciences Centre (London ) 2 1 ------------------------------------------------------------------------- Manitoulin Health Centre (Little Current) 0.5 ------------------------------------------------------------------------- Markham Stouffville Hospital (Markham) 2 ------------------------------------------------------------------------- Mattawa General Hospital Inc. (Mattawa) 0.5 ------------------------------------------------------------------------- The McCausland Hospital (Terrace Bay) 0.5 ------------------------------------------------------------------------- MICS Group of Hospitals (Matheson, Iroquois Falls, Cochrane) 0.5 ------------------------------------------------------------------------- Strathroy Middlesex General Hospital (Strathroy - part of Middlesex Hospital Alliance) 0.5 ------------------------------------------------------------------------- Mount Sinai Hospital (Toronto) 1 ------------------------------------------------------------------------- Niagara Health System (Niagara Region) 4 1 ------------------------------------------------------------------------- Nipigon District Memorial Hospital (Nipigon) 0.5 ------------------------------------------------------------------------- Norfolk General Hospital (Simcoe) 1 ------------------------------------------------------------------------- North Bay General Hospital (North Bay) 1 1 ------------------------------------------------------------------------- North Simcoe Hospital Alliance (Huronia / Penetanguishene) 1 ------------------------------------------------------------------------- North Wellington Health Care Corporation (Mount Forest) 0.5 ------------------------------------------------------------------------- Northeast Mental Health Centre (Sudbury) 2 ------------------------------------------------------------------------- Northumberland Hills Hospital (Cobourg) 0.5 0.5 ------------------------------------------------------------------------- The Ottawa Hospital (Ottawa) 1 ------------------------------------------------------------------------- Orillia Soldiers' Memorial Hospital (Orillia) 2 ------------------------------------------------------------------------- Pembroke General Hospital Inc. (Pembroke) 1 0.5 ------------------------------------------------------------------------- Penetanguishene Mental Health (Penetanguishene) 1 0.5 ------------------------------------------------------------------------- Perth and Smiths Falls District Hospital (Smiths Falls) 0.5 ------------------------------------------------------------------------- Peterborough Regional Health Centre (Peterborough) 1 ------------------------------------------------------------------------- Providence Healthcare (Toronto) 1.5 ------------------------------------------------------------------------- Providence Continuing Care Centre (Kingston) 2 0.5 ------------------------------------------------------------------------- Queensway Carleton Hospital (Ottawa) 1 0.5 ------------------------------------------------------------------------- Quinte Healthcare Corporation (Belleville) 1.5 0.5 ------------------------------------------------------------------------- Red Lake Margaret Cochenour Memorial Hospital (Red Lake) 0.5 ------------------------------------------------------------------------- Renfrew Victoria Hospital (Renfrew) 0.5 ------------------------------------------------------------------------- Ross Memorial Hospital (Lindsay) 0.5 ------------------------------------------------------------------------- Rouge Valley Health System (Toronto) 1.5 0.5 ------------------------------------------------------------------------- Royal Ottawa Health Care Group (Ottawa) 2.5 ------------------------------------------------------------------------- The Royal Victoria Hospital of Barrie (Barrie) 1 ------------------------------------------------------------------------- Runnymede Healthcare Centre (Toronto) 1 ------------------------------------------------------------------------- The Salvation Army Toronto Grace Hospital (Toronto) 1 ------------------------------------------------------------------------- Sault Area Hospital (Sault Ste Marie) 2.5 1 ------------------------------------------------------------------------- The Scarborough Hospital (Toronto) 1 ------------------------------------------------------------------------- Sensenbrenner Hospital (Kapuskasing) 0.5 0.5 ------------------------------------------------------------------------- SCO Health Service (Ottawa ) 2.5 0.5 ------------------------------------------------------------------------- Services de Sante de Chapleau Health Services (Chapleau) 0.5 ------------------------------------------------------------------------- Sioux Lookout Meno-Ya-Win Health Centre (Sioux Lookout) 0.5 ------------------------------------------------------------------------- South Bruce Grey Health Centre (Kincardine) 0.5 ------------------------------------------------------------------------- Southlake Regional Health Centre (Newmarket) 1 ------------------------------------------------------------------------- St. John's Rehabilitation Hospital (Toronto) 1 ------------------------------------------------------------------------- St. Joseph's Care Group (Thunder Bay) 2 ------------------------------------------------------------------------- St. Joseph's General Hospital (Elliot Lake) 0.5 ------------------------------------------------------------------------- St. Joseph's Health Care (London) 4 0.5 ------------------------------------------------------------------------- St. Joseph's Health Centre (Toronto) 1 ------------------------------------------------------------------------- St. Joseph's Heathcare (Hamilton) 2.5 1 ------------------------------------------------------------------------- St. Joseph's Health Centre (Guelph) 0.5 ------------------------------------------------------------------------- St. Mary's General Hospital (Kitchener) 1 ------------------------------------------------------------------------- St. Peter's Hospital (Hamilton) 1.5 0.5 ------------------------------------------------------------------------- St. Thomas-Elgin General Hospital (St Thomas) 0.5 ------------------------------------------------------------------------- Stevenson Memorial Hospital (Alliston) 0.5 ------------------------------------------------------------------------- Sunnybrook Health Sciences Centre (Toronto) 1 1 ------------------------------------------------------------------------- Temiskaming Hospital (New Liskeard) 1 ------------------------------------------------------------------------- Thunder Bay Regional Hospital (Thunder Bay) 2 1 ------------------------------------------------------------------------- Tillsonburg District Memorial Hospital (Tillsonburg) 0.5 ------------------------------------------------------------------------- Timmins and District Hospital (Timmins) 0.5 ------------------------------------------------------------------------- Toronto East General & Orthopaedic Hospital Inc. (Toronto) 2 0.5 ------------------------------------------------------------------------- Toronto Rehabilitation Institute (Toronto) 3 0.5 ------------------------------------------------------------------------- Trillium Health Centre (Mississauga) 3 1 ------------------------------------------------------------------------- University Health Network (Toronto) 1 ------------------------------------------------------------------------- West Haldimand General Hospital (Hagersville) 0.5 ------------------------------------------------------------------------- West Lincoln Memorial Hospital (Grimsby) 0.5 ------------------------------------------------------------------------- The West Nipissing General Hospital (Sturgeon Falls) 0.5 ------------------------------------------------------------------------- West Park Healthcare Centre (Toronto) 1 0.5 ------------------------------------------------------------------------- Whitby Mental Health (Whitby) 2 0.5 ------------------------------------------------------------------------- William Osler Health Centre (Brampton) 1.5 1 ------------------------------------------------------------------------- Wilson Memorial General Hospital (Marathon) 0.5 ------------------------------------------------------------------------- Winchester District Memorial Hospital (Winchester) 0.5 ------------------------------------------------------------------------- Windsor Regional Hospital (Windsor) 2.5 1 ------------------------------------------------------------------------- Women's College Health Centre (Toronto) 1 ------------------------------------------------------------------------- York Central Hospital (Richmond Hill) 1 0.5 ------------------------------------------------------------------------- ------------------------------------------------------------------------- Total Allocation for 2004/2008 136 ------------------------------------------------------------------------- Total Allocation for 2008/2009 30 ------------------------------------------------------------------------- Total ICP Allocation between 2004/2005 - 2008/2009 166 ------------------------------------------------------------------------- ------------------------------------------------------------------------- Disponible en français BACKGROUNDER ------------------------------------------------------------------------- HOSPITAL DESIGN AND INFECTION CONTROL Ontario has developed leading edge guidelines for the construction of new hospitals to support the delivery of high quality health care services, and to improve their ability to prevent the spread of infectious diseases. These guidelines have been developed with input from national and international experts. The guidelines are part of a new set of standards the province has developed to improve the efficiency of the planning process, create greater consistency for high quality health care, and prevent the spread of infectious diseases in hospital settings. Together, they are called GOS (Generic Output Specifications). These new standards (GOS) will ensure that new hospitals in Ontario are better prepared to stop the spread of infectious diseases. They will have more square footage to accommodate separate entrances and exits for staff and visitors, and new configurations for clinical spaces so that contamination of hospital equipment is less likely to occur. The consultation process for GOS included multidisciplinary teams consisting of doctors, nurses, allied health professionals, technicians, health care design consultants and maintenance staff looking at international standards and global best practices. While GOS guidelines were developed based on current and evolving health care benchmarks, the guidelines will be updated regularly to reflect changing clinical practice, technology, and evidence based-practices from around the world. With respect to infection prevention and control, GOS includes recommendations for hand hygiene stations, airborne precaution rooms, HVAC (Heating Ventilation and Air Conditioning), spacing and storage, clean and soiled storage areas, and waste management. Examples include: - One hand washing sink inside each in-patient room, adjacent to the entrance. The hand washing sink in the room is in addition to the sink in the washroom; - Hand washing sinks must be free standing and not inserted into or immediately adjacent to a counter; - Alcohol-based hand rub bottles shall be mounted on the external wall immediately adjacent to the entrance to every in-patient room; - Alcohol-based hand rub bottles shall be mounted adjacent to the bedside in all situations. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only) ------------------------------------------------------------------------- Disponible en français BACKGROUNDER ------------------------------------------------------------------------- REPORTING C. DIFFICILE RATES IN HOSPITALS Beginning today, Clostridium difficile associated disease (CDAD) rates of all hospitals are being published on the Ministry of Health and Long-Term Care's public website. About this reporting tool Ontario is requiring all hospitals to monitor and report CDAD in their facilities so the most appropriate infection control measures can be put in place. Hospitals will use this information to ensure they're maintaining the highest possible standards of patient safety. How to interpret CDAD 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 CDAD rates. These include: - Size of the hospital; - Complexity of the services offered; - Type of patient population served; - Number of people hospitalized for respiratory infection; - Use of antibiotics; - Percentage of patients age 65 or older in the hospital. CDAD rates may also vary seasonally. An increase of infection rates in several facilities over the winter months is to be expected. Trends in CDAD 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 CDAD cases as well as the CDAD rate by month. The data presented on the ministry's website has been confirmed by the hospitals and is also being reported on the hospitals' websites. The rate is calculated by dividing the number of new cases observed at the hospital site by the number of patient days per reporting period, multiplied by 1000. Rates are expressed as cases per 1,000 patient days and exclude patients less than one year of age. This rate calculation allows the level of hospital activity to be taken into account, which may fluctuate over time and is different across hospitals. 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. These hospital types take into consideration differences in hospital size and patient case mix, factors which can make a significant difference in average CDAD rates. For example, teaching hospitals generally serve more complex or sicker - and therefore more vulnerable - patients and could have a higher CDAD rate than the provincial average. The provincial CDAD rate is aggregated data, compiled from the data for all hospitals in Ontario. August 2008 data For the period covering August 2008, there were 319 cases of C. difficile associated disease found among the 228 hospital sites in Ontario. The provincial CDAD rate was 0.39 per 1,000 patient days. This is the first time hospitals have been required to report and it will take time to establish a trend. However, public reporting of C difficile 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. For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only) ------------------------------------------------------------------------- Disponible en français BACKGROUNDER ------------------------------------------------------------------------- C. DIFFICILE REPORTING IN OTHER JURISDICTIONS A number of jurisdictions across North America and Europe report information on C. difficile associated disease (CDAD). Comparisons of this information are difficult because of differences in case reporting, surveillance coverage and reporting timeframe. Rates are generally higher in winter months. The table below includes case counts and rates for CDAD reporting in other jurisdictions. Rates have been adjusted to 1,000 patient days. ------------------------------------------------------------------------- Jurisdiction Case counts / Reporting period Rates reported ------------------------------------------------------------------------- Ontario - 319 cases August 2008 - 0.39 cases per 1,000 patient days ------------------------------------------------------------------------- Manitoba - 80 Cases April 2008 - No reporting of rates ------------------------------------------------------------------------- Quebec - 232 4-week period ending - 0.6 cases per 1,000 December 8, 2007 patient days ------------------------------------------------------------------------- Canadian - 420 Cases January 1 to April 30, 2007 Nosocomial - 0.82 (95%CI, Infection 0.74-0.90) cases per Surveillance 1,000 patient days Program (CNISP) ------------------------------------------------------------------------- UK - 55,393 cases April 2007 to March 2008 - 1.18 cases per 1,000 bed days ------------------------------------------------------------------------- Northern - 288 inpatient cases January - March 2008 Ireland - 61 community cases - 1.163 cases per 1,000 bed days ((greater than or equal to) 65 years) ------------------------------------------------------------------------- Scotland - 6,035 cases October 2006 to September 2007 - 2.03 cases per 1,000 acute occupied bed days ((greater than or equal to) 65 years) ------------------------------------------------------------------------- US - 1.22 per 1,000 1987 to 1998 patient days ------------------------------------------------------------------------- For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only) ------------------------------------------------------------------------- Disponible en français

For further information:

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

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