Frequently Asked Questions

No. The HSMR results should not be used as a guide of choosing where to seek care. A higher than average HSMR result does not necessarily mean that a hospital is “unsafe” – nor does a lower than average HSMR mean a hospital is “safe.” Patients should know that KGH is safe and that the care they receive is top-notch. Every effort – on behalf of everyone serving patients in a hospital – is made to ensure patients receive the highest-quality care possible. Hospital care is complicated and depends on many factors, not all of which are reflected or accounted for by HSMR. That is why many indicators must be examined in order to get a sense of how hospitals are performing – where they excel and where improvements could be made. It is important to look at all of these indicators in combination. To judge performance on only one indicator would be misleading.

The HSMR is an overall quality indicator and measurement tool that allows for comparison of an acute care hospital’s mortality rate with the overall mortality rate among peer hospitals and regions in Canada. HSMR has been used by many hospitals in several countries to assess and analyze in hospital mortality rates and to help improve quality of care and enhance patient safety. Ontario hospitals are beginning to use the HSMR for internal benchmarking purposes: to show hospitals how their HSMR has changed, where they have made progress and where they can continue to improve.

Morbidity and mortality patterns are changing. Hospitals, like ours, have implemented a range of initiatives to reduce mortality and improve patient care. As a result, HSMR results across the country have been progressively improving. So, this year, CIHI updated the methodology used to calculate HSMR results. For example, Quebec is now included, more diagnoses are added and a new approach to logistic regression modeling is used.

The rate reported by CIHI for KGH has included patients whose secondary diagnosis included palliative care. These are patients whose hospitalization was for the purpose of palliative care for the majority of their hospital stay. Because palliative care was not the primary diagnosis, CIHI has included these patients in their calculation for KGH’s HSMR. At KGH, palliative patients accounted for 64 per cent of deaths last year. Without these palliative care deaths, the HSMR would be lower. 

The Hospital Standardized Mortality Ratio (HSMR) is an overall quality indicator and measurement tool used by all acute care hospitals and regions in Canada. HSMR has been used by many hospitals in several countries to help improve quality of care and enhance patient safety.

The Hospital Standardized Mortality Ratio (HSMR) is an overall quality indicator and measurement tool used by all acute care hospitals and regions in Canada. HSMR has been used by many hospitals in several countries to help improve quality of care and enhance patient safety.

 

If a person has diarrhea due to CDI, a doctor will prescribe a type of antibiotic that kills the C. difficle germs. The two most commonly used antibiotics to treat CDI are metronidazole and vancomycin.

Clostridium difficile Infection (CDI) is often abbreviated to C. difficile or C. diff for short.

C. difficile is a germ that can be found, on occasion, in people’s bowels. It does not always cause problems or symptoms but in some cases can. In some people who are also taking antibiotics, the germ can grow because the antibiotics kill off many of the “good” and harmless germs that normally prevent the C. difficile from growing to high numbers.

C. difficile makes a toxin that damages the fragile lining of the bowel causing inflammation and loose watery bowel movements (diarrhea) and inflammation.

For more information and other related topics we recommend you visit:

• Ministry of Health and Long-Term Care - Patient Safety 
• Public Health Ontario - Regional Infection Control Networks (RICN)

It is not possible to prevent every case of C. difficile infection but each of us can protect ourselves and others by cleaning our hands often. Health-care providers in hospitals must clean their hands according the Ontario Ministry of Health and Long-Term Care’s and hygiene guidelines. If you are receiving care in a hospital it is OK to ask anyone providing care to you if they have cleaned their hands. Cleaning your own hands after using the toilet, before you eat, after blowing your nose and any time they are dirty is a basic and important step to prevent the spread of all infections including C. difficile. Taking antibiotics only as needed and as prescribed by your doctor or nurse-practitioner (advanced practice nurse) and watching out for diarrhea are also important.

Yes, in severe cases of CDI, death can occur. This is uncommon and tends to occur in those people with other severe health problems. The vast majority of people recover from CDI.

If CDI is suspected, a stool (bowel movement) sample is tested in a laboratory for the toxin it makes. The test takes several hours to perform and most hospitals do this test in their own laboratory. Those hospitals that do not do this test themselves will send the stool sample to another laboratory to do the test. Sometimes a doctor will look directly into the bowel with a special scope (called a sigmoidoscope or colonoscope) to detect abnormal changes in the lining of the bowel that mean that C. difficile is causing the diarrhea. 

If a person has diarrhea due to CDI, a doctor will prescribe a type of antibiotic that kills the C. difficile germs. The two most commonly used antibiotics to treat CDI are metronidazole and vancomycin.

C. difficile can be spread from one person to another by contact, hand hygiene is critical to preventing its spread in a health-care setting.

If a patient is positive for C. difficile they are placed on Contact Precautions.

So what are Contact Precautions?

Contact Precautions aim to limit the spread of C. difficile to other patients and to health care providers. You may be placed in a private room or with other patients who are also carrying the bacteria. A sign may be placed on your door to remind others who enter your room about these special Contact Precautions. Those caring for you as well as visitors will be asked to clean their hands, gown and glove before entering your room. Everyone who enters and leaves your room must clean their hands well. The room and equipment in the room will be cleaned and disinfected regularly.

If you get the C. difficile germ you most often do not develop any symptoms of diarrhea at all. People, particularly those taking antibiotics, may get diarrhea. The diarrhea can range from mild to severe with many bowel movements in a day and accompanied by abdominal pain and cramps.

The C. difficile germ enters your body by ingestion of C. difficile spores. This is why cleaning your hands is so important to prevent picking up C. difficile and other germs. You can pick up the C. difficile germ anywhere, but the C. difficile germ is especially common in hospitals because hospitals have many people being given antibiotics. The chances of the C. difficile germ spreading from person to person is much higher in a hospital than it is in your own home, for example.

C. difficile is one of the most common infections found in hospitals and long-term care facilities, and has been a known cause of health-care associated diarrhea for about 30 years.

Healthy people are not usually susceptible to C. difficile. Seniors and people who have other illnesses or conditions being treated with antibiotics and those who take acid-suppressing stomach medications are at greater risk of an infection from C. difficile.

If a person has diarrhea due to CDI, a doctor will prescribe a type of antibiotic that kills the C. difficle germs. The two most commonly used antibiotics to treat CDI are metronidazole and vancomycin.

If a person has diarrhea due to CDI, a doctor will prescribe a type of antibiotic that kills the C. difficle germs. The two most commonly used antibiotics to treat CDI are metronidazole and vancomycin.

If a patient is carrying MRSA, generally no treatment is necessary, as the organism is not causing an illness and often will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, skin infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

If a patient is carrying MRSA, generally no treatment is necessary, as the organism is not causing an illness and often will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, skin infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

If a patient is carrying MRSA, generally no treatment is necessary, as the organism is not causing an illness and often will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, skin infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

Most people do not die if they are infected with MRSA. However in severe cases of MRSA bacteremia, death can occur. This is uncommon and tends to occur in those people with other severe health problems. The vast majority of people recover from MRSA, once their health is restored.

If a patient is carrying MRSA, generally no treatment is necessary, as the organism is not causing an illness and often will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, skin infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

Swabs are performed when patients are admitted to the hospital and periodically for patients whom are at risk. The swabs are sent to the laboratory for analysis and if positive, the laboratory notifies infection prevention and control so that the patient can be placed on Contact Precautions.

Contact Precautions aim to limit the spread of MRSA to other patients and to health care providers. You may be placed in a private room or with other patients who are also carrying the bacteria. A sign may be placed on your door to remind others who enter your room about these special contact precautions. Those caring for you as well as visitors will be asked to clean their hands, gown and glove before entering your room. Everyone who enters and leaves your room must clean their hands well. The room and equipment in the room will be cleaned and disinfected regularly.

Because MRSA is spread from one person to another by contact, hand hygiene is critical to preventing its spread in a health-care setting. KGH actively conducts regular surveillance to find cases of MRSA infection and to identify carriers of MRSA. If a patient is positive for MRSA they are placed on Contact Precautions.

MRSA is spread from one person to another by contact, usually on the hands of caregivers. MRSA can be present on the health care provider’s hands either from touching contaminated material from infected persons or from touching articles contaminated by a person carrying MRSA, such as towels, sheets and wound dressings. MRSA can live on hands and objects in the environment for extended periods of time.

Risk factors for MRSA infections include invasive procedures, prior treatment with antibiotics, prolonged hospital stay, stay in an intensive care or burn unit, surgical wound infection and close proximity to someone who is carrying MRSA. 

A bacteremia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection.

Staphylococcus aureus is a germ that lives on the skin and mucous membranes of healthy people. Occasionally, Staphylococcus aureus is a  cause of human infection. When Staphylococcus aureus develops resistance to certain antibiotics, it is called Methicillin-resistant Staphylococcus aureus or MRSA.

For more information and other related topics we recommend you visit:

• Ministry of Health and Long-Term Care - Patient Safety 
• Public Health Ontario - Regional Infection Control Networks (RICN)

If a patient is simply carrying VRE, no treatment is necessary, as the organism will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, urine infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

If a patient is simply carrying VRE, no treatment is necessary, as the organism will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, urine infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

If a patient is simply carrying VRE, no treatment is necessary, as the organism will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, urine infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

Generally, people do not die if they infected with VRE. In severe cases of VRE bacteremias can lead to death. This is rare and tends to occur in those people with other severe health problems. The vast majority of people recover from VRE once their health is restored.

If a patient is simply carrying VRE, no treatment is necessary, as the organism will be cleared on its own when the person’s health is restored. If it is determined that the patient is infected (they have a blood infection, urine infection or wound infection etc.) then the patient will treated with the appropriate antibiotic as determined by a physician.

We do not routinely monitor or isolate persons who carry VRE. Patients with VRE infections are identified during their care and treated accordingly.

All infection prevention and control precautions or Routine Practices aim to limit the spread of any bacteria to other patients and to health care providers.  

Here at KGH we do not routinely place patients on precautions or isolate those who carry or are infected with VRE. Routine Practices are used because VRE, like other germs can be spread from one person to another by contact; hand hygiene is critical to preventing the spread of all infections in a healthcare setting. Health care providers are routinely required to clean their hands before, during and after patient contact. We also clean and disinfect all patient rooms and equipment to help stop the spread of VRE and other germs. 

VRE is spread from one person to another by contact, usually on the hands of health care providers (HCP). VRE can be present on the health care provider’s hands either from touching contaminated material excreted by the infected person or from touching articles contaminated by the skin of a person with VRE, such as towels, sheets and wound dressings. VRE can live on hands and objects in the environment.

Risk factors for VRE acquisition include severe underlying illness, presence of invasive devices, prior colonization with VRE, antibiotic use and longer hospital stay.

Enterococci are bacteria that are normally present in the human intestines and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called Vancomycin-resistant Enterococci (VRE).

A bacteremia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection.

For more information and other related topics we recommend you visit:

• Ministry of Health and Long-Term Care - Patient Safety 
• Public Health Ontario - Regional Infection Control Networks (RICN)

VAP is a serious lung infection that can occur in patients being treated in an intensive care unit (ICU) who need assisted breathing with a mechanical ventilator for at least 48 hours.

VAP is a serious lung infection that can occur in patients being treated in an intensive care unit (ICU) who need assisted breathing with a mechanical ventilator for at least 48 hours.

VAP is a serious lung infection that can occur in patients being treated in an intensive care unit (ICU) who need assisted breathing with a mechanical ventilator for at least 48 hours.

Day treatment is a form of outpatient care.

• Part 1 involves you spending half-days with our team (including a psychiatrist, nurse practitioner, therapist, and dietitian), Monday through Friday for 12 weeks. The program involves individual counselling, medical monitoring, group therapy, family/friend support, and meal support.
• You may choose to opt into Part 2, which involves less frequent visits to further your treatment for 8 weeks, while encouraging you to apply skills in your usual life setting. 

• Our therapy model is based on cognitive behavioural therapy enhanced (CBT-E) and dialectical behaviour therapy (DBT)
• These therapies address thoughts, behaviours, and how to regulate emotions that make it hard to overcome eating disorder symptoms
• Nutrition care aims to normalize eating patterns and increase compassion and care around food and eating
• Meal support (involving eating with our Day Treatment team) helps you to practice skills and to receive support and guidance along the way
• Medical monitoring supports keeping you well and informed about how your health affects your day-to-day life.

Our Program Philosophy and goals are emphasized throughout the program:

• Restore physical health (including normalization of eating and weight restoration)
• Symptom interruption (e.g., interruption of bingeing, purging, restriction, excessive exercise)
• Acquisition of recovery-oriented skills (e.g., mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness skills)
• Improve participants’ quality of life.

Most infections are treated with antibiotics – the type of medication will depend on the germ causing the infection. An infected skin wound may be reopened and cleaned. If an infection occurs where an implant is placed, the implant may be removed. If the infection is deep within the body, another operation may be needed to treat it.

Ask lots of questions. Learn what steps the hospital is taking to reduce the danger of infection.

• If your doctor instructs, shower or bathe with antiseptic soap the night before and day of your surgery. You may be asked to use a special antibiotic cleanser that you don’t rinse off.
• If you smoke, stop or at least cut down. Ask your doctor about ways to quit.
• Only take antibiotics when told by a health care provider. Using antibiotics when they’re not needed can create germs that are harder to kill. If prescribed, finish all your antibiotics, even if you feel better.
• After your surgery, eat healthy foods.
• When you return home, care for your incision as instructed by your health care provider.

Health care providers should be taking the following precautions to prevent SSIs:

• Practicing proper hand-hygiene techniques. Before the operation, the surgeon and all operating room staff scrub their hands and arms with an antiseptic soap.
• Cleaning the site where your incision is made with an antiseptic solution.
• Wearing medical uniforms (scrub suits), long-sleeved surgical gowns, masks, caps, shoe covers and sterile gloves.
• Covering the patient with a sterile drape with a hole where the incision is made.
• Closely watching the patient’s blood sugar levels after surgery to make sure it stays within a normal range. High blood sugar can delay the wound from healing.
• Warming IV fluids, increasing the temperature in the operating room and providing warm-air blankets (if necessary) to ensure a normal body temperature. A lower-than-normal body temperature during or after surgery prevents oxygen from reaching the wound, making it harder for your body to fight infection.
• Clipping, not shaving any hair that has to be removed. This prevents tiny nicks and cuts through which germs can enter.
• Covering your closed wound (closed with stitches) with sterile dressing for one or two days. If your wound is open, packing it with sterile gauze and cover it with sterile dressing.

The risk of acquiring a surgical site infection is higher if you:

• Are an older adult
• Have a weakened immune system or other serious health problem such as diabetes
• Smoke
• Are malnourished
• Are very overweight
• Have a wound that is left open instead of closed with sutures

• Increased soreness, pain, or tenderness at the surgical site.
• A red streak, increased redness, or swelling near the incision.
• Greenish-yellow or foul-smelling discharge from the incision.
• Fever of 101 degrees Fahrenheit (38.5 degrees Celsius) or higher

Symptoms can appear at any time from hours to days after surgery. Implants such as an artificial knee or hip can become infected up to 3 months or more after the operation.

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 can happen because germs are everywhere – on your skin, and on things you touch. Most infections are caused by germs found on and in your body.

Health care providers should be taking the following precautions to prevent SSIs:

• Practicing proper hand-hygiene techniques. Before the operation, the surgeon and all operating room staff scrub their hands and arms with an antiseptic soap.
• Cleaning the site where your incision is made with an antiseptic solution.
• Wearing medical uniforms (scrub suits), long-sleeved surgical gowns, masks, caps, shoe covers and sterile gloves.
• Covering the patient with a sterile drape with a hole where the incision is made.
• Closely watching the patient’s blood sugar levels after surgery to make sure it stays within a normal range. High blood sugar can delay the wound from healing.
• Warming IV fluids, increasing the temperature in the operating room and providing warm-air blankets (if necessary) to ensure a normal body temperature. A lower-than-normal body temperature during or after surgery prevents oxygen from reaching the wound, making it harder for your body to fight infection.
• Clipping, not shaving any hair that has to be removed. This prevents tiny nicks and cuts through which germs can enter.
• Covering your closed wound (closed with stitches) with sterile dressing for one or two days. If your wound is open, packing it with sterile gauze and cover it with sterile dressing.