Colleagues,

Today, Ontario's Ministry of Health and Long Term Care releases two additional patient safety indicators including the results of the hand hygiene audit and the surgical site infection indicator which looks at the administration of antibiotics prior to hip and knee surgeries. 

As you know, Dr. Michael Baker is the Province's Executive Lead on Patient Safety and he has been touring the province, talking about what these indicators mean and how people should interpret them.  There is overwhelming interest in the audit of hand hygiene so I'll address our results for the audit first.

Auditors were in hospitals through the province, observing and recording whether health care workers washed their hands prior to patient contact and after contact with each patient.  At least 50 observations were recorded in each hospital and a percentage of compliance was then worked out for each site.  In our case, the results were:

Site, patient, orcontact      % compliance before initial patient 
or patient environment
     
        % compliance after
patient environment contact
TGH44% (594)70% (1,590)
TWH34% (212)60% (420​)
PMH36% (348)61%

 

 The number in brackets is the number of observations made at each site for each category.

The complete list of all Ontario hospitals may be found on the Ministry website or at www.myhospitalcare.com which is the OHA's site which is fully searchable by category.  We are discouraged from comparisons, but it is difficult not to look at other acute care settings.  While we aren't the worst, there is lots of room for improvement.  I was very impressed with the numbers in some of the larger community hospitals which have recorded compliance in the 80 – 90% range for both measures.

Michael Baker points out that this method has its difficulties as it is possible to individually be compliant nine out of 10 times but if the observation is taken at the moment you don't comply, you are rated 0 for compliance.  While it is tempting to blame the method, there's no getting around the fact that if we were all compliant all the time, it would be the best scenario possible for our patients and ourselves.  Given that the best way to prevent the spread of disease – including swine flu – is adherence to hand hygiene, I hope that we will all try to do better in the weeks and months ahead.  This indicator will be reported on a yearly basis so we have ample time to ramp up our efforts.

The other new indicator looks at the whether antibiotics were administered to patients having hip and knee surgeries.  This is a process measure.  The expectation is that surgical site infections are reduced by having antibiotics administered in the hour before the initial cut is made in the surgery and so measuring the process stands as a surrogate for the number of surgical site infections which you would find if you followed all cases after they were released from hospital.   In our case, of the 57 surgeries recorded at the Toronto Western Hospital, 96.61% of these patients were administered their antibiotics within the appropriate time.  The provincial average is 85.45% with 2,284 cases reported.  Congratulations to the entire surgical team at the Toronto Western Hospital for all of the work that has gone on to ensure that we are compliant with this measure.

Bob Bell​

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