Patient Safety Indicators

At Unity Health Toronto, we take your safety seriously and we are committed to providing you with high quality health-care services.

We have a number of practices in place to help reduce the chances of you getting hospital-acquired infections like C. difficile, MRSA or VRE. Our teams are constantly practicing, following, and improving infection prevention and control standards.

Paying close attention to the spread of infectious diseases is essential, and it can show us what we need to do to improve. The Ontario Ministry of Health has established a number of patient safety indicators. All hospitals are required to publicly report these indicators but we also believe it’s the right thing to do. It’s important to us for you to know how we are performing.

Clostridium Difficile Infection Rate

We report the number of new hospital-acquired C. difficile (C. diff) cases on a monthly basis.

What determines the rate?

Number of new cases divided by Total number of patient days (for one month), and then multiplied by 1000.

What is C. difficile?

Clostridium difficile is one of many types of bacteria that can be found in feces (bowel movements). C. difficile occurs when antibiotics kill your good bowel bacteria,  allowing the C. diff to grow. C. diff produces toxins that can damage the bowel and may cause diarrhea. It can be mild, severe (possibly requiring surgery), and in extreme cases C. diff may cause death. There are three things that we need to do all the time to prevent C. diff:

  1. Practice proper hand hygiene.
    • Our health-care teams are practicing the four moments of hand hygiene every time we approach a patient. This means washing their hands with soap and water or using alcohol-based hand rub whenever we are working with patients.
  2. Make patients and families partners in care.
    • We are educating patients and family members about the importance of hand hygiene and the extra precautions to take when caring for a loved one with C. difficile. We are also encouraging our patients and their families to ask their healthcare providers if they have washed their hands.
  3. Practice antibiotic stewardship.
    • We are making sure we are giving patients the right antibiotic for the right period of time.

We regularly audit our cleaning practices for the hospital environment and patient equipment, and ensure cleaning is consistent, thorough and done with a cleaning product that is registered with Health Canada to kill C. difficile. Enhanced cleaning is done in our high traffic areas such as the Emergency Department.

Clostridium difficile infection rate for hospital patients (per 1,000 inpatient days)

St. Joseph’s Health CentreSt. Michael’s HospitalProvidence Healthcare
0.340.070.00

Hand Hygiene Rate

Hand hygiene relates to the removal of visible soil and the removal or killing of transient microorganisms from the hands and may be accomplished using soap and running water or an alcohol-based hand rub.

What determines the rate?

Number of times hand hygiene performed divided by number of observed hand hygiene indications, multiplied by 100.

Public reporting of hand hygiene compliance is another measure to ensure care becomes even safer and improves over time. It provides a benchmark for tracking and monitoring performance improvement measures.

We are continuing to educate our staff about the importance of practicing the four moments of hand hygiene. We are also constantly checking and monitoring our infection prevention and control practices to ensure they are aligned with the Provincial Infectious Diseases Advisory Committee (PIDAC) best practices documents and the Ministry of Health’s Just Clean Your Hands program[ET2] .

We are also educating our patients, their families and visitors about proper hand hygiene and encouraging them to ask their health-care providers if they have cleaned their hands with alcohol-based hand rub or soap and water before coming into their room to treat them.

Hand hygiene compliance by hospital care providers (%)

 St. Joseph’s Health CentreSt. Michael’s HospitalProvidence Healthcare
Before patient contact (moment 1)60%73%96%
After patient contact (moment 4)79%79%97%

Hospital Standardized Mortality Ratio

We report our Hospital Standardized Mortality Ratio (HSMR) cases once a year.

What is HSMR?

The Hospital Standardized Mortality Ratio is a measure of the hospital’s mortality rate compared to the overall average mortality rate.

How to interpret HSMR:

  • An HSMR equal to 100 suggests that there is no difference between the hospital’s mortality rate and the overall average rate.
  • An HSMR greater than 100 suggests that the local mortality rate is higher than the overall average.
  • An HSMR less than 100 suggests that the local mortality rate is lower than the overall average.

It is important to note that the HSMR is not designed for comparisons between hospitals, it is intended to track a hospital’s trend over time.

Methicillin-Resistant Staphylococcus Aureus

We report the number of Methicillin-resistant Staphylococcus aureus (MRSA) cases and the bacertaemia rate on a quarterly basis (every three months).

What is MRSA?

Staphylococcus aureus is a bacteria that lives on the skin and mucous membranes of healthy people. When Staphylococcus aureus becomes resistant to certain antibiotics it is called Methicillin-resistant Staphylococcus aureus or MRSA. MRSA can also live in the nose and on the skin of some individuals. People who carry the bacteria but do not get sick are known as carriers. If people get sick from MRSA, there are a few antibiotics that can be used to treat them. MRSA does not usually pose a problem to healthy individuals.

What determines the rate?

The MRSA bacteraemia rate is calculated by dividing the number of new cases observed in the hospital by the average number of patient days per reporting period for the facility (e.g. 100 patients staying an average of 10 days = 1,000 patient-days). This rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Rates are expressed as cases per 1,000 patient-days.

MRSA bloodstream infections in hospital patients (per 1,000 inpatient days)

St. Joseph’s Health CentreSt. Michael’s HospitalProvidence Healthcare
0.000.000.00

Surgical Safety Check List

We report our Surgical Safety Checklist compliance rate on a bi-annual basis (every six months).

What is the Surgical Safety Checklist?

The Surgical Safety Checklist provides the opportunity for everyone on a surgical team to discuss important information regarding the patient and procedure. It guides the surgical team members – nurses, surgeons, anesthesiologists – in verifying all information to ensure that they are performing the right procedure on the right patient.

Our compliance rate is intended to help us set a starting point so that we can track results over time. Should our compliance increase, we will try to sustain our successes. If our compliance decreases, we will look at our operating room processes to target areas for improvement.

For patients having surgery, you can expect that your healthcare team will use the Surgical Safety Checklist as part of your care.

What determines the rate?

Number of times all three phases of the surgical safety checklist was performed divided by Total surgeries, multiplied by 100.

Surgical Site Infection

We report our Surgical Site Infection (SSI) Prevention Rate on a quarterly basis (every three months).

What are surgical site infections?

Surgical site infections occur when harmful germs enter your body through the surgical site (any cut the surgeon makes in the skin to perform the operation). Infections happen because germs are everywhere – on your skin, in the air and on things you touch. Most infections are caused by germs found on and in your body.

What determines the rate?

One of the ways to prevent surgical site infections is by giving patients antibiotics 0 to 60 minutes (for common antibiotics) or 0 to 120 minutes (for a specific antibiotic known as vancomycin) before they go into surgery. The Surgical Site Infection indicator reports the percentage of time the healthcare team gave patients their antibiotics within the appropriate time period before the surgery. This will apply only to patients who are 18 years or older who were about to undergo primary hip or knee joint replacement surgery. This does not measure the number of actual surgical site infections after surgery.

What determines the rate?

Number of Hip/Knee total joint replacement surgeries who received usual antibiotics within 60 min of skin incision divided by total number of patients during the reporting period who had a primary knee/hip total joint replacement surgical procedure, add the number of hip/knee total joint replacement surgeries who received the antibiotic vancomycin within 120 min of skin incision, and then multiply by 100.

Vancomycin-Resistant Enterococcus Rate

We report our Vancomycin-resistant Enterococcus (VRE) rate on a quarterly basis (every three months).

What is VRE?

Enterococci are bacteria (bugs) that are part of the normal human bowel. All normal bugs can cause infection if they are given an opportunity, for example, moving from their usual home onto a surgical incision or drain. Certain strains of the Enterococci bug have learned how to survive even with the use of antibiotics. This is called antibiotic resistance. One such strain has become resistant to the antibiotic called Vancomycin.

What determines the rate?

The VRE bacteraemia rate is calculated by dividing the number of new cases observed in the hospital by the average number of patient days per reporting period for the facility (e.g. 100 patients staying an average of 10 days = 1,000 patient-days). This rate calculation allows the level of hospital activity to be taken into account because this will fluctuate over time and is different across hospitals. Rates are expressed as cases per 1,000 patient-days.

VRE bloodstream infections in hospital patients (per 1,000 inpatient days)

St. Joseph’s Health CentreSt. Michael’s HospitalProvidence Healthcare
0.000.000.00

Last updated December 03, 2021