Enhancing bedside manner with iPad.

Not only has iPad increased efficiency from a provider perspective

its increased engagement between the provider and patient.
Dale Potter, Senior Vice President Strategy and Transformation, The Ottawa Hospital
Bedside care is a vital part of health care professionals relationships with their patients. But the staff at The Ottawa Hospital found
that modern technology sometimes made those interactions more difficult. Since the introduction of technology in this industry,
Senior Vice President Dale Potter explains, physicians have been tethered to devices like PCs and forced to go seek information.
Even a laptop wasnt truly mobile.
This inability to bring information to the bedside meant physicians had to constantly shuttle between patients and tethered PCs to
get status updates, schedule surgeries, prescribe drugs, view X-rays, and perform other important tasks.
When Apple introduced iPad, physicians at The Ottawa Hospital knew theyd found a solution. With iPad, the hospitals doctors and
nurses have bedside access to everything they need, and can remain in contact with patients and their families while viewing
information that is critical to their care.
They can answer patients questions immediately and make decisions about whats going to be done, with the most current
information available, says Dr. Glen Geiger, Chief Medical Information Officer. Nothing beats being able to use an app to pull up an
X-ray on the device.
Increased Patient Interaction
Physicians at The Ottawa Hospital have started using iPad in innovative new ways. They can use the built-in iPad camera to
photograph a patients wound during treatment, and store the image in the patients electronic medical record for future reference.
Using iPad, physicians can show patients the progress of their recovery right at the bedside, Dr. Geiger notes. I can say, Heres
what your wound looked like three weeks ago. Im showing them what it looked like then and what it looks like today.
iPad fits physicians workflows in many ways, Potter says: The form factor of iPad is very attractive. The screen size is optimal.
Theres almost instant access to information. Battery life exceeds the length of a shift. Its critically important for a physici an to be
able to know that they can rely on that device, work for an entire shift, and provide the same level of care to all their patients.
Substantial Time Savings
The Ottawa Hospital has also developed an in-house app called the Clinical Mobile App. The app facilitates three major aspects of
physicians daily workflows: accessing patients clinical information, viewing clinical images such as X-rays and CT scans, and
ordering clinical tests and prescriptions.
iPad and the Clinical Mobile App enable physicians to significantly reduce the time they spend reviewing patients cases before
making their rounds each morning. This would take several hours, Dr. Geiger says. We would just be sitting in the room going
over each case. The process was so time-consuming that some non-critical care patients often didnt get to see their physicians
that day.
But iPad and the Clinical Mobile App have changed all that. Now we meet first thing in the morning, make sure we have a complete
record of all the patients, and immediately start to see them, says Dr. Geiger.
By eliminating lengthy meetings and the need to shuttle between patients and tethered PCs, Potter estimates the physicians save
approximately two hours per day in their clinical care activities. Not only has iPad increased efficiency from a provider perspective
its increased engagement between the provider and patient, he says.
Developing on the iOS platform is actually fairly quick. Were talking days and weeks
as opposed to months and sometimes years.
Valrie Gamache-OLeary, Chief Information Officer, The Ottawa Hospital
Quick Development Times
In addition to the Clinical Mobile App, the hospital has developed three other custom apps: a pain study app to document a patients
pain thresholds and determine proper treatment; a hand hygiene app to record and report on hand hygiene compliance; and a
patient rounding app with a standard set of questions that nurses ask patients on a daily basis, so the answers are recorded in a
consistent way.
Developing on the iOS platform is actually fairly quick, says Valrie Gamache-OLeary, Chief Information Officer. Compared to
applications in other environments, youre able to iterate through versions of software, get them into production, and test them
very, very quickly. Were talking days and weeks as opposed to months and sometimes years.
A Hospital-Wide Solution
The Ottawa Hospital has thousands of iOS devices in circulation. Physicians, pharmacists, nurses, and executives rely on iPad, and
many other employees also use iPhone and iPod touch. A housekeeper can say, Im in this room, Im at this bed, and its ready for a
patient, and that information can be immediately transmitted from their iPod touch or iPhone, Potter says.
Among the hospitals executives, iPad is a key part of the drive toward paper-free meetings. Everyone has an iPad, says Potter. We
can intercommunicate with each other. We can share documents. There really is no reason for us to have paper in our meetings.
I believe iPad represents the future of patient-centered care at The Ottawa Hospital.
Dr. Glen Geiger, Chief Medical Information Officer, The Ottawa Hospital
The Future of Patient Care
As Potter walks through the hospital, he finds physicians engaging with patients the way they used to many decades ago. As I
observe the physicians doing their work, theyre at the bedside interacting with patients and family members, he says. Theres an
intimacy there that wasnt possible before iPad.
In fact, he adds, The riskiest thing I could do in my position as CIO at The Ottawa Hospital is try to take iPads away from my users!
iPad and apps help physicians at The Ottawa Hospital interact more effectively with patients and provide more immediate, focused
treatment. iPad and apps have changed the way we deliver care, Dr. Geiger says. Its the foundation for patients becoming more
directly engaged with their own health care. I believe iPad represents the future of patient-centered care at The Ottawa Hospital.
Patient Safety is a priority at The Ottawa Hospital. It is one of four quadrants that make up our Quality Framework:
1. Access
2. Appropriate (effective and efficient)
3. Safety
4. Satisfaction.
As a leader in patient safety, The Ottawa Hospital strives to create a Patient Safety Culture that features:
Acknowledgement of the high risk and error-prone nature of health care activities
A blame free environment where individuals are able to report errors and close calls without fear of reprimand or punishment
An expectation of collaboration to seek solutions and create action plans
A willingness on the part of the organization to divert resources for addressing safety concerns
Centre for Patient Safety
The Ottawa Hospital is home to The Centre for Patient Safety, a 'virtual' centre created in 2005 to guide TOH to provide the safest patient care through nationally
recognized research, education, and evaluation methods.
The Centre is a result of a strong collective commitment from clinicians and renowned researchers at our hospital and our research arm, the Ottawa Hospital Research
Institute to improve the safety of patient care at TOH.
Every year in Canada patients die or become seriously ill from infections acquired in hospitals. It is estimated that at least 30% of hospital acquired infections
are preventable. Bacteria that cause infections are most frequently spread from one patient to another on the hands of health care workers.

Scientific evidence shows that hand hygiene is the single most important way of controlling the spread of micro organisms which can cause infection.

In an effort to promote and improve hand hygiene, The Ottawa Hospital takes part in the Ministry of Health and Long Term Care's Just Clean Your Hands
program. This evidence-based program builds on work done by the World Health Organization and the United Kingdom . It was specifically designed for
Ontario hospitals and was successfully pilot tested in 10 Ontario hospitals, including The Ottawa Hospital.

The goals of the program are:
Improve Hand Hygiene practices among health care workers
Obtain and sustain long term improvement in the hand hygiene practices among Ontario's health care workers
Build a culture of hand hygiene compliance where infection prevention and control is everyone's business.
For more information visit, Just Clean Your Hands.


Patient safety remains the most important priority for The Ottawa Hospital and we are working to create a culture of patient safety that involves everyone health-care
administration, health-care professionals, and, of course, patients and families.
Research shows that hand hygiene is the single most effective way to reduce the risk of healthcare-associated infections. Hand hygiene is a key issue for our hospital, and
we continually work to improve compliance. Of course it is something we all do but we want to continue to do better and ensure everyone cleans their hands at the right
times and in the right way.
Patients can help improve their own 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 patient-specific information is available at www.ontario.ca/patientsafety and www.oha.com/patientsafetytips andwww.oha.com/cleanhandsprotectlives.
Measuring compliance rates

Ontario hospitals are posting their hand hygiene compliance rates as percentages for time periods identified by the Ministry of Health and Long-Term Care, using the
following formula:
# of times hand hygiene performed x 1000
# of observed hand hygiene indications
These percentages also reflect:
1. hand hygiene before initial patient/patient environment contact by combined health-care provider type (e.g., nurses, health professionals, physicians, housekeeping,
support staff, etc.)
2. hand hygiene after patient/patient environment contact by combined health-care provider type (e.g., nurses, health professionals, physicians, housekeeping,
support staff, etc.)
In simple terms, the rates include hand hygiene compliance both before and after contact with the patient.
Hand hygiene compliance rates at The Ottawa Hospital

Patient Safety

Patient Safety Indicator results at Health Quality Ontario
Effective December 2012, patient safety indicator results, as reported by Ontario hospitals, as well as other patient safety information, are available on Health
Quality Ontarios (HQO) website. Publically reporting patient safety indicators aligns with HQOs mandate to monitor and report on Ontarios health care
system to the public.
Public reporting also increases transparency and accountability, and supports quality improvement efforts. Viewprovincial and individual hospital results of
nine patient safety indicators on the Health Quality Ontario website.
Other useful links
For more information on infection prevention and control, please visit Public Health Ontario
Additional tools and resources through The Ontario Hospital Association


Patient Safety Indicator Public Reporting
Improving patient safety is about creating an environment that is transparent and committed to change. This is the mandate of the government's Patient
Safety Initiative.
The government announced public reporting of eight indicators on May 28, 2008 as part of a comprehensive plan to create an unprecedented level of
transparency in Ontarios hospitals. A Public Hospitals Act (PHA) regulatory amendment, effective July 28, 2008, requires hospitals to publicly report on
patient safety indicators related to hospital-acquired infections, actions undertaken to reduce such infections, and mortality. Under Regulation 965 of the PHA,
hospitals are required to disclose the results of each indicator through their website.
As of 2010 Ontario hospitals publicly report on nine patient safety indicators. Standardized data elements, case definitions and reporting requirements have
been developed for all indicators. The list of patient safety indicators and timeframes for reporting are given below.
Patient Safety Indicator Date of initial Public Reporting Reporting Frequency
Clostridium difficile Infection (CDI) rate Sept. 26, 2008 Monthly
Methicillin-resistant Staphylococcus aureus(MRSA) rate Dec. 30, 2008 Quarterly in January, April, July and October
Vancomycin-resistant Enterococci (VRE) rate Dec. 30, 2008 Quarterly in January, April, July and October
Hospital-Standardized Mortality Ratio (HSMR) Dec. 30, 2008 Annually in December
Ventilator-Associated Pneumonia (VAP) rate April 30, 2009 Quarterly in January, April, July and October
Central Line-Associated Primary Blood Stream Infection (CLI) rate April 30, 2009 Quarterly in January, April, July and October
Surgical Site Infection (SSI) prevention rate in hip and knee joint
replacement surgeries
April 30, 2009 Quarterly in January, April, July and October
Hand Hygiene Compliance April 30, 2009 Annually in April
Surgical Safety Checklist (SSC) compliance July 30, 2010 Bi-annually in January and July



Other Patient Safety Initiatives
The Ontario government has taken a number of steps to strengthen patient safety in health care institutions across the province.
CDI Outbreak Definition
A Health Protection and Promotion Act regulatory amendment, effective September 1, 2008, makes Clostridium difficileInfection (CDI) a communicable
disease designated as reportable. As a result, public hospitals are required to report all cases and outbreaks of CDI to their Public Health Unit.
Hand Hygiene Improvement
Effective December 1, 2011, the Ministry of Health and Long-Term Care completed the transfer of the Just Clean Your Hands (JCYH) program to Public
Health Ontario.
JCYH is an evidence-based, multifaceted program established in Ontario in 2008 to improve compliance with hand hygiene best practices in health care
settings to prevent healthcare associated infections and promote patient safety. In 2009, JCYH was adapted and rolled out for use in long-term care homes,
and launched to retirement homes in 2011.
For more information about the JCYH program, please visit the Public Health Ontario website at oahpp.ca/services/jcyh.
Regional Infection Control Networks
Fourteen Regional Infection Control Networks (RICNs) have been created across the province to promote the best approaches to infection prevention and
control. This includes promoting consistent infection prevention and control policies and surveillance practices. Development of the networks has brought
together infection prevention and control expertise from all health care settings, including hospitals, public health units, community care centres and long-term
care homes.
Infection Prevention and Control Practitioners
The government has provided funding for infection prevention and control practitioners (ICPs) in hospitals across the province. ICPs are typically health care
professionals who have specialized training and expertise in infection prevention and control. The ICP works with all departments in an organization to
prevent health care-associated infections through planning, implementing, evaluating and providing feedback on current practices. They also educate health
care staff on infection prevention and control, conduct surveillance and provide expert consultation as needed.
An extensive education program for infection prevention and control professionals in acute care facilities has been developed by the government in
partnership with infection prevention and control experts and other stakeholders. The program provides current, evidence-based educational modules for
front-line health care professionals in acute care settings. The modules focus on hand hygiene, chain of transmission and routine practices.
Nationally recognized for its leadership in infection control, The Ottawa Hospital's Infection Prevention and Control Program is an essential component of quality patient
care. The program's evidence-based guidance and recommendations help reduce the risk of infection for patients, staff and visitors.
The program helps ensure the protection of patients, health care workers, staff and visitors from preventable nosocomial disease through surveillance, education,
consultation, outbreak investigation, research and the development of policies and procedures.
Nosocomial or Hospital-Acquired Infection
A nosocomial infection is one that was not present or incubating prior to the patient being admitted to the hospital, but occurred within 48 hours after admittance to the
hospital. It is often referred to as hospital-acquired'.
TOH monitors infection rates very closely. Despite our best efforts, nosocomial rates for MRSA, VRE and C difficile are on the rise in hospitals across Canada , as well as
in the United States and Europe . Increases are being seen for a number of reasons including:
Todays hospitalized patients are sicker than ever before;
The number of patients with weakened immune systems is increasing;
New devices and procedures with inherent risks are in use;
Antibiotic use is resulting in the development of resistant bacteria;
Increased travel allows global spread of bacteria and other pathogens.
To combat this global rise in infection rates, TOH has implemented several measures to address infection rates, including:
Hand hygiene program with increase access to alcohol gel;
Screening patients on admission for silent carriage of resistant organisms;
Use of single rooms, gowns, and gloves to control transmission;
Renovations to patient care areas;
Increased housekeeping resources;
Education and awareness campaigns for patients and health care providers.
Learn more about:
Antibiotic-Associated Diarrhea
Avian Flu
C difficile
MRSA
The Ottawa Hospital publicly reports on several patient safety indicators and immediately reports Clostridium Difficile (C. difficile) outbreaks to their local public health units
so that Medical Officers of Health have the information they need to monitor and respond to emergent outbreaks.

Units currently experiencing a greater than normal rate of patients affected, can be viewed on the Monitoring Clusters and Outbreakspage.

Patient safety indicators to be reported publicly are:
Central line infections
Clostridium difficile (C. difficile)
Hand hygiene compliance
Hospital Standardized Mortality Ratio (HSMR)
Methicillin-resistant Staphylococcus aureus (MRSA)
Surgical Safety Checklist
Surgical site infections (SSI)
Vancomycin-resistant Enterococci (VRE)
Ventilator-associated pneumonia (VAP)

Monitoring
As a result of extremely high occupancy rates, The Ottawa Hospital can experience an increased number of cases of MRSA , andClostridium difficile (C. difficile) in its in-
patient units. Our health-care teams work hard to reduce their occurrence and when cases are detected, special measures are put in place to reduce thei r spread.

These include:
Isolating patients who have diarrhea in private rooms when possible.
Using a bleach solution to clean the environment.
Auditing to ensure equipment and hands are cleaned between patients.
Reminders to staff, patients and visitors that frequent hand washing, or use of alcohol -based hand rubs, is the best way to stop the infection.
Preventing unnecessary traffic and congestion in the unit experiencing the outbreak.
Outbreaks
The Ontario government strongly encourages all hospitals to report outbreaks and outbreak-associated cases of MRSA, VRE and C.difficile to their local public health unit
when the definition of an outbreak is met in their facility. For details of this definition, please visit the Ministry website at www.health.gov.on.ca.

Clusters
The Ottawa Hospital is committed to providing patients and their visitors with the information they need to play a greater role in their care and the care of their loved ones.
As a result, the hospital goes a step beyond Ministry requirements, and reports on units that are experiencing a greater than normal number of cases but have not reached
outbreak levels.
In-patient units currently on alert:
Civic Campus General Campus
VRE --- ---
MRSA D7/F7, E5 ---
C. difficile --- ---
Norovirus --- ---
* Identified as meeting Ministry of Health and Long Term Care definition of outbreak
As we work to manage clusters and outbreaks, we ask that patients and visitors please respect our Infection Control Visitor Protocols for those in-patient units on alert. We
are asking that patients in the affected units limit themselves to one visitor at a time during normal visiting hours (3-8 p.m.).

Patients in units not affected by the infection control precautions will continue to be permitted two visitors at a time from 3-8 p.m. as per our usual Visitor Guidelines.

When you visit, please clean your hands at
one of the many hand washing stations
throughout the hospital before, during and
after your visit. If you are unwell, please do
not visit patients in the hospital.

Central line infect
When a patient requires long-term access to medication or fluids through an IV, a central line is put in place to provide easy access to a vein. It is placed into a large vein
in the neck, chest, groin, arm or abdomen. This is used instead of having to frequently insert needles for treatments such as chemotherapy, antibiotics and intravenous
fluids, and feeding, or to take samples of blood for testing.
A central line blood stream infection (CLI-BSI) can occur when bacteria and/or fungi enters the blood stream, causing a patient to become sick. The bacteria can come
from a variety of places (e.g., skin, wounds, environment, etc.), though it most often comes from the patients skin.
Hospitals follow best practices on how to prevent bacteria from entering into a central line. Patients in the Intensive Care Unit (ICU) often require a central line since they
are seriously ill, and will require a lot of medication, for a long period of time.
More patient-specific information is available at www.ontario.ca/patientsafety and www.oha.com/patientsafetytips andwww.oha.com/cleanhandsprotectlives.
In Ontario, all hospitals with ICUs are required to report into the Critical Care Information System (CCIS) a centralized data collection system where hospitals report a
variety of critical care information. Included in the data is the CLI rate.
These Ontario hospitals are posting their quarterly CLI-BSI rate and case count for those infections acquired in their facility, using the following formula:
total # of ICU related CLI-BSIs after 48 hours of central line placement x 1000
total # of central line days for ICU patients 18 years and older
Central line blood stream infection rates at The Ottawa Hospital


C difficile
C. difficile is just one of the many types of bacteria that can be found in the environment and the intestines. For most people, it does not pose a health risk. However,
C. difficile associated disease (CDAD) can sometimes occur when antibiotics are prescribed. Antibiotics work by killing off bacteria the bad bacteria but also good
bacteria. This can allow the C. difficile bacteria to multiply, which may cause diarrhea and can damage the bowel.
CDAD is the most common cause of infectious diarrhea in healthcare facilities. The effects of CDAD are usually mild but can sometimes be more severe. In severe cases,
surgery may be needed, and in extreme cases CDAD may cause death.
Rates of C. difficile are the first of eight patient safety indicators that hospitals will be required to publicly report. All of these indicators will be posted on the Ministry of
Health and Long-Term Web site and also on each hospitals own Web site.
Its important to understand that the reporting of these rates is not the overall solution to reducing the rates of healthcare associated infections. They are tools which will
provide hospitals with good information to assist them in understanding where patient safety issues exist and help them to take action to improve their safety standards.
The public reporting builds on other initiatives such as Just Clean Your Hands a hand hygiene program for all Ontario Hospitals that was launched in March 2008 and the
creation of 14 Regional Infection Control Networks across the province.

Rates of C. difficile
It is important to note that C. difficile rates, as is the case for all infections, can fluctuate over the course of a year for a number of reasons. For example in winter, we admit
more patients with respiratory infection than at other times of the year. An increase of respiratory infections often results in more antibiotics being prescribed, a leading
factor in new cases of C. difficile.
An increase in the rates of C. difficile may also be related to periods of increased occupancy levels. An increased number of patients mean that more patients are being
cared for closer together. Close physical proximity can result in C. difficile being spread more easily.
When we experience cases of C. difficile, they are usually contained in a limited geographic area or unit of the hospital. Also, patients and families should know that
compared to the overall number of patients admitted each year, these cases are relatively low in number.
That said, The Ottawa Hospital pays close attention and follow a number of procedures to control and manage new cases of C. difficile. As described in the provincial best
practice standards for managing C. difficile, we are:
Isolating individuals identified or suspected to have C. difficile, wearing gowns and gloves to enter their rooms.
Ensuring that all patients suspected of having C. difficile in hospital are tested.
Reminding all staff of the importance of proper hand hygiene.
Ensuring proper cleaning of all patient rooms, including rooms of C. difficile cases.
Ensuring that visitors are instructed in hand washing and other control measures.
Providing education where needed so that all members of our team are up-to-date with current management strategies.
Ensuring that all patients with C. difficile infection are appropriately treated.
The C. difficile infection 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.
The rate is calculated as follows:
Number of new hospital acquired cases of C. difficile in our facility x 1000
Total number of patient days (for one month)
C-difficile Rates at The Ottawa Hospital
C-difficile Rates for All Ontario Hospitals
The Ottawa Hospital Shows Positive Results HSMR 2012
TOH continues to see much fewer deaths than expected based on how sick patients are when they arrive for treatment. Overall, The Ottawa Hospital is seeing favourable
trends in its HSMR data, largely due to decreases in mortality at the Civic Campus. Mortality rates remain stable at the General Campus and the number of observed
deaths does not exceed the number expected. As TOH cares for the most seriously ill and injured in our region, the result is viewed positively overall.

TOH works to continuously improve outcomes in quality and patient safety and strives to better understand system factors that influence why patients die in hospital. The
HSMR results will support efforts to further reduce the mortality rate in our hospital and other hospitals in Canada.

It is important to note that in the time since TOH set its corporate HSMR target in March 2012, the Canadian Institute for Health Information (CIHI) revised the way it
calculates HSMR. CIHI changed its methodology to reflect the advances in care across all hospitals since they initially developed their approach. As a result, hospitals in
Canada - including TOH - have recently recalculated their HSMR targets to reflect the new methods. At TOH, patient safety epidemiologists compared the old and new
approaches to determine a new target of 95. This level can be considered to mean that 5% fewer patients die than would be expected to based on how sick patients are
when they arrive at the hospital.

HSMR* HSMR* 95% CI
2004 - 2005 120 113-127
2005 - 2006 114 108-121
2006 - 2007 117 111-124
2007 - 2008 104 98-110
2008 - 2009 107 101-114
2009-2010
104 98-110
2010-2011
100 94-106
2011-2012
92 86-97

Hospitals included in the corporation result:
The Ottawa Hospital Civic Campus
The Ottawa Hospital General Campus
Notes:
* Previously referred to as HSMR All Cases
95% CI 95 percent confidence interval
The result is statistically different from the 2004-2005 baseline HSMR of 100 (p<0.05)
The Ottawa Hospital strongly supports the provincial governments new public reporting as we believe it will inspire improved performance, enhance patient safety, and
strengthen the publics confidence in Ontarios hospitals. The dedicated health professionals at TOH are committed to providi ng the best possible patient care and we use
HSMR as a tool to help make quality improvements based on the results.
What is HSMR?
The hospital standardized mortality ratio (HSMR) is a measure of patient safety that compares a hospital's mortality rate with a national standard. It is used by many
hospitals worldwide to assess and analyze mortality rates and has been proven useful in identifying areas that can be changed to improve patient safety and the quality of
care.

HSMR gives hospital administrators and health providers a snapshot of a hospitals performance at a given time and must be vi ewed in context with other indicators to help
track progress over time.

It is important to note that hospitals even within a region often serve different segments of the population with different health needs. That may help explain why our
hospital scored differently than other hospitals in our LHIN.
How is HSMR calculated?
HSMR is a ratio of "observed" to "expected" deaths, multiplied by 100. A ratio greater than 100 means more deaths occurred than expected, while a ratio less than 100
suggests fewer deaths occurred than expected.
HSMR =
Observed Deaths
x 100
Expected Deaths
HSMR is based on diagnosis groups that account for 80% of deaths
HSMR is adjusted for factors affecting mortality (e.g. age, sex, length of stay)
To see the full report or for more information, please visit the Canadian Institute for Health Information (CIHI) Web site.
Methicillin-resistant Staphylococcus aureus (MRSA)
MRSA stands for methicillin-resistant Staphylococcus aureus. Staphylococcus aureus is a common bacterium or germ which commonly lives in the nose and on the skin.
Most people who carry the Staphylococcus aureus bacteria do not have an infection. Sometimes people develop infections with this bacterium and require treatment.
Infection in the bloodstream is called bacteremia.
When common antibiotics are not able to destroy Staphylococcus aureus, the bacterium is called resistant, or MRSA. Infections caused by MRSA are not more serious
than infections caused by the regular Staphylococcus aureus bacterium. However, only a few antibiotics will treat MRSA infections.
Vancomycin-resistant Enterococcus (VRE)
VRE stands for vancomycin-resistant enterococcus. Vancomycin is an antibiotic used to treat infections. Enterococcus is a common bacterium that is normally found in the
lower intestine. Sometimes people develop infections with this bacterium and require treatment. Only a few antibiotics can effectively treat enterococcal infections, and one
of them is vancomycin. If the enterococcus bacterium develops resistance to vancomycin (vancomycin-resistant enterococcus), the antibiotic vancomycin will not be able
to destroy the bacteria. There are other antibiotics that will treat VRE infections.
Information for Patients and Families
For more information about MRSA and VRE, who gets it and how it is treated, please visit Infection Prevention and Controls patient information sheets.
MRSA Patient Information
VRE Patient Information
MRSA and VRE Rates
MRSA Rates at The Ottawa Hospital
VRE Rates at The Ottawa Hospital
MRSA/VRE Rates for All Ontario Hospitals

Surgical list
Building on the government's patient safety indicator initiative, The Ottawa Hospital is reporting on its surgical safety checklist compliance.
The surgical safety checklist covers the most common tasks and items that operating room teams carry out, and has been shown to reduce rates of death and
complications among patients. It is a one-page list of items that surgical teams must discuss at three key times:
1. Before the patient is given anesthesia with all team members present.
2. Before skin incision.
3. While all team members are present before closing the patient.
The Ottawa Hospital has been performing surgical safety checklists since 2005, but has been using the formal list being mandated by the province since June 2009. By
implementing the new surgical safety checklist, The Ottawa Hospital will improve overall patient safety, teamwork and communi cation, and elevate surgical teams to an
even higher standard of performance.
The dedicated health professionals who work at The Ottawa Hospital are committed to providing the best possible care to patients, and they believe that a public reporting
regime will inspire improved performance, enhance patient safety and strengthen the public's confidence.
Surgical Safety Checklists Public Reporting
Ongoing monitoring and support of the surgical safety checklist process is essential to ensuring proper adherence. All Ontari o hospitals that perform surgeries are required
to report on their use of the surgical safety checklist to the Ontario government, and to the public.
Surgical safety checklist rates at The Ottawa Hospital

Ventilator
For our public reporting purposes, ventilator associated pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in an intensive care
unit (ICU), requiring, external mechanical breathing support (a ventilator) intermittently or continuously, through a breathing tube for more than 48 hours.
VAP can develop in patients for many reasons. Because they are relying on an external machine to breath, their normal coughing, yawning, and deep breath
reflexes are suppressed. Furthermore, they may have a depressed immune system, making them more vulnerable to infection. ICU teams have many ways to
try to assist patients with these normal breathing reflexes, but despite this, patients are still at risk for developing pneumonia.
VAP Rates
All hospitals with ICUs required to report into the Critical Care Information System (CCIS) a centralized data collection system where hospitals report a
variety of critical care information must publicly report the VAP indicator data.
These Ontario hospitals are posting their quarterly VAP rate and case count for those infections acquired in their facility, using the following formula:
total # of ICU cases of VAP after 48 hours of mechanical ventilation x 1000
total # of ventilator days for ICU patients 18 years and older
More patient-specific information is available at www.ontario.ca/patientsafety and www.oha.com/patientsafetytips andwww.oha.com/cleanhandsprotectlives.
Ventilator associated pneumonia rates at The Ottawa Hospital