Infection Reporting Required for All Hospitals

All Ontario hospitals are now required to report publicly on their rates and number of new hospital-acquired C. difficile cases, according to the Ontario Ministry of Health and Long-Term Care (MOHLTC).

Other hospital-acquired infections will be required to be publicly reported in coming months, including Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE).

"We support the Ministry's new public reporting requirements. Our staff, nurses, and doctors are dedicated to providing the best possible care to our patients," Mike Mazza, CEO of Middlesex Hospital Alliance (MHA), says.

A hospital-acquired infection, as the name suggests, is one that the patient contracts while staying in the hospital - not the reason the patient entered the hospital. Hospital patients can be more vulnerable to infection as their immune systems may be compromised by illness.

According to Yvonne Richardson, Infection Control Professional at MHA, C.difficile (Clostridium difficile) is a bacteria that can be part of the normal bacteria in the intestine of 3-5% of adults and is one of the many bacteria that can be found in stool (a bowel movement). A C.difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing the C.difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause diarrhea. C.difficile is one example of a hospital-acquired infection and has been a known cause of health care associated diarrhea for about 30 years.

"Patient safety is a priority at Middlesex Hospital Alliance," Nancy Maltby-Webster Chief Operating Officer for Middlesex Hospital Alliance (MHA), says. "We have ongoing Patient Safety initiatives and support a "transparent" approach to Patient Safety. This means that MHA requires accurate reporting of all incidents by staff and supports sharing of Patient Safety information, such as infection rates, on the website."

"We have been publicly reporting our rates for hospital-acquired infections - C.difficile, VRE and MRSA - on our web site ( http://www.mhalliance.on.ca/ ) since the beginning of this year," Maltby-Webster, says, "This new Ministry mandate will simply ensure that all Ontario hospitals are reporting at the same time and using the same criteria."

For example, the Ministry requires that C.difficile infection rate be publicly reported as a rate and as a number of new cases. The rate is calculated as a rate per 1,000 patient days. The "total patient days" represents the sum of the number of days during which services were provided to all inpatients during the given time period.

For the actual number reporting, the Ministry requires that any number of cases under 10 be reported as "less than 10" - whether that is one or nine cases.

Additionally, all Ontario hospitals will have their C.difficile infection rates posted on the Ministry web site, grouped by "comparable" hospitals, not necessarily by geography. That site is at: www.ontario.ca/patientsafety .

"In terms of reporting rates, the smaller the hospital, such as SMGH and FCHS, the greater the rates will vary, from month to month, because a change in even one case in a small facility will cause the rate to go up or down considerably," Dr. Pravin Shah, chief of pathology at MHA, says.

For the month of August, the first Ministry-mandated reporting month, the infection rate for both Four Counties Health Services and Strathroy Middlesex General Hospital was zero (0) indicating no cases at either site.

The page on the MHA's website that shows infection rates is included in the Performance Indicators section, along with other indicators such as Patient Satisfaction and Wait Times. The section called Performance Indicators, is available from the home page, under the Quick Links section (http://www.mhalliance.on.ca/ ).

Middlesex Hospital Alliance tracks several Performance Indicators to allow the organization to evaluate how well it is doing its job as a healthcare organization. The Performance Indicators section of the web site will continue to be updated and revised as data or reporting methods change. "Sharing this information on our web site allows patients, staff, our partners and stakeholders to be informed about our patient safety initiatives - and results," Mazza says.

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Infection Reporting Required for All Hospitals