Credit Valley Hospital

The Credit Valley Hospital has established a strong commitment to patient safety and quality improvement. Our patient safety program is designed to align, support and promote our mission, vision and values by facilitating the continuous improvement of patient, visitor, staff, volunteer and physician safety. We have implemented a systematic, hospital-wide approach to patient safety by integrating and coordinating all patient activities by all members of the multidisciplinary team (physicians, clinical departments, support services, volunteers and administration).

Credit Valley has created a working environment that encourages safety event identification, remediation, non-punitive reporting with just accountability, and prevention through education, system redesign and/or process improvement. The role every individual plays in ensuring patient safety will result in the reduction of safety events and risks and the improvement of hospital efficiency and quality of care.

On September 26th the Credit Valley Hospital, along with all other hospitals in the province, began reporting our monthly C. difficile rates. Over the next few months, we will be reporting additional safety information to you as noted in the chart below.

Patient Safety Indicator	Start Date of Public Reporting
Clostridium difficile (C. difficile) »	Sept. 26 2008
Methicillin-resistant Staphylococcus Aureus (MRSA) »	December 2008
Vancomycin-resistant Enterococci (VRE) »	December 2008
Hospital Standardized Mortality Ratio (HSMR) »	December 2008
Ventilator-Associated Pneumonia (VAP) »	April 2009
Central Line Primary Blood Stream Infection (CLI) »	April 2009
Surgical Site Infection Prevention »	April 2009
Hand hygiene compliance »	April 2009
Surgical Safety Checklist Compliance Rate »	June 2010

Credit Valley believes public reporting of these rates will inspire us to improve our performance, enhance patient safety, and strengthen your confidence in our hospital.

Quick Facts About C. difficile

C. difficile is one of many types of bacteria that can be found in feces (bowel movement), and has been a known cause of health care-associated diarrhea for about 30 years.
C. difficile can be picked up on the hands from exposure in the environment and can get into the stomach once the mouth is touched, or if food is handled and then swallowed. Once in the stomach, the bacteria usually doesn’t cause problems unless the other bowel bacteria are disturbed, which can happen when antibiotics are taken. The use of antibiotics increases the chances of developing C. difficile diarrhea as it alters the normal level of good bacteria found in the intestines and colon. Without the presence of normal bowel bacteria, the C. difficile bacteria may start to grow and produce a toxin that can damage the bowel and lead to watery diarrhea, fever and abdominal pain or tenderness.
When a person has C. difficile, the bacteria in their feces can contaminate surfaces such as toilets, bedpans, commode chairs, and door handles. Other healthy individuals can contaminate their hands if they touch these items and then if these individuals touch their mouths without washing their hands, they can become infected.
To reduce the spread of C. difficile and other infectious diseases, please wash your hands well and often.
A high number of C. difficile cases in a one-month period does not necessarily mean that a hospital is “unsafe”. Conversely, a lower number of cases in a one-month period doesn’t mean that a hospital is “safe”. That’s why it’s vital to review C. difficile rates within the context of other performance indicators. Analysis of C. difficile rates over time provides us with helpful information that we’ll use to make quality improvements in our organization.