Frequently Asked Questions

What are infection prevention and control precautions? How does this affect my care?

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.  

What are infection prevention and control precautions? How does this affect my care?

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.  

Can someone die from VRE?

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.

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What is the treatment for VRE?

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.

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How is VRE diagnosed?

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

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What are infection prevention and control precautions? How does this affect my care?

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.  

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What precautions are used to prevent the spread of VRE in the hospital?

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. 

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How is VRE spread?

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.

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Who is at risk of contracting VRE?

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

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What are Vancomycin-resistant Enterococci (VRE)?

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).

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What is a bacteremia?

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

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Where can I get more information about this and other Patient Safety Indicators?
What are infection prevention and control precautions? How does this affect my care?

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.  

What are some of the key contributing factors to KGH’s HSMR rate?

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. 

Does an above average HSMR mean the care is not good at KGH?

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.

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Why is the HSMR an important measure?

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.

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Why was a new methodology for calculating HSMR initialized?

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.

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What are some of the key contributing factors to KGH’s HSMR rate?

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. 

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What is the Hospital Standardized Mortality Ratio (HSMR)?

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.

What are some of the key contributing factors to KGH’s HSMR rate?

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. 

What are some of the key contributing factors to KGH’s HSMR rate?

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. 

What can patients do to help reduce their chances of infection in general?

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.

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How is a central line associated bloodstream infection (CLI) treated?

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

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What can patients do to prevent a central line associated bloodstream infection (CLI)?
  • 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. 
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What are health care providers doing to prevent a central line associated bloodstream infection (CLI)?
  • 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.

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What are some of the risk factors for a central line associated bloodstream infection (CLI)?

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 
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What are some of the symptoms of a central line associated bloodstream infection (CLI)?
  • 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 
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What is a central line associated bloodstream infection (CLI)?

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.

What are some of the risk factors for a central line associated bloodstream infection (CLI)?

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 
What are some of the risk factors for a central line associated bloodstream infection (CLI)?

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 
What are some of the risk factors for a central line associated bloodstream infection (CLI)?

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 
What can patients do to help reduce their chances of infection in general?

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.

,
How is a central line associated bloodstream infection (CLI) treated?

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

,
What can patients do to prevent a central line associated bloodstream infection (CLI)?
  • 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. 
,
What are health care providers doing to prevent a central line associated bloodstream infection (CLI)?
  • 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.

,
What are some of the risk factors for a central line associated bloodstream infection (CLI)?

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 
,
What are some of the symptoms of a central line associated bloodstream infection (CLI)?
  • 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 
,
What is a central line associated bloodstream infection (CLI)?

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.

What are some of the symptoms of a central line associated bloodstream infection (CLI)?
  • 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 
What are some of the symptoms of a central line associated bloodstream infection (CLI)?
  • 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 
What are some of the symptoms of a central line associated bloodstream infection (CLI)?
  • 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 
What are surgical site infections (SSIs)?

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.

How are SSIs treated?

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.

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What can patients do to help prevent SSIs?

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.
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What precautions are hospitals/health care providers taking to prevent SSIs?

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.
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What are the risk factors for SSIs?

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
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What are the symptoms of SSIs?
  • 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.

,
What are surgical site infections (SSIs)?

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.

What are surgical site infections (SSIs)?

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.

What are surgical site infections (SSIs)?

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.