Patient Safety Indicators

Monthly infection report: January 2024

Number of new cases = 1

Number of patient days = 2385

Excluding <1 year of age

Infection rate = 1/2385 X 1,000 = 0.42

What is C Difficile?

C difficile bacteria can turn themselves into a special form, a spore, which lives for a long time. Others can be infected if they accidentally ingest (eat) the spore. Contaminated hands spread the spores through touch, and then eating or preparing food.

About half of healthy newborns can carry C difficile in their stool but do not have any illness. This is called colonization. After the age of 5 years, this rate becomes similar to adults where 5% may carry the bacteria without symptoms.

How do we work to prevent the spread of C Difficile at CHEO?

Always wash your hands after using the washroom and before eating. Ask others, including doctors and nurses, to wash their hands before they touch you. If you have diarrhea that splashes onto a surface in your room or the washroom, tell your nurse immediately. It will need to be properly cleaned up.

We look closely at C difficile cases, which allows us to know if there's a problem in the hospital, and if so, how severe. We also educate our staff and medical staff on C difficile and the importance of hand washing to prevent spreading diseases. If there is a cluster of cases of C difficile, our cleaning staff administers additional cleaning activities.

Because we monitor the situation so closely, we can give the right medicine very early to treat infection.

What to do once you arrive home

Healthy people who are not on antibiotics are at very low risk of getting C difficile. There are precautions you can take at home. If you have C difficile, talk to your doctor if the diarrhea does not stop or comes back once you return home.

Hand washing

Wash your hands for at least 15 seconds:

• After using the toilet.
• After touching dirty or contaminated surfaces.
• Before eating.
• Before preparing meals.

Remind everyone in your home to wash their hands regularly. If your caregivers handle feces or other bodily fluids, they should wear gloves. They should also wash their hands when they take their gloves off.

House cleaning

You can use an all-purpose, regular household cleaner to clean surfaces when you have a C difficile infection. Make sure you rub surfaces well. Toilets and bathrooms need extra attention. If feces have splashed onto a surface, wipe clean first. After, use the household cleaner on the area. If possible, use a separate bathroom from the rest of the household until diarrhea stops.

Laundry

Wash clothing soiled with feces separately. First, rinse off the feces. Hot water and soap help remove the bacteria. Using a clothing dryer (instead of hanging clothes to dry) also helps.

Dishes

Wash dishes in a sink with soap and hot water or in the dishwasher. Don't share dishes or utensils while you have C difficile.

Medicine

Take all your medication as prescribed by your doctor. Do not use any drugs from the drugstore to stop your diarrhea (e.g., Imodium®).

More information on C Difficile infections

Symptoms

Symptoms include mild to moderate diarrhea, abdominal cramps and fever. In children, diarrhea is the most common symptom.

Infection can produce a toxin that can cause swelling in the intestine. Your doctor will order a test that can identify the toxin. Some cases can be very severe. In rare cases, surgery is necessary when the intestine is badly damaged. In extreme cases, the infection can cause death.

Who is at risk?

People who have been on antibiotics are at greater risk of infection. If infected, older adults and those with serious illnesses or poor overall health are at a greater risk of having a more severe case.

New strain

C difficile has been a concern for more than 30 years, but recently a new strain was found that is causing more problems. As such, hospitals have been looking at C difficile more closely than ever before.

Treatment

Sometimes, stopping to take antibiotics can stop the C difficile infection. This can allow the normal, good bacteria to grow back and resume control. There are also special antibiotics for the C difficile infection. Always speak to your doctor for treatment direction.

Visiting the hospital

Healthy people who are not taking antibiotics are at very low risk of getting C difficile infection. You should still wash your hands after visiting someone in the hospital. Follow all precautions that the staff members explain. If you are caring for someone with an infection, wear a gown and gloves. Do not sit on the bed or commode (special) chair in the hospital room.

Special precautions

Patients who are sick with C difficile can spread the spores in their environment. A lot of hospital patients can be on antibiotics, which increases their chances of getting an infection if they get C difficile. To help protect everyone, we use special precautions including gowns and gloves. If you have the infection, we may move you to a single room. We may also give you a special commode or toilet to use while you have diarrhea.

Visitors who come to see you while you are on special precautions should not visit other patient rooms. You will need to stay in your room until your diarrhea stops.

Hang hygiene is an important practice at CHEO for health care providers, patients, families and visitors. It significantly reduces the spread of infection in hospitals. Hand hygiene is a different way of thinking about safety and patient care and involves everyone.

How can children, youth and families help?

Hand hygiene involves everyone at CHEO, including children, youth and their families! Hand cleaning is one of the best ways you and your health-care team can prevent the spread of many infections. Patients and their visitors should also practice good hand hygiene before and after entering patient rooms.

Visit our patient safety page for more information

Public reporting of CHEO's hand washing rates

The public reporting of hand hygiene compliance is a helpful measure to make sure we are continuously improving our care. It provides a benchmark for tracking and monitoring performance improvement measures.

Hand washing is something we all do here at CHEO, but it's also something that we want to continue to do better – and are committed to improving.

How are these rates calculated?

Before entering a patient environment

• Number of times hand hygiene was performed by health care provider before patient/patient environment contact = 1178
• Number of times hand hygiene was indicated before patient/patient environment contact = 1431
• 1178 (# of times hand hygiene performed) x 100
• 1431 (# of observed hand hygiene indications)
• Hand hygiene compliance rate before patient/patient environment = 82.3%

After entering a patient environment

• Number of times hand hygiene was performed by health care provider after patient/patient environment contact = 1006
• Number of times hand hygiene was indicated after patient/patient environment contact = 1142
• 1006 (# of times hand hygiene performed) x 100
• 1142 (# of observed hand hygiene indications)
• Hand hygiene compliance rate after patient/ patient environment = 88.1%

Quarterly infection report: October 1, 2023 – December 31, 2023

Number of new cases of health-care associated infection = 1

Number of patient days = 11445

Infection Rate = 1/11445 x 1,000 = 0.09

What is MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria. MRSA is resistant to certain or all types of the beta-lactam classes of antibiotics. This includes penicillins, penicillinase-resistant penicillins (e.g., cloxacillin) and cephalosporins.

MRSA are strains of S. aureus that have an MIC to oxacillin of ≥ 4 mcg/ml or contain the mecA gene coding for penicillin binding protein 2a (PBP 2a).

How and where is MRSA transmitted?

MRSA is often hospital-acquired. This means patients contract MRSA after being admitted into the hospital. Symptoms may begin 72 hours later.

MRSA is most often transmitted through the hands of health care workers in hospitals. These health care workers acquire it from contact with colonized or infected patients. This can also happen from contact after handling contaminated material or equipment.

Children can also get MRSA from their mother's breast milk.

Risk factors for MRSA

• Invasive procedures
• Prior treatment with antibiotics
• Prolonged hospital stay
• Stay in an intensive care or burn unit
• Surgical wound infection
• Close proximity to a colonized person

Quarterly infection report: October 1, 2023 – December 31, 2023

Number of new cases of health-care associated infection = 0

Number of patient days = 11445

Infection Rate = 0/11445 x 1,000 = 0.00

What is VRE

Enterococci are bacteria. They are normally present in the human intestines and in the female genital tract. They are also found in the environment. These bacteria can cause infections. Vancomycin is the antibiotic often used to treat these infections. Sometimes, enterococci are resistant to this Vancomycin. These are called Vancomycin-resistant Enterococci (VRE).

VRE have a minimal inhibitory concentration (MIC) to vancomycin of ≥ 32 mcg/ml. They contain the resistance genes VAN-A or VAN-B.

How and where are VRE transmitted?

VRE is often hospital-acquired. This means patients contract VRE after being admitted into the hospital. Symptoms usually begin 72 hours after admission.

VRE is most often transmitted through the hands of health care workers in hospitals. These health care workers acquire it from contact with colonized or infected patients. This can also happen from contact after handling contaminated material or equipment.

Risk factors for VRE

• The severity of underlying illness
• Presence of invasive devices
• Prior colonization with VRE
• Antibiotic use
• Length of hospital stay