Frequently Asked Questions
Health Care Tomorrow: Hospital Services, is a project that has been undertaken by the seven hospitals in our region (KGH, HDH, Providence Care, Quinte Health Care, Brockville General Hospital, Lennox and Addington General Hospital and Perth and Smiths Falls District Hospital) along with the South East Local Health Integration Network, the Community Care Access Centre and the Faculty of Health Sciences at Queen’s University. Together these organizations are looking for opportunities to share services on a regional level.
While the KGH and HDH integration announcement is not directly linked to the work that was started as part of Health Care Tomorrow, the project did serve as a helpful starting point for conversations as we began to look at integrating ourselves and deepening the partnership between our two hospitals. Our local integration plan is consistent with the intent of Health Care Tomorrow, which is to provide high quality, patient-centred and efficient services to patients in the South East.
It is too early to know if there will be any specific impact on jobs, however we do know that we will continue to deliver all of the services we currently offer to patients and families. That means we will continue to need the individuals who currently provide this care. We do anticipate there will be a reorganization of the management structure within the new academic health sciences centre.
As this process unfolds we will regularly provide updates to our staff, unions and all our stakeholders to ensure that they are aware of changes that are taking place. We are also committed to providing them with the opportunity to ask questions and share ideas with us as the process unfolds.
There are no plans to reduce the services offered on either site. Under the new entity, each site will continue to fulfill its unique role with the KGH site providing complex-acute and specialty care and the HDH site providing acute-ambulatory care. The services currently offered by KGH and HDH will continue to be offered by the new academic health science centre and we will continue to preserve, respect and honour the unique missions and cultures of both sites as we work more closely together.
This is first and foremost about making a bold step for our community to improve the experience of patients and families by delivering better and more coordinated care. We believe that by integrating our hospitals we will provide more efficient care that may also result in some financial savings.
We remain committed to honouring the unique missions and cultures of both sites as we move forward. The Hotel Dieu site will retain its Catholic identity and mission, and KGH will remain a secular site.
The choice to move forward with the integration was reached by both hospitals after consultation with the South East Local Health Integration Network, the Ministry of Health and Long-Term Care, as well as the Roman Catholic sponsors of Hotel Dieu Hospital, Catholic Health International. With their support and with the agreement in principle of Kingston Archbishop Brendan O’Brien there is clear consensus in moving forward with the integration.
Over the next several months, the hospitals will begin formal planning to establish the legal and operational structures for the new academic health sciences centre. During this time, the Interim CEO at KGH, Jim Flett, and Dr. Pichora, in his role as CEO at HDH, will work closely together to develop a transition plan. A joint team will be charged with leading this process and will also be engaging with the community to seek their input. It is anticipated that it will take up to 12 months to form the new corporation, at which time Dr. Pichora will assume the role of CEO.
HDH’s current Chief Executive Officer, Dr. David Pichora, will be the inaugural President and CEO of the new academic health science centre. The Boards of both hospitals and a selection committee carefully considered the needs of the new organization and felt that as a practicing physician who works at both KGH and HDH, in combination with his administrative role at HDH, Dr. Pichora was the ideal person to lead this new organization. His experience bridges both hospitals from an administrative, clinical and academic perspective and he embodies the already existing integration between the two hospitals.
The two Boards chose this direction as way to provide better, more integrated acute care for patients and families. This is an exciting, progressive approach to providing care. Many of our patients receive care at both HDH and KGH and we believe that the more closely we work together, the better experience we will deliver for patients, families and staff. There will also be the added benefit of a reduction in duplication between the two sites. For example, we will only need to produce one Quality Improvement Plan, one budget and undertake one accreditation process to name just a few examples.
The Board of Directors of Kingston General Hospital (KGH) and Hotel Dieu Hospital (HDH) have agreed to create a new integrated academic health sciences centre that will bring together the operations of the two hospitals. The new organization will operate as one hospital with one budget, on two separate sites, and will be overseen by one Board of Directors, Chief Executive Officer and Executive team.
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.
The information you provide will be stored in your genetics chart in the Medical Genetics office or the Familial Oncology Program office. These offices are part of Kingston General Hospital and will be protected under provincial health privacy laws. For more information about privacy at KGH, please click here.
This service is covered by your provincial health insurance. Any exceptions will be discussed ahead of time.
The decision to have genetic testing is a very personal one. The genetic counsellor or medical geneticist will talk to you about the benefits and limitations of genetic testing and will help you decide whether or not testing is right for you and your family. Most genetic tests are done using a blood sample.
Before you go to your first appointment, try to gather information about your family history, medical history, pregnancy history, and genetic concerns. A genetic counsellor may contact you to get some of this information before your appointment. You may be sent a family history form to complete and return to us before your appointment. You may also be asked to bring photos of family members. All of this information helps us to be as prepared as possible for your appointment and allows more time for us to answer any questions you may have during your actual appointment.
For those people who are referred regarding a family history of cancer, you may be mailed release forms to have signed and returned. This allows us to get information about the cancer diagnoses in your family so we can provide you with the most accurate and up-to-date information during your appointment.
You will begin by meeting with a genetic counsellor or medical geneticist who will review your (or your child's) medical and family history. If it is needed, the medical geneticist will do a physical exam. Additional tests may also be recommended. If a condition is diagnosed they will review information about the condition, what it may mean for your family, and discuss plans for management and follow-up care.
Appointments normally last about 1 to 1.5 hours. Please come 10 minutes early to allow time for registration. We also suggest that you allow extra time to find parking because parking is limited in the area surrounding the hospital. For more information about parking, or getting to KGH, click here.
You will meet with either a genetic counsellor or medical geneticist, or sometimes both. Genetic counselors are health care professionals with specialized training in counselling and genetics. Medical Geneticists are specialist doctors who have expert training and certification in genetics and inherited diseases.
Genetic counselling can help you learn how certain diseases, disabilities, or birth defects can affect you and the rest of your family. Your counsellor will provide you with information and support to help you make personal decisions about your health and the health of your children or pregnancies.
External cephalic version is a technique whereby a doctor turns a breech baby in utero to a head down position. The procedure involves the baby being turned manually by using pressure on your abdomen. The ECV is done by an Obstetrician with assistance from a Obstetrical Resident. Your healthcare provider can book your ECV with one of the obstetricians who does this procedure. You will be instructed to call Connell 5 on the morning of the procedure to set up a time throughout the day when it can be done. The doctor will discuss the procedure and the risks with you. The nurse will check your vital signs and start an intravenous line. You will feel a great deal of pressure during the procedure, however, it should not be painful. It can be completed in about five minutes. If you require further information about ECV, please ask your healthcare provider.
There are high-risk obstetricians available at KGH who specialize in managing your care during pregnancy. They will discuss any questions or concerns you may have and monitor your baby's well-being during your pregnancy. The use of narcotics during pregnancy is a balance of risks and benefits. If possible, discuss your medications with your healthcare provider before you get pregnant. You will be cared for through our obstetrical care clinic located on Kidd 5. For more information, click here, then scroll down to high-risk obstetrical care.
Every new mom hopes for a healthy baby but sometimes things don't go as planned. Babies can be born prematurely, with a serious health condition or can become ill after delivery. The Neonatal Intensive Care Unit (NICU) is equipped to deal with babies who need highly specialized care. When you are there, you and the NICU team will all work towards the same goal, to get your baby home. The NICU is located on the same floor as the postpartum unit which makes it easily accessible for you to visit your baby frequently. If you would like to learn more about the NICU, click here.
A birthing plan is an excellent way to clarify your expectations when preparing for childbirth. It is important to relate your issues and concerns, hopes or anxieties about the experience of birth to your doctor or midwife. You may wish to discuss other issues such as pain control, support persons in labour, infant care and handling, intravenous, labour positions and episiotomy. You may discuss any of these issues at your prenatal visits.Your care team will discuss your wishes for your plan of care and provide you with all the information to maintain a supportive labour and birth. Our caregivers respect your personal needs and choices.
Induction is a form of using artificial means to get your labour started. This may be done by using drugs or by rupturing the membranes. You may require this if you or your baby has a medical condition that would benefit delivering the baby earlier than expected. This may also be done if you past your due-date. Your physician or midwife will discuss with you your eligibility for outpatient induction. For more information click here and scroll to the bottom of the page.
Newborns do not generally get 'dirty' as long as they are cleaned with each diaper change. Two to three baths a week is appropriate, and provides stimulation for your baby. These baths will also go a long way towards making you feel more comfortable in handling your baby. As they get older and start to eat solid foods you will find that they probably need a bath every day.
Until your baby's umbilical cord falls off, it may be best to give them a sponge bath and avoid the tub. The cord should fall off after approximately 10 days to three weeks. If you decide that your baby needs a bath in the tub ensure that the cord is dried well afterwards. For more information on bathing your newborn, visit our newborn care section.
Postpartum depression is a serious psychiatric condition that requires immediate attention. You may have feelings of hopelessness, guilt, anxiety, panic attacks, little interest in your baby or suicidal thoughts. First, notify your caregiver right away. They will provide you with care and counselling. For urgent care, please go visit KGH's Emergency Department. For more information please refer to the Canadian Association of Mental Health.
Infertility is a common problem that affects approximately 8 per cent of women. Infertility is described as the inability to get pregnant after one year of trying for the first pregnancy, or six months thereafter. Although there are five factors that can contribute to infertility, 30 per cent of the time no specific cause for infertility can be found. KGH operates a infertility clinic that is available to you upon referral from your family physician or gynecologist. If you would like more information on techniques you can try on your own to help get your body ready for pregnancy, you can also visit the Queen's University Department of Obstetrics website.
Upon discharge, your doctor or nurse will give you instructions on which medications you should continue at home, which medications you should stop at home and which ones you should start taking.
While in hospital there may be various reasons why your pills look different. The medication may be made by a different company so they look slightly different; the medication may have been substituted with another drug from the same class of medication; or your medication may have been stopped and another drug started for another reason. Do not hesitate to ask your nurse or doctor to give you the name of the medication you are receiving and the reason why.
You can return to your usual home pharmacy. We encourage you to request a “Meds Check” from your pharmacist in order for you to have an updated medication list from your drug store.
No, medications are supplied to you through nurses.
Yes, the table weight limit is 400 lb. or 180 kg., with a maximum width restriction of 60 cm. For optimal images it is necessary for the area being examined to be within the magnets isocentre which is located directly in the centre of the scanner. For patient specific questions please contact our MRI bookings department.
The area of the scanner that creates the images is located in the centre of the magnet and is called the isocentre. Therefore, in order to scan your head most of your upper body will be in the scanner. The same is true when imaging the spine and upper extremities.
No. The MR scanner can scan almost any part of the body but each scan is limited to a specific area. It can take from 30-60 minutes to scan each area.
Both MRI and CT create cross-sectional images of the body. The main difference is that MRI uses a large magnet and radio waves to produce images where as a CT scanner uses ionizing radiation.
No. Although there may be noise emitted from the MRI scanner during your test, there is no pain involved during the procedure.
The noise that the scanner creates is the electrical current rising within the wires of the gradient magnet. The current in the wires are opposing the main magnetic field; the stronger the field the louder the gradient noise.
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.
Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.
The actual number of VAP cases (case count) will be shown if the number is zero or totals five or more cases associated with that hospital site. If the number is greater than zero but less than five cases, it will be shown as <5 (less than five) in the case count column. The VAP rate is the number of new cases of VAP in the ICU per 1,000 ventilator days. To calculate this rate the total number of VAP cases in the ICU after 48 hours of mechanical ventilation in the ICU is divided by the total number of ventilator days for patients 18 years and older.
Since VAP is caused by bacteria in the lungs, it is treated with antibiotics.
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.
- Practising proper hand cleaning techniques
- Keeping the patient’s head of the bed elevated to a 30-45-degree angle
- Discontinuing mechanical ventilation as soon as safely possible
- and good oral care.
- Being on a ventilator for more than five days
- Recent hospitalization (last 90 days)
- Residence in a nursing home
- Prior antibiotic use (last 90 days)
- Dialysis treatment in a clinic
The most important symptoms include:
- Low body temperature
- New purulent sputum (foul smelling infectious mucous or phlegm coughed up from the lungs or airway)
- Hypoxia (decreased amounts of oxygen in the blood)
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.
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).
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
- 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.
Patient safety is a number one priority for all KGH. There are numerous checks and balances in place to ensure the safety of our hospital but hospital care is complicated and depends on many factors. The public reporting of hospitals’ checklist 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. Like other patient safety indicators, it is important to look at checklist 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.
The public reporting of our surgical checklist percentage compliance allows us to establish a baseline from which we can track over time. We will closely monitor our rates and should they decrease, we will look closely at our operating room processes and target areas for improvement. The checklist percentage compliance measures the degree to which all three phases (i.e., a briefing, a time out, and a debriefing) of the checklist were performed correctly and appropriately for each surgical patient. We are always striving for 100 per cent compliance.
Hospitals will post their bi-annual percentage compliance at the end of July and January.
KGH implemented the checklist in one surgical specialty in November 2009. The checklist was implemented in all surgeries in April 2010.
As part of the Ministry of Health and Long-Term Care’s public reporting of patient safety indicators initiative, eligible hospitals are legally required to post their checklist compliance percentages. KGH strongly supports the provincial government’s strategy to publicly report patient safety Indicators because we believe it will enhance patient safety and strengthen the public’s confidence in our hospitals.
The Canadian Patient Safety Institute has a checklist template that has mandatory requirements for Ontario hospitals to use. KGH then adds additional items to this template that allows us to customize items to fit the type of surgeries performed here and have been declared to be important to the KGH patient population.
If you undergo a surgery at Kingston General Hospital, you can expect that the surgical safety checklist will be used as part of the procedure. As a patient, you will be asked questions by a surgical team member so that they can complete a portion of the checklist with you. It will then be used by your surgical team members before, during and after your surgery to help the surgical team members familiarize themselves with your medical history and any special requirements that may be needed for your individual case.
Operating room teams have many important steps to follow in order to ensure a safe and effective surgery for every patient. The checklist is a useful tool that helps promote good communication and teamwork among the health care team to help ensure the best outcomes for patients.
The checklist is used at three distinct stages or phases during surgery:
- pre-induction (before the patient is put to sleep)
- time out (just before the first incision)
- and debriefing (during or after surgical closure)
Some examples of items contained in the checklist include:
The briefing phase:
- Verify with patient name and procedure to be done
- Allergy check
- Medications check
- Operation site, side and procedure
- Lab tests, X-rays
The “time out” phase:
- Patient position
- Operation site and side and procedure
- Antibiotics check
The debriefing phase:
- Surgeon reviews important items
- Anesthesiologist reviews important items
- Nurse reviews correct counts
A surgical safety checklist is a patient safety communication tool that is used by a team of operating room professionals (nurses, surgeons, anesthesiologists, and others) to discuss important details about each surgical case. In many ways, the surgical checklist is similar to an airline pilot’s checklist used just before take-off. It is a final check prior to surgery used to make sure everyone knows the important medical information they need to know about the patient, all equipment is available and in working order, and everyone is ready to proceed.
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.
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.
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:
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.
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. difficle is causing the diarrhea.
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.
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.
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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.
Make sure to follow all instructions carefully about medications, food and drink, that you received from the Pre-Surgical Screening clinic. Please call your surgeon's office if you have any questions.
In order to decrease your risk of infection, please shower or bathe before arriving for your surgery.
If your are being discharged the day of your surgery ( going home once recovered from surgery) arrange a ride home and plan to have someone stay with you for the first 24 hours after surgery.
Your Surgeon and Anesthesiologist will speak with you and answer your questions on the day of your surgery, prior to you going to the operating room. If you have questions earlier than that, please contact your Surgeon’s office.
If for any reason you need to reschedule or cancel your surgery (you’re feeling sick, or you no longer want to have the surgery), please call your surgeon’s office as soon as possible.
If you need to cancel or reschedule less than one week before your scheduled surgery date and you are unable to reach the surgeon's office, please call the KGH Operating Room at 613-548-7820.
You should bring your Health Card, insurance information, credit card, medications in original containers as well as a housecoat and slippers. We also encourage patients to bring their CPAP or BiPAP machines from home in order to assist your breathing as you recover from surgery.
If you are staying in the hospital after your surgery and would like to have some personal belongings with you during your stay, please have a family member bring them once your surgery is complete and you have arrived in your hospital room. If your are being discharged the day of your surgery ( going home once recovered), do not bring any extra belongings with you.
Please do not bring valuables (e.g. large amounts of money, jewellery) of any kind to the hospital.
A member of our team will call you the night before your surgery (any time after 2:00 p.m.) to confirm the time that you are required to arrive at KGH’s Same Day Admission Centre which is located on Connell 2.
You will soon be contacted by the Pre-Surgical Screening office which is located at Hotel Dieu Hospital to book an appointment to help prepare you for your surgery.
If you have not been contacted by the office one week before your scheduled surgery date, please call: 613-544-3400 ext. 2203
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