Patient safety indicators and infection rates

What is Clostridium difficile?

Clostridium difficile (C. difficile) is a common bacterium that is found in the environment and occurs naturally in some people. Although people usually associate it with health-care facilities, it actually doesn't originate in hospitals and can be part of the normal bacteria in the bowel and is one of the many bacteria that can be found in a bowel movement.

How does a C. difficile infection occur?

A C. difficile infection occurs when other healthy bacteria in the bowel are eliminated or decreased, permitting the C. difficile bacteria to grow and produce toxin. This toxin can damage the bowel and cause diarrhea. We’ve known C. difficile to be one of the most common infections acquired in hospitals and health-care facilities for the past three decades.

• The C. difficile infection rate is calculated as a rate per 1,000 patient days.
• Infants under the age of one are not included.
• We calculate the C. difficile rate at Holland Bloorview on a monthly basis for reporting purposes.

What is VRE?

Enterococci are germs that live in the gastrointestinal tract (bowels) of most individuals and generally do not cause harm. Vancomycin-resistant enterococci (VRE) are strains of enterococci that are resistant to the antibiotic vancomycin. If a person has an infection caused by VRE, such as a urinary tract infection or blood infection, it may be more difficult to treat as antibiotics that can be used are limited.

What is a bacteremia?

Bacteremia is the presence of bacteria in the blood, and is referred to as a bloodstream infection.

How does VRE spread?

VRE is spread from one person to another by contact, usually on the hands of caregivers. VRE can be present on the caregiver’s hands either from touching contaminated material excreted by an infected person or from touching articles soiled by feces. VRE can survive well on hands and can survive for weeks on inanimate objects such as toilet seats, taps, door handles, bedrails, furniture and bedpans. VRE is easy to destroy with the proper use of disinfectants and good hand hygiene.

We calculate the VRE bacteremia infection rate at Holland Bloorview on a quarterly basis for reporting purposes.

What is MRSA?

Staphylococcus aureus (S. aureus) is a germ that lives on the skin and mucous membranes of healthy people. Occasionally S. aureus causes an infection and, if it develops a resistance to certain antibiotics, it is called methicillin-resistant Staphylococcus aureus (MRSA).

What is bacteremia?

Bacteremia is the presence of bacteria in the blood, and is referred to as a bloodstream infection.

How does MRSA spread?

MRSA is spread from one person to another by contact – usually on the hands of caregivers. It can be present on a caregiver’s hands either from touching contaminated material excreted by an infected person or from touching contaminated articles such as towels, sheets and wound dressings. MRSA can live on the hands as well as objects in the environment.

We calculate the MRSA bacteremia infection rate at Holland Bloorview on a quarterly basis for reporting purposes.

As our safety partners, visitors should avoid visiting Holland Bloorview if they are sick with one or more of the following symptoms:

• New cough
• Fever
• Shortness of breath (worse than usual)
• Severe headache (worse than usual)
• Unexplained muscle aches
• Unexplained extreme fatigue
• Vomiting and/or diarrhea

Each patient may have a maximum number of four visitors at any time; an adult must accompany any visitor under the age of 12.

Sometimes when patients are admitted to the hospital, they can get infections during their stay. These are called hospital-acquired infections (HAI). We have implemented many measures to maintain and improve our high standards of infection prevention and control – from the basic necessity of using hand wash/rinse stations throughout the building to consulting with individuals and departments about best practices for prevention, to maintaining a hospital-wide surveillance system that can respond immediately if action needs to be taken. The latter involves: 

• A screening and surveillance program where clients are monitored daily for infections

• Isolating all patients at the onset of symptoms

• Hosting ongoing education sessions for staff focused on hospital-acquired infections and hand hygiene

• Following recommended guidelines for environmental cleaning

• Consultation between infection prevention and control practitioners and multidisciplinary teams

For all clients new to Holland Bloorview we maintain an infectious disease screening process. Clients found to have infections of a certain type may be isolated in various ways, while family and visitors will be asked to dutifully respect hand-washing standards. This is especially important at a time when health-care facilities are facing the challenge of antibiotic-resistant pathogens. In some cases, staff (as well as parents and caregivers) may be required to wear protective equipment such as gloves, gowns and masks.

At Holland Bloorview inpatient units we perform targeted surveillance on four key types of hospital-acquired infections we want to monitor: urinary tract infections, lower respiratory tract infections, upper respiratory tract infections and gastrointestinal infections. These represent the infection rate that we calculate as the number of infections per 1,000 client days.

Total inpatient infection rates (updated quarterly):

• As part of the Ministry of Health and Long-Term Care’s public reporting of patient safety indicators initiative, Holland Bloorview tracks hand hygiene compliance rates among our health-care professionals.
• Research shows that hand hygiene is the single most effective way to reduce the risk of health care-associated infections, and Holland Bloorview has demonstrated a strong commitment to ensuring the overall safety and wellbeing of patients.
• By collecting and publicly reporting these rates, hospitals can establish a baseline from which to track their hand hygiene improvement over time. This information will help identify areas for improvement and point to strategies for reducing the incidence of health care-associated infections.
• The goal of publicly reporting hand hygiene compliance is to achieve an overall assessment of whether compliance rates are improving. It is normal for rates to vary from hospital to hospital.

Hand hygiene rate

April 1 2023 to March 31 2024 

Hand hygiene rate for before patient contact/contact with the environment -86%

Hand hygiene rate for after patient contact/contact with the environment -93%

For more information on public reporting in Ontario you can visit Health Quality Ontario.

For more information about infection control, as well as resource sites, please refer to the following:   

• Toronto Public Health 

• Telehealth 

• Travel Health Advisory 

• Ontario Ministry of Health and Long-Term Care 

• Health Canada