Frequently Asked Questions

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.

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.

Yes, referrals are required for both the non-urgent and urgent Adult Mental Health Program streams.

• The non-urgent stream requires a referral from a medical doctor or nurse practitioner. If you do not have a family physician, we accept referrals from walk-in clinics.

• Referrals from the urgent stream are ONLY accepted internally from the KGH Emergency Department, HDH Urgent Care Centre, Inpatient Mental Health & Addiction Program, and the Consult/Liaison Psychiatry Team.

Once a non-urgent referral is received, the referring practitioner will receive correspondence either accepting the referral and advising of the current wait time or recommending alternate services that may better fit your needs.

Once we have accepted your referral, you will be placed on a waitlist for a telephone call from an intake nurse, which could take up to a year, dependant on the current referral volume.  At the time of intake call, you will either be given an appointment, or be placed on our waitlist for the next available appointment.

Once an urgent referral is received, you will be contacted by an intake nurse. We aim to contact patients referred from the Emergency Department or Inpatient Mental Health Unit within 72 hours, however this may take longer depending on when the referral was received, and whether we need to obtain collateral information.

At the time of intake call, you will either be given an appointment, be placed on our waitlist for the next available appointment or be advised that your case will be discussed during interdisciplinary rounds with an outcome to follow.

You can expect various outcomes, based on your referral and the intake information gathered:

• You may be booked with psychiatry
• You may be placed on a waitlist for a future appointment
• You may be enrolled in group psychotherapy
• We may recommend services that better meet your needs
• Your referral may be closed owing to adequate services already in place for you

The Adult Mental Health Program is unable to provide the following services:

• Disability follow-up appointments as part of employment Insurance

• Canada Pension Plan

• Workplace Safety & insurance Board

• Ontario Disability Support Program requirements

• Independent Medical Evaluations for Court & Child Welfare Assessments

• Forensics or Capacity Assessments.

The non-urgent stream does not offer counseling services, crisis services, or urgent appointments.

Length of treatment is patient-specific. Some patients have just one consult visit and some may have short-term follow-up. It is not within the program’s mandate or capacity to follow patients for a significant length of time. Our model always anticipates patient care will be resumed by a primary care provider.

The urgent stream is a brief intervention service.

The AMHP sees patients in the Kingston, Frontenac, Lennox & Addington area. If you reside outside of that area and have questions about what mental health agency is in your area, please contact our clinical intake coordinator at 613-544-3400 ext. 3700 or search the Connex Ontario website.

If your psychiatrist starts you on a medication, they may prescribe it themselves or they may recommend your referring practitioner initiate the medication. Once you have been discharged from the AMHP, it will be the responsibility of your referring practitioner to continue prescribing the medication. Should you not have a family physician, we recommend attending a walk-in clinic to access refills.

We are unable to book patients for a psychiatric assessment solely for the purpose of providing medication refills.

As part of KHSC, and in collaboration with Queen’s University, St. Lawrence College and other educational institutions we often have students and learners from across many disciplines participate in our various clinics.

• Psychiatry residents (licensed medical doctor that is undergoing their psychiatry training)

• Clinical fellows (a licensed psychiatrist who is training in a specialized psychiatric field)

In the Adult Mental Health program we have both international and Canadian doctors training in sub-specialty streams.

• Clerk/Medical student present for your assessment. All psychiatric care will be provided under the supervision of AMHP Staff Psychiatrist, who you may or may not see in-person.

• Allied Health care providers - Many of our allied health care providers also provide field placements or internships for several disciplines including nursing, occupational therapy, and social work which may involve learners working in the services being provided to you by our provided.

We have very high referral volume and a lengthy waitlist; therefore, it is important that you attend your appointments. However, if you must cancel, please notify us at least 24 hours prior, so that we can fill the vacant spot. If you cancel in advance, we will gladly rebook you, however, please be advised that you may have to wait several months.

A no-show for a new patient assessment will result in an automatic file closure, and a re-referral will be required to be seen again.

A group session allows people to learn new skills and hear from others who may have similar experiences dealing with mental health concerns. Participants may share their thoughts and feelings with others if they are comfortable.

Your appointment may occur in person or virtually.  This will be discussed during your telephone intake when your email address is collected by the intake nurse.  You will be provided an appointment notice letter with this information.

For a virtual appointment, the secretary will email you a link to attend. This link may not be sent until the day before your scheduled appointment and will provide clear instructions on how to proceed. Please note that you must use the internet browser Chrome for the virtual visit to be effective. 

Other resources can be found on the Community Resources page. 

Ask lots of questions

• Ask what precautions your hospital is taking to prevent VAP
• Wash their own hands often. Use soap and water if visibly soiled or alcohol-based hand rub on all other occasions.

Ask lots of questions

• Ask what precautions your hospital is taking to prevent VAP
• Wash their own hands often. Use soap and water if visibly soiled or alcohol-based hand rub on all other occasions.

Ask lots of questions

• Ask what precautions your hospital is taking to prevent VAP
• Wash their own hands often. Use soap and water if visibly soiled or alcohol-based hand rub on all other occasions.

Hand hygiene involves everyone in the hospital, including patients. 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.

More information is available at:

•  Ministry of Health and Long Term Care - Patient Safety  
• Public Health Ontario - Just Clean Your Hands campaign

KGH works hard-to create a culture of patient safety involves everyone – health care administration, health -care professionals, and, of course, patients and families. If low hand hygiene compliance rates are identified, we will review infection prevention and control practices to ensure that they align with best practices documents, as well as the Just Clean Your Hands program and introduce educational interventions and make appropriate revisions to our program.

For the purpose of public reporting, data will be reported on an annual basis. The decision was made to report annually so that hospitals were able to submit enough data and that the compliance rate was statistically valid.

Patients should know that their hospital is safe, that the care they receive is topnotch, and that every effort is made to ensure the highest quality of care possible. Public reporting of hand hygiene compliance rates is another helpful measure to ensure the care provided to Ontario patients is even safer, and continues to improve over time. 

A low reported compliance rate does not necessarily mean that health care providers are not performing hand hygiene. The audit tool measures whether health care providers are performing hand hygiene at the right times and the right way. That is why it is vital that hand hygiene compliance rates are viewed in the context of other performance indicators. That said, the analysis of these rates, over time will certainly provide helpful information that can be used to make system improvements in each hospital.

No. Patient safety is a number one priority for all Ontario hospitals. There are numerous checks and balances in place to ensure the safety of public hospitals but hospital care is complicated and depends on many factors. The public reporting of hospitals’ hand hygiene compliance rates is not intended to serve as a measure for hospitals to compare themselves against other organizations, or for the public to use as a measure of where to seek care. Rates can vary from hospital to hospital, month to month. Some hospitals will have lower observation opportunities because they do not have as much direct provider-to-patient care opportunities. Due to the types and patient populations (i.e. mental health) of these hospitals, their rates may seem lower. Like other indicators, it is important to look at hand hygiene compliance rates in a broader context. The rates 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.

Health care providers performing hand hygiene is a practice that continues to improve as we learn more about hand hygiene best practices. Both hospitals and the health care system have invested considerable resources to improve hand hygiene in hospitals.

The Public Health Ontario provincial hand hygiene campaign, Just Clean Your Hands, was designed to help hospitals and individuals overcome barriers to proper hand hygiene and improve compliance with hand hygiene best practices. The program recognizes that health care providers are busy and require immediate access to hand hygiene products at the right time in the patient care process.

At KGH, for example, where sinks used to be located inconveniently throughout hospitals, there is now fast and easy access to more than 2,200 alcohol-based hand rubs outside all inpatient rooms and adjacent to patients’ bedsides. There are also more freestanding hand cleaning stations located at all main entrances. In addition, ongoing education sessions are held to ensure health care providers know when and where to clean their hands to ensure patient safety.

Direct observation of hand hygiene practice is done by trained observers using the provincial audit tool. The observer conducts observations openly, recording what they see, with the identity of the health care provider is kept confidential.

The single most common transmission of healthcare-associated infections in a health care setting is via the hands of health care providers.

Health care providers acquire germs from contact with infected patients, or after handling contaminated material or equipment. Hand hygiene is an important practice for health care providers but also involves everyone in the hospital, including patients, families and visitors.

Effective hand hygiene practices in hospitals play a key role in improving patient and health care worker safety, and in preventing the spread of healthcare-associated infections.

Hand hygiene is the removal of visible soil and removal or killing of microorganisms from the hands. This can be accomplished using soap and water for visibly soiled hands or an alcohol-based hand rub.

Hand hygiene involves everyone in the hospital, including patients. 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.

More information is available at:

•  Ministry of Health and Long Term Care - Patient Safety  
• Public Health Ontario - Just Clean Your Hands campaign

Hand hygiene involves everyone in the hospital, including patients. 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.

More information is available at:

•  Ministry of Health and Long Term Care - Patient Safety  
• Public Health Ontario - Just Clean Your Hands campaign

Hand hygiene involves everyone in the hospital, including patients. 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.

More information is available at:

•  Ministry of Health and Long Term Care - Patient Safety  
• Public Health Ontario - Just Clean Your Hands campaign

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.

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.

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.

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.

Patients should always follow instructions given to them by your health care team.  Frequent hand cleaning is another way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.

Patients should always follow instructions given to them by your health care team.  Frequent hand cleaning is another way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.

Patients should always follow instructions given to them by your health care team.  Frequent hand cleaning is another way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.

Treatment depends on the type of catheter, the severity of the infection and the patient’s overall health. Generally, your doctor will prescribe antibiotics to fight the infection and the central line may need to be removed. In some cases, the line is flushed with high doses of antibiotics to kill the germs causing the infection so that the line does not have to be removed

• Ask lots of questions.
• Find out why you need the line and where it will be placed.
• Learn what steps the hospital is taking to reduce the danger of infection.
• Wash your own hands often. Use soap and water or an alcohol-based hand rub containing at least 60 per cent alcohol.
• Try not to touch your line or dressing. 

• All health care providers should practice proper hand cleaning techniques.
• Everyone who touches the central line must wash their hands with soap and water or use alcohol-based hand rub.
• Wear sterile clothing – a mask, gloves and hair covering – when putting in the line.
• The patient should be covered with a sterile drape with a small hole where the line goes in.
• The patient’s skin should be cleaned with “chlorhexidine” (a type of soap) when the line is put in.
• Choose the most appropriate vein to insert the line.
• Check the line every day for infection.
• Replace the line as needed and not on a schedule.
• Remove the line as soon as it is no longer needed.  

Health care providers who insert a central line in the vein of a patient fill out a central line insertion check list and procedure note which dates, tracks and documents the procedure.

Anyone who has a central line can get an infection. The risk is higher if you:

• Admitted to the ICU
• Have a serious underlying illness or debilitation
• Receiving bone marrow or chemotherapy
• Have the line in for an extended time 

• Redness, pain or swelling at or near the catheter site
• Pain or tenderness along the path of the catheter
• Drainage from the skin around the catheter
• Sudden fever or chills 

Central line infections occur when a central venous catheter (or “line”) is placed in the patient’s vein and the line gets infected. Patients in the intensive care unit (ICU) often require a central line since they are seriously ill and require a lot of medication for a long period of time. When a patient requires long-term access to medication or fluids through an intravenous (IV), a central line is put in place. A central line infection can occur when bacteria and/or fungi enters the blood stream. The bacteria can come from a variety of places (skin wounds, environment etc.), though it most often comes from the patient’s own skin.

Patients should always follow instructions given to them by your health care team.  Frequent hand cleaning is another way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.

• Ask lots of questions.
• Find out why you need the line and where it will be placed.
• Learn what steps the hospital is taking to reduce the danger of infection.
• Wash your own hands often. Use soap and water or an alcohol-based hand rub containing at least 60 per cent alcohol.
• Try not to touch your line or dressing. 

• Ask lots of questions.
• Find out why you need the line and where it will be placed.
• Learn what steps the hospital is taking to reduce the danger of infection.
• Wash your own hands often. Use soap and water or an alcohol-based hand rub containing at least 60 per cent alcohol.
• Try not to touch your line or dressing.