Infection Control

COVID-19 infection typically presents with respiratory symptoms.

Infection is primarily spread from symptomatic people to others who are in close contact through respiratory droplets, like a cough or sneeze. Infection can also spread by direct contact with infected persons, or when a person comes in contact with contaminated objects and surfaces and then touches their eyes, nose, or mouth.

COVID-19 infection can be severe. The elderly population and those with underlying medical conditions are most vulnerable to the disease. However, for many, symptoms will be like those of the common cold or influenza. Eighty per cent of cases are mild to moderate and do not lead to hospitalization.

Common symptoms of COVID-19 include fever, cough, and shortness of breath. Sore throat, runny nose, fatigue, and a loss of smell and taste are also reported symptoms.

For detailed information about COVID-19 outbreaks in Ottawa healthcare institutions, please consult the Ottawa Public Health website.

Clostridium difficile is commonly known as C. difficile or “C. diff.” It is a bacteria commonly found in the environment, including in human and animal intestines and feces. Not normally dangerous, C. difficile can infect patients taking antibiotics, the elderly, and people with compromised health. Infection can cause diarrhea, fever, abdominal pain, and, in extreme cases, death.

The bacteria is spread through contact with contaminated surfaces, especially in washrooms, or with feces. The best prevention is good hygiene, including thorough washing of the hands.

For more information on C. difficile, please see the Province of Ontario fact sheet.

C. difficile Infection Rates

* Patient days indicate the total number of days spent by patients at the Heart Institute in a given month. The incidence rate is used as a standardized measure for comparison across healthcare facilities.  

MRSA stands for methicillin-resistant Staphylococcus aureus. Staphylococcus aureus is a common bacterium, or germ, that can be found in the nose and on the skin. Most people who carry the bacterium do not have an infection, but sometimes people will develop infections requiring treatment. When the infection is in your blood, it is called bacteremia.

When common antibiotics, such as penicillin, are not able to destroy Staphylococcus aureus, the bacterium is called “resistant,” or in this case MRSA. Infections caused by MRSA are not necessarily more serious than infections caused by the regular Staphylococcus aureus bacterium. However, only a few antibiotics will treat MRSA infections.

MRSA is spread by direct contact with an infected person, with their excretions, or with contaminated materials. The bacteria can live on hands or other surfaces, so the best prevention is good hygiene. Hands should be washed thoroughly with soap and water, or with an alcohol-based hand sanitizer after using the bathroom or blowing your nose, and before touching wounds and dressings.

For more information on MRSA, please see the Province of Ontario fact sheet.

MRSA Infection Rates

* Patient days indicate the total number of days spent by patients at the Heart Institute in a given month. The incidence rate is used as a standardized measure for comparison across healthcare facilities. 

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 become infected 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, the antibiotic will not be able to destroy the bacteria. There are other antibiotics that will treat VRE infections, however.

VRE is usually spread on the hands of caregivers who have come in direct contact with an infected person. Excretions and feces are the most likely sources of contamination. Without proper cleaning with disinfectants, VRE can survive for long periods on bathroom and hospital room surfaces. Thorough hand washing with soap and water or an alcohol-based sanitizer is the best prevention against the spread of infection.

For more information on VRE, please see the Province of Ontario fact sheet.

VRE Infection Rates

* Patient days indicate the total number of days spent by patients at the Heart Institute in a given month. The incidence rate is used as a standardized measure for comparison across healthcare facilities. 

A central line is a catheter inserted into a patient’s vein that supplies blood and replaces fluids or nutrients. Central lines also let health care providers monitor fluids and make determinations about the heart and blood. Central line infection (CLI) occurs when a central line becomes infected and bacteria spread to the bloodstream.

CLI is more likely to occur on an intensive care unit . It is also more common in patients who have a serious underlying illness or debilitation, are receiving bone marrow or chemotherapy, or have a central line for an extended period of time. Symptoms of CLI include redness, pain or swelling around the catheter site, or pain or tenderness along the path of the catheter. There may also be fluid drainage from the skin around the catheter, and the patient may experience sudden fever or chills.

Infections are treated with antibiotics but they are preventable. Patients should wash their hands often with soap and water or an alcohol-based sanitizer, and they should try not to touch their lines or dressings. Health care providers or anyone else touching the lines should wash their hands thoroughly.

For more information on CLI, please see the Province of Ontario fact sheet.

CLI Infection Rates

* Central line days indicates the total number of days of inserted central lines at the Heart Institute in a given quarter. The incidence rate is used as a standardized measure for comparison across healthcare facilities. 

Pneumonia is a serious lung infection. Patients who need assistance breathing with a mechanical ventilator for more than 48 hours are at increased risk of developing ventilator-associated pneumonia (VAP). Patients who are on a ventilator for more than five days, who are residents of a nursing home, or who have been hospitalized or have taken antibiotics within the last 90 days are at the greatest risk.

Symptoms of VAP include fever, low body temperature, foul smelling mucous or phlegm coughed up from the lungs or airway, and hypoxia, which is decreased oxygen levels in the blood.

VAP can be prevented through frequent hand washing using soap and water or an alcohol-based sanitizer, by keeping the patient’s head elevated at 30 to 45 degrees, and by taking patients off mechanical ventilation as soon as possible.

For more information on VAP, please see the Province of Ontario fact sheet.

VAP Infection Rates

* Mechanically ventilated days indicate the total number of days of patients on mechanical ventilation at the Heart Institute in a given quarter. The incidence rate is used as a standardized measure for comparison across healthcare facilities

Research shows that hand hygiene is the single most effective way to reduce the risk of health care-associated infections. Alcohol-based hand rub is the preferred method for decontaminating hands when they are not visibly soiled. Hand washing with soap and running water is necessary when hands are visibly soiled.

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. Everyone, including visitors, should practice good hand hygiene before and after entering patient rooms.

Hand Hygiene Compliance Rates

The Heart Institute posts hand hygiene compliance rates quarterly, using the following formula:

(number of times hand hygiene performed) ÷ (number of observed hand hygiene indications) x 100 = % compliance

These percentages reflect:

1) Hand hygiene before initial patient/patient environment contact by health care provider type (i.e., nurses, physicians, allied health professionals, housekeeping, support staff, etc.).
2) Hand hygiene after patient/patient environment contact by healthcare provider (i.e., nurses, physicians, allied health professionals, housekeeping, support staff etc.).

For more information on hand hygiene, please see the Province of Ontario fact sheet.

Hand Hygiene (HH) Compliance Rates

* Hand hygiene opportunity indicates a point in time at which hand hygiene should occur. The compliance rate of HH Performed divided by Observations is used as a standardized measure for comparison across healthcare facilities. 

Research shows that the use of checklists during surgical interventions can improve health outcomes for patients. These checklists and preoperative briefings have been shown to reduce preventable delays, improve operating room efficiency and create shorter wait times for patients with acute illnesses, lower nurse turnover rate and increase job satisfaction.

The Surgical Checklist encompasses three aspects:

• Briefing: The preoperative evaluation of the conscious patient prior to induction of the anesthesia with all members present.
• Time Out: The time out immediately prior to incision.
• Debriefing: The preparations for appropriate postoperative care prior to the patient leaving the operating room.

The Heart Institute posts surgical checklist compliance rates twice a year, using the following formula:

(number of times all three phases of the surgical safety checklist was performed) ÷ (total surgeries) x  100 = % compliance

Surgical Checklist Compliance Rates

Information for Patients

Heater-cooler devices are often necessary for use during surgery because circulating blood and organs must be maintained at specific temperatures. The benefits of temperature control during surgery outweigh the small risk of infection associated with these devices.

Frequently Asked Questions

What type of bacteria is involved in infections with heater-coolers?

Nontuberculous Mycobacterium (NTM) bacteria are commonly found in the environment, such as in water and soil. There is the potential for NTM to be present and grow inside the heater-cooler device.

Are certain groups of patients at higher risk of NTM infection?

NTM organisms may cause infections in very ill patients including patients with compromised immune systems, underlying lung disease, diabetes, undergoing chemotherapy or certain invasive healthcare procedures, or receiving organ/tissue transplant.

If I’ve been exposed to NTM during surgery, what are the chances that I have or will get infected?

While rare, NTM infections can and do occur. Most often they appear in patients who have undergone open-chest surgery. Patients who have underlying lung disease or a weakened immune system may also be susceptible to NTM infections.

What are the symptoms of NTM infections?

Some NTM bacteria can grow rapidly, but most NTM species associated with heater-cooler infections are slow-growing. Because these bacteria grow slowly, it can take several months to over a year for an infection to develop.

Signs of a possible NTM infection may include:

• Fatigue
• Fever
• Pain
• redness, heat, or pus at the surgical site
• muscle pain
• joint pain
• night sweats
• weight loss
• abdominal pain
• nausea
• vomiting

What should I do if I am experiencing symptoms?

Contact your health care provider if you are experiencing symptoms and inform them that you had open-chest surgery.

Can NTM infection be treated?

NTM infections can be treated with combinations of specific antibiotics. Some patients who become infected may need prolonged treatment (from months to years). Additionally, although rare, some heart valve patients who develop NTM infections after having cardiac surgery may require additional surgery. If untreated, NTM infection could be potentially fatal.

Can I become infected through contact with someone who is infected with NTM?

No, NTM infection is not contagious. It is not spread from person-to-person.

What should I discuss with my doctor prior to open-chest surgery?

Discuss the benefits and risks of your surgical procedure with your doctor. For most patients, the benefit of undergoing a surgical procedure recommended by their doctor outweighs the risk of infection. Ask your doctor what to expect following your procedure and when to seek medical attention. Ask your doctor what measures are being taken to minimize your risk of infection.

Should I postpone my surgical procedure?

Patients with concerns about infection risks should consult with their doctor. However, life-saving surgical procedures should not be delayed. Patients should ask their doctor what to expect following their procedure and when to seek medical attention.

How are heater-cooler devices associated with infection?

Heater-cooler devices are used during open-chest surgeries to warm or cool a patient during the surgery and as part of their care. There is the potential for NTM to grow in a water tank in the heater-cooler units. It is important to note that the water in the heater-cooler unit is not designed to come into contact with the patient’s blood or body fluids. However, we have found that contaminated water droplets from the tank may transmit bacteria through the air (aerosolize) and escape from the heater-cooler unit into the operating room environment. The aerosolized NTM may then find its way into the open-chest cavity or a sterile implant.

Source: US Food & Drug Administration

Healthy Canadians - Heater-Cooler Devices - Risk of Nontuberculous Mycobacteria Infections

Noroviruses are a group of viruses that cause gastroenteritis, an illness that usually includes diarrhea and/or vomiting. Noroviruses are commonly found throughout North America and are very infectious.