Dr. Michael Baker, the Executive Lead for Patient Safety
in Ontario talks to members of the Quality Healthcare Network
about MRSA and lessons learned from the launch of publicly
reporting C.difficile rates

While profiling Dr. Michael Baker for the QHN Centre Stage, we thought we
would use the opportunity to ask him some questions on what organizations can do
to be successful on MRSA.

Quality Healthcare Network's Question:
As Executive Lead of Patient Safety, for the Ministry of Health and Long-term Care,
you were directly involved in Ontario hospital’s first mandatory public reporting of their
C.difficile rates on September 30, 2008. The next set of indicators that hospitals will be
required to publicly report on is Methicillin-resistant Staphylococcus aureus (MRSA)
on December 31, 2008. Do you have any lessons learned from the launch of the first
publicly reported C.difficile rates?

Dr. Michael Baker Answers:
The first lesson I learned was how important it was to spend time up front getting
the definitions right. It was a learning curve for me to understand how important it
was to be very specific, because with so many hospitals involved, with so many people
involved across this vast province it was going to be difficult to give people a lot of
leeway or judgment or have corridors to change diagnoses. So we spent a lot of time,
more time than I thought we would need with the C.difficile exercise, making very
precise definitions. In the end we found that we probably have to modify them or
improve them, but nevertheless, it was crucial to have them the same.

The other reason it turned out to be crucial to get the definitions right was that it’s
quite rare for a very large jurisdiction like the province of Ontario to have so many hospitals
and so many units reporting on exactly the same definitions of infection and this gives us
tremendous ability to learn and study the problem.

Question:
On December 31, 2008, as part of the Ontario government’s plan to create an
unprecedented level of transparency in Ontario’s hospitals, all hospitals will be required
to publicly report their MRSA rates. Do you think public reporting is going to improve
patient safety in Ontario?

Answer:
I’m convinced that it is a very valuable tool to improve patient safety. It simply gives us the
impetus to pay a great deal of attention to something that we all recognize as important.
But of course I fully understand that hospitals are filled with all kinds of important,
crucial and time-sensitive issues for our patient care and because in the end patient safety
regardless of the therapy or the diagnosis, is paramount in everyone’s mind. This just gives
us a focus for paying a great deal of attention to it, simply because human nature is like that;
we want to report our results. We want to show that we can do the best we can.

Question:
What do you say to hospitals that ask, ‘why should we care about MRSA?’

Answer:
I’ve never heard of a hospital or CEO that didn’t care about MRSA. I would not be surprise
to have a busy and successful CEO or hospital management team say that they have a long list
of crucial issues – just take your pick. This morning there was a big article in the news about
emergency department waiting times, surgical cancellations, nursing shortages, personnel
shortages, doctor shortages, finical issues and the financial down-turn for the province.
There is a long list of important issues. So I don’t think any CEO, manager or doctor would say,
‘MRSA is not important’. They might say that they have other issues that they feel are more
important. The point of view that I take, that has been successful with C.difficile, is regardless of
how long a patient waits, or regardless of the nursing to patient ratio, or the financial difficulties
of providing various forms of diagnosis or treatment, we for sure don’t want to harm our patients
when they come into the hospital no matter what else we do for them. And that always resonates.
I’ve never found a CEO, manager, doctor or a healthcare team member that doesn’t agree with that.

Question:
What do organizations need to do to be successful on MRSA?

Answer:
PIDAC as well as Safer Healthcare Now! and other organizations have excellent standards of
practice available for all of us to prevent various infections including MRSA.

The first requirement of any hospital and this is probably generally true across Ontario, is to
recognize it as a problem.

The second requirement is to educate ourselves on the surveillance that is done in many hospitals,
the diagnosis, the technical aspects of making a definition.

And then, probably most importantly, we need to implement the best practices in terms of hand
washing and housekeeping and isolation procedures to prevent these dangerous infections from
spreading to the next person, who is so to speak, an innocent bystander.

So the approach is multi-factorial. It involves every member of the hospital team, from department
heads and CEOs to housekeepers and all of the bed-side care-giving team, to be aware of it and to
understand some of the simple, but highly effective things we can all do. The best example being
hand washing. And the next perhaps is paying close attention to hygiene and cleaning in the units.

For more information about this interview please contact Tanya Flanagan
at tanya.flanagan@qhn.ca. Or contact Dr. Michael Baker at michael.baker@uhn.on.ca.