October 30, 2008

Updated Clostridium difficile associated disease (CDAD) rates of all hospitals are being published today on the Ministry of Health and Long-Term Care’s public website.

For the first time ever, CDAD rates were published on the ministry website last month.

Ontario is requiring all hospitals to monitor and report CDAD in their facilities so the most appropriate infection prevention and control measures can be put in place.

Hospitals will use this information to ensure they’re maintaining the highest possible standards of patient safety.

When interpreting the data it’s important to understand that many differences exist from hospital to hospital which could affect their case counts and CDAD rates. These include :

• Size of the hospital;
• Complexity of the services offered;
• Type of patient population served;
• Number of people hospitalized for respiratory infection;
• Use of antibiotics;
• Percentage of patients age 65 or older in the hospital.

CDAD rates may also vary seasonally. An increase of infection rates in several facilities over the winter months is to be expected.

Trends in CDAD rates will be posted on the Ministry of Health and Long-Term Care’s website when enough data is available. Fluctuations in rates across reporting periods are better interpreted when rates from different periods are taken into account.

The data presented on the ministry website is best used to measure individual hospital performance over time. It can also be used to ask informed questions to hospital representatives about their infection prevention and control program. It’s not intended to be the only source of information for making decisions about hospital care nor is it information for generalizing about the overall quality of care provided by hospitals.

Data are presented in tables by hospital site. Included in the tables is data on the number of new hospital-acquired CDAD cases as well as the CDAD rate by month. The data presented on the ministry’s website has been confirmed by the hospitals and is also being reported on the hospitals’ websites.

The rate is calculated by dividing the number of new cases associated with the hospital site by the number of patient days per reporting period, multiplied by 1, 000. Rates are expressed as cases per 1,000 patient days and exclude patients less than one year of age. This rate calculation allows the level of hospital activity to be taken into account, which may fluctuate over time and is different across hospitals.

Hospitals are grouped by hospital type to facilitate more relevant comparisons. The hospital types are :

• Large Community;
• Small Community;
• Mental Health;
• Acute Teaching;
• Complex Continuing Care & Rehabilitation.

These hospital types take into consideration differences in hospital size and patient case mix, factors which can make a significant difference in average CDAD rates. For example, teaching hospitals generally serve more complex or sicker - and therefore more vulnerable - patients and could have a higher CDAD rate than the provincial average.

The provincial CDAD rate is aggregated data, compiled from the data for all hospitals in Ontario.

For the period covering September 2008, there were 363 cases of C. difficile associated disease found among the 228 hospital sites in Ontario. The provincial CDAD rate was 0.44 per 1,000 patient days. This is only the second time hospitals reported CDAD rates and it will take time to establish a trend.

For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)

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