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Shock","2025-12-15T17:20:46.093Z","2026-03-10T16:21:42.030Z","2026-03-10T16:21:42.100Z",123411030455315,{"new":290,"seo":490,"_uid":493,"hero":494,"type":174,"topics":519,"Noindex":290,"content":520,"audience":1986,"duration":16,"regional":1987,"component":1988},{"_uid":491,"title":484,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"e6301e5d-7507-42bb-a36e-4d2f3ef5786d","Healthcare Excellence Canada has developed this Hospital Harm Improvement Resource – a compilation of resources to support patient safety and improvement 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Mechanisms may involve decreased circulating volume, decreased cardiac output, and vasodilation, sometimes with shunting of blood to bypass capillary exchange beds (Procter, 2020). It is a clinical state that occurs when a mismatch arises between oxygen supply and metabolic demand, resulting in cellular hypoxia. If not recognized and treated appropriately, shock will ultimately progress to organ failure (Broussard & Ural, 2018; Gaieski & Mikkelsen, 2018; Vincent & De Backer, 2013). It is one of the leading causes of death in hospitalized patients (Nichol & Ahmed, 2014).",{"type":12,"content":514},[515],{"type":15},{"type":12,"content":517},[518],{"type":15},[76,8],[521,536,873,913,1674,1721,1839,1875,1955],{"_uid":522,"link":523,"image":524,"title":526,"component":527,"media_type":528,"description":529},"a40f3c31-2be0-450d-8ec3-bc72ad634bf2",[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":525},{},"Goal","info-block-program","none",{"type":12,"content":530},[531],{"type":15,"attrs":532,"content":533},{"textAlign":53},[534],{"text":535,"type":299},"Reduce the incidence of procedure-associated shock.",{"_uid":537,"content":538,"component":872},"1010ae87-305e-4413-a52a-63495dbe7cf3",[539],{"_uid":540,"content":541,"component":871},"a217acfe-5514-41a9-b405-799b24d56e71",{"type":12,"content":542},[543,550,571,576,581,586,599,863],{"type":544,"attrs":545,"content":547},"heading",{"level":546,"textAlign":53},2,[548],{"text":549,"type":299},"Overview and Implications",{"type":15,"attrs":551,"content":552},{"textAlign":53},[553,555,569],{"text":554,"type":299},"Healthcare Excellence Canada has developed this ",{"text":556,"type":299,"marks":557},"Hospital Harm Improvement Resource",[558],{"type":559,"attrs":560},"link",{"href":561,"uuid":356,"anchor":53,"custom":562,"target":563,"linktype":564,"story":565},"/resources/hospital-harm-improvement-resource",{},"_self","story",{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},119563150823813,"hospital-harm-improvement-resource","resources/hospital-harm-improvement-resource",{"text":570,"type":299}," – a compilation of resources to support patient safety and improvement efforts.",{"type":15,"attrs":572,"content":573},{"textAlign":53},[574],{"text":575,"type":299},"There are several types of shock that a patient may experience during or after a procedure.  Mechanisms of organ hypoperfusion and shock may be due to a low circulating volume (hypovolemic shock), vasodilation (distributive shock), a primary decrease in cardiac output (both cardiogenic and obstructive shock), or a combination of all of them. Untreated shock is usually fatal. Even with treatment, mortality from cardiogenic shock after myocardial infarction [MI] (60 to 65 per cent) and septic shock (30 to 40 per cent) is high. Prognosis depends on the cause, preexisting or complicating illness, time between onset and diagnosis, and promptness and adequacy of therapy (Procter, 2020).",{"type":15,"attrs":577,"content":578},{"textAlign":53},[579],{"text":580,"type":299},"Organ dysfunction in patients can be represented by an increase in the Sequential Organ Failure Assessment (SOFA) score (Vincent et al., 1996) of two points or more, which is associated with an in-hospital mortality greater than 10 per cent. Patients with septic shock can be identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater AND serum lactate level greater than 2 mmol/L in the absence of hypovolemia (i.e. after adequate fluid resuscitation). This combination is associated with hospital mortality rates greater than 40 per cent (Singer et al., 2016).",{"type":15,"attrs":582,"content":583},{"textAlign":53},[584],{"text":585,"type":299},"Table 1 was created by Dr. Denny Laporta at the Jewish General Hospital, McGill University, Montreal, QC (Laporta, 2018). The table summarizes the various types of shock that may be encountered in the peri-procedure period. In hypovolemic shock the reduced cardiac output is due to a reduction in circulating volume and consequent venous return. 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",{"text":1360,"type":299,"marks":1361},"https://www.merckmanuals.com/professional/critical-care-medicine/shock-and-fluid-resuscitation/shock",[1362],{"type":559,"attrs":1363},{"href":1360,"uuid":53,"anchor":53,"custom":1364,"target":911,"linktype":912},{},{"type":669,"content":1366},[1367],{"type":15,"attrs":1368,"content":1369},{"textAlign":53},[1370,1372],{"text":1371,"type":299},"National Institute for Health and Care Excellence (NICE) ",{"text":1373,"type":299,"marks":1374},"www.nice.org.uk",[1375],{"type":559,"attrs":1376},{"href":1377,"uuid":53,"anchor":53,"custom":1378,"target":911,"linktype":912},"https://www.nice.org.uk/",{},{"type":669,"content":1380},[1381],{"type":15,"attrs":1382,"content":1383},{"textAlign":53},[1384,1386],{"text":1385,"type":299},"New England Journal of Medicine ",{"text":1387,"type":299,"marks":1388},"www.nejm.org",[1389],{"type":559,"attrs":1390},{"href":1391,"uuid":53,"anchor":53,"custom":1392,"target":911,"linktype":912},"https://www.nejm.org/",{},{"type":669,"content":1394},[1395],{"type":15,"attrs":1396,"content":1397},{"textAlign":53},[1398,1400],{"text":1399,"type":299},"Vincent J-L, De Backer D. Circulatory Shock. N Engl J Med. 2013;369(18):1726-1734. doi:",{"text":1401,"type":299,"marks":1402},"10.1056/NEJMra1208943",[1403],{"type":559,"attrs":1404},{"href":1405,"uuid":53,"anchor":53,"custom":1406,"target":911,"linktype":912},"https://www.nejm.org/doi/10.1056/NEJMra1208943",{},{"type":669,"content":1408},[1409,1421,1423,1430],{"type":15,"attrs":1410,"content":1411},{"textAlign":53},[1412,1414],{"text":1413,"type":299},"Royal College of Anaesthetists ",{"text":1415,"type":299,"marks":1416},"www.rcoa.ac.uk",[1417],{"type":559,"attrs":1418},{"href":1419,"uuid":53,"anchor":53,"custom":1420,"target":911,"linktype":912},"https://www.rcoa.ac.uk/",{},{"type":15,"attrs":1422},{"textAlign":53},{"type":15,"attrs":1424,"content":1425},{"textAlign":53},[1426],{"text":1427,"type":299,"marks":1428},"Seminars in Thrombosis and Hemostatsis",[1429],{"type":618},{"type":15,"attrs":1431},{"textAlign":53},{"type":669,"content":1433},[1434],{"type":15,"attrs":1435,"content":1436},{"textAlign":53},[1437,1439],{"text":1438,"type":299},"James AH, Grotegut C, Ahmadzia H, Peterson-Layne C, Lockhart E. Management of Coagulopathy in Postpartum Hemorrhage. Semin Thromb Hemost. 2016;42(7):724-731. doi:",{"text":1440,"type":299,"marks":1441},"10.1055/s-0036-1593417",[1442],{"type":559,"attrs":1443},{"href":1444,"uuid":53,"anchor":53,"custom":1445,"target":911,"linktype":912},"https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593417",{},{"type":669,"content":1447},[1448],{"type":15,"attrs":1449,"content":1450},{"textAlign":53},[1451,1453],{"text":1452,"type":299},"Society of Critical Care Medicine ",{"text":1454,"type":299,"marks":1455},"https://www.sccm.org/Research/Journals/Critical-Care-Medicine",[1456],{"type":559,"attrs":1457},{"href":1458,"uuid":53,"anchor":53,"custom":1459,"target":911,"linktype":912},"https://www.sccm.org/research/journals/critical-care-medicine",{},{"type":669,"content":1461},[1462],{"type":15,"attrs":1463,"content":1464},{"textAlign":53},[1465,1467],{"text":1466,"type":299},"Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3). doi:",{"text":1468,"type":299,"marks":1469},"10.1097/CCM.0000000000002255",[1470],{"type":559,"attrs":1471},{"href":1472,"uuid":53,"anchor":53,"custom":1473,"target":911,"linktype":912},"https://journals.lww.com/ccmjournal/fulltext/2017/03000/surviving_sepsis_campaign__international.15.aspx",{},{"type":669,"content":1475},[1476],{"type":15,"attrs":1477,"content":1478},{"textAlign":53},[1479],{"text":1480,"type":299},"UPTODATE www.uptodate.com",{"type":669,"content":1482},[1483],{"type":15,"attrs":1484,"content":1485},{"textAlign":53},[1486,1488],{"text":1487,"type":299},"Gaieski DF, Mikkelsen ME. Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock. UpToDate. 2018 October, last updated. ",{"text":1489,"type":299,"marks":1490},"https://www.uptodate.com/contents/evaluation-of-and-initial-approach-to-the-adult-patient-with-undifferentiated-hypotension-and-shock",[1491],{"type":559,"attrs":1492},{"href":1489,"uuid":53,"anchor":53,"custom":1493,"target":911,"linktype":912},{},{"type":669,"content":1495},[1496],{"type":15,"attrs":1497,"content":1498},{"textAlign":53},[1499,1501],{"text":1500,"type":299},"Hrymak C, Funk DJ, O'Connor MF, Jacobsohn E. Intraoperative management of shock in adults. UpToDate. 2018 July, last updated. ",{"text":1502,"type":299,"marks":1503},"https://www.uptodate.com/contents/intraoperative-management-of-shock-in-adults?search=Intraoperative%20management%20of%20shock%20in%20adults&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1",[1504],{"type":559,"attrs":1505},{"href":1502,"uuid":53,"anchor":53,"custom":1506,"target":911,"linktype":912},{},{"type":669,"content":1508},[1509],{"type":15,"attrs":1510,"content":1511},{"textAlign":53},[1512,1514],{"text":1513,"type":299},"Parker WH, Wagener WH. Management of hemorrhage in gynecologic surgery. UpToDate. 2018 May, last updated. ",{"text":1515,"type":299,"marks":1516},"https://www.uptodate.com/contents/management-of-hemorrhage-in-gynecologic-surgery",[1517],{"type":559,"attrs":1518},{"href":1515,"uuid":53,"anchor":53,"custom":1519,"target":911,"linktype":912},{},{"type":669,"content":1521},[1522],{"type":15,"attrs":1523,"content":1524},{"textAlign":53},[1525,1527],{"text":1526,"type":299},"Siparsky N. Overview of postoperative fluid therapy in adults. UpToDate. 2018 May, last updated. ",{"text":1528,"type":299,"marks":1529},"https://www.uptodate.com/contents/overview-of-postoperative-fluid-therapy-in-adults",[1530],{"type":559,"attrs":1531},{"href":1528,"uuid":53,"anchor":53,"custom":1532,"target":911,"linktype":912},{},{"type":669,"content":1534},[1535],{"type":15,"attrs":1536,"content":1537},{"textAlign":53},[1538],{"text":1539,"type":299},"For additional references you may also find the following Hospital Harm Improvement Resources helpful:",{"type":669,"content":1541},[1542],{"type":15,"attrs":1543,"content":1544},{"textAlign":53},[1545],{"text":1546,"type":299,"marks":1547},"Obstetric Hemorrhage",[1548],{"type":559,"attrs":1549},{"href":1550,"uuid":380,"anchor":53,"custom":1551,"target":563,"linktype":564,"story":1552},"/resources/obstetric-hemorrhage",{},{"name":1546,"id":1553,"uuid":380,"slug":1554,"url":1555,"full_slug":1555,"_stopResolving":461},122003132269399,"obstetric-hemorrhage","resources/obstetric-hemorrhage",{"type":669,"content":1557},[1558],{"type":15,"attrs":1559,"content":1560},{"textAlign":53},[1561],{"text":1562,"type":299,"marks":1563},"Venous Thromboembolism",[1564],{"type":559,"attrs":1565},{"href":1566,"uuid":442,"anchor":53,"custom":1567,"target":563,"linktype":564,"story":1568},"/resources/venous-thromboembolism",{},{"name":1562,"id":1569,"uuid":442,"slug":1570,"url":1571,"full_slug":1571,"_stopResolving":461},121319446221623,"venous-thromboembolism","resources/venous-thromboembolism",{"type":669,"content":1573},[1574],{"type":15,"attrs":1575,"content":1576},{"textAlign":53},[1577],{"text":1578,"type":299,"marks":1579},"Electrolyte and Fluid Imbalance",[1580],{"type":559,"attrs":1581},{"href":1582,"uuid":337,"anchor":53,"custom":1583,"target":563,"linktype":564,"story":1584},"/resources/electrolyte-and-fluid-imbalance",{},{"name":1578,"id":1585,"uuid":337,"slug":1586,"url":1587,"full_slug":1587,"_stopResolving":461},120972560962131,"electrolyte-and-fluid-imbalance","resources/electrolyte-and-fluid-imbalance",{"type":669,"content":1589},[1590],{"type":15,"attrs":1591,"content":1592},{"textAlign":53},[1593],{"text":1594,"type":299,"marks":1595},"Sepsis",[1596],{"type":559,"attrs":1597},{"href":1598,"uuid":424,"anchor":53,"custom":1599,"target":563,"linktype":564,"story":1600},"/resources/sepsis",{},{"name":1594,"id":1601,"uuid":424,"slug":1602,"url":1603,"full_slug":1603,"_stopResolving":461},121007657911080,"sepsis","resources/sepsis",{"type":669,"content":1605},[1606],{"type":15,"attrs":1607,"content":1608},{"textAlign":53},[1609],{"text":1610,"type":299,"marks":1611},"Anemia - Hemorrhage (Procedure-Associated Condition)",[1612],{"type":559,"attrs":1613},{"href":1614,"uuid":311,"anchor":53,"custom":1615,"target":563,"linktype":564,"story":1616},"/resources/anemia-hemorrhage-procedure-associated-conditions-",{},{"name":1617,"id":1618,"uuid":311,"slug":1619,"url":1620,"full_slug":1620,"_stopResolving":461},"Anemia – Hemorrhage (Procedure-Associated Conditions)",122365821297521,"anemia-hemorrhage-procedure-associated-conditions","resources/anemia-hemorrhage-procedure-associated-conditions","Clinical and System Reviews, Incident Analyses","accordion-2-columns",{"type":12,"content":1624},[1625,1636,1642],{"type":15,"attrs":1626,"content":1627},{"textAlign":53},[1628,1630,1634],{"text":1629,"type":299},"Given the broad range of potential causes of ",{"text":484,"type":299,"marks":1631},[1632],{"type":1633},"italic",{"text":1635,"type":299},", in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":1637,"content":1639},{"textAlign":1638},"left",[1640],{"text":1641,"type":299},"Occurrences of harm are often complex with many contributing factors. Organizations need to:",{"type":1643,"attrs":1644,"content":1645},"ordered_list",{"order":608},[1646,1653,1660,1667],{"type":669,"content":1647},[1648],{"type":15,"attrs":1649,"content":1650},{"textAlign":53},[1651],{"text":1652,"type":299},"Measure and monitor the types and frequency of these occurrences.",{"type":669,"content":1654},[1655],{"type":15,"attrs":1656,"content":1657},{"textAlign":53},[1658],{"text":1659,"type":299},"Use appropriate analytical methods to understand the contributing factors.",{"type":669,"content":1661},[1662],{"type":15,"attrs":1663,"content":1664},{"textAlign":53},[1665],{"text":1666,"type":299},"Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.",{"type":669,"content":1668},[1669],{"type":15,"attrs":1670,"content":1671},{"textAlign":53},[1672],{"text":1673,"type":299},"Have mechanisms in place to mitigate consequences of harm when it occurs.",{"_uid":1675,"items":1676,"title":1712,"component":1713,"description":1714},"be3b7a82-b7ec-4b53-a512-e4112073c052",[1677,1688,1696,1704],{"_uid":1678,"image":1679,"title":1683,"component":1684,"description":1685},"458f36cf-6776-4902-a081-12df8c65ad9f",{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":1682,"is_external_url":290},119537678778928,"https://a-ca.storyblok.com/f/850807391887861/600x600/c301964117/checkmark-icon.png",{},"You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.","small-text-image-item",{"type":12,"content":1686},[1687],{"type":15},{"_uid":1689,"image":1690,"title":1692,"component":1684,"description":1693},"498e534c-913a-4ac0-90da-3396951645da",{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":1691,"is_external_url":290},{},"Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.",{"type":12,"content":1694},[1695],{"type":15},{"_uid":1697,"image":1698,"title":1700,"component":1684,"description":1701},"5c88ef3c-3fd2-442e-b9cf-478a0643de91",{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":1699,"is_external_url":290},{},"Whenever possible, use measures you are already collecting for other programs.",{"type":12,"content":1702},[1703],{"type":15},{"_uid":1705,"image":1706,"title":1708,"component":1684,"description":1709},"6c6d04c8-d218-424c-945d-1f645847d838",{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":1707,"is_external_url":290},{},"Try to include both process and outcome measures in your measurement scheme.",{"type":12,"content":1710},[1711],{"type":15},"Measures","small-text-image",{"type":12,"content":1715},[1716],{"type":15,"attrs":1717,"content":1718},{"textAlign":53},[1719],{"text":1720,"type":299},"Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures). In selecting your measures, consider the following:",{"_uid":1722,"items":1723,"title":1818,"component":1622,"description":1819},"ed575e2d-c13a-4a32-9df1-afe3f84c8465",[1724,1756,1782],{"_uid":1725,"title":1726,"ctaLeft":1727,"ctaRight":1728,"component":921,"columnLeft":1729,"columnRight":1733},"31df90e3-3c2a-448e-8c03-8cbb7c9f6e6f","Selection Criteria",[],[],{"type":12,"content":1730},[1731],{"type":15,"attrs":1732},{"textAlign":53},{"type":12,"content":1734},[1735,1747],{"type":15,"attrs":1736,"content":1737},{"textAlign":53},[1738,1743],{"text":1739,"type":299,"marks":1740},"Code",[1741,1742],{"type":618},{"type":1633},{"text":1744,"type":299,"marks":1745},": Code Description",[1746],{"type":1633},{"type":15,"attrs":1748,"content":1749},{"textAlign":53},[1750,1754],{"text":1751,"type":299,"marks":1752},"T81.1",[1753],{"type":618},{"text":1755,"type":299},": Identified as diagnosis type (2) AND Y60-84 in the same diagnostic cluster",{"_uid":1757,"title":1758,"ctaLeft":1759,"ctaRight":1760,"component":921,"columnLeft":1761,"columnRight":1765},"b9b8c1e0-53ae-4f62-8dc7-54e61e464643","Codes & Code Descriptions",[],[],{"type":12,"content":1762},[1763],{"type":15,"attrs":1764},{"textAlign":53},{"type":12,"content":1766},[1767,1774],{"type":15,"attrs":1768,"content":1769},{"textAlign":53},[1770,1773],{"text":1739,"type":299,"marks":1771},[1772],{"type":618},{"text":1744,"type":299},{"type":15,"attrs":1775,"content":1776},{"textAlign":53},[1777,1780],{"text":1751,"type":299,"marks":1778},[1779],{"type":618},{"text":1781,"type":299},": Shock during or resulting from a procedure, not elsewhere classified",{"_uid":1783,"title":1784,"ctaLeft":1785,"ctaRight":1786,"component":921,"columnLeft":1787,"columnRight":1791},"298700c3-a866-4c7b-9c20-e87c98c04dea","Additional codes & Inclusions",[],[],{"type":12,"content":1788},[1789],{"type":15,"attrs":1790},{"textAlign":53},{"type":12,"content":1792},[1793,1802],{"type":15,"attrs":1794,"content":1795},{"textAlign":53},[1796,1800],{"text":1797,"type":299,"marks":1798},"Additional Codes",[1799],{"type":618},{"text":1801,"type":299},": Inclusions",{"type":15,"attrs":1803,"content":1804},{"textAlign":53},[1805,1809,1811],{"text":1806,"type":299,"marks":1807},"Y60-84",[1808],{"type":618},{"text":1810,"type":299},": Complications of medical and surgical care (refer to Appendix A) of the ",{"text":1812,"type":299,"marks":1813},"Hospital Harm Indicator General Methodology Notes.",[1814],{"type":559,"attrs":1815},{"href":1816,"uuid":53,"anchor":53,"custom":1817,"target":911,"linktype":912},"https://www.cihi.ca/sites/default/files/document/hospital-harm-indicator-general-methodology-notes.pdf",{},"Discharge Abstract Database",{"type":12,"content":1820},[1821,1830],{"type":15,"attrs":1822,"content":1823},{"textAlign":53},[1824,1826],{"text":1825,"type":299},"Discharge Abstract Database (DAD) Codes included in this clinical category: ",{"text":1827,"type":299,"marks":1828},"D25: Procedure-Associated Shock",[1829],{"type":618},{"type":15,"attrs":1831,"content":1832},{"textAlign":53},[1833,1837],{"text":1834,"type":299,"marks":1835},"Concept",[1836],{"type":618},{"text":1838,"type":299},": Shock during or resulting from a procedure.",{"_uid":1840,"content":1841,"component":872},"e9f6966a-522e-4969-8c8e-8fac07d89f26",[1842],{"_uid":1843,"content":1844,"component":871},"4aea05a6-3f65-4776-92ce-11c63a02ff1f",{"type":12,"content":1845},[1846,1851,1856,1861,1866],{"type":544,"attrs":1847,"content":1848},{"level":546,"textAlign":53},[1849],{"text":1850,"type":299},"Success Stories",{"type":544,"attrs":1852,"content":1853},{"level":588,"textAlign":53},[1854],{"text":1855,"type":299},"Surviving Sepsis",{"type":15,"attrs":1857,"content":1858},{"textAlign":53},[1859],{"text":1860,"type":299},"In April 2008, a 70-year-old independent lady with no previous comorbidities became a grandmother for the first time and was looking forward to watching her family grow-up. She developed a cough' became breathless and presented to her local hospital. She was admitted and developed severe sepsis and septic shock secondary to her community-acquired pneumonia; she died within seven hours. Her sepsis was not recognized, and antibiotics and fluids were not given in a timely manner. The patient's family and the well-meaning and competent medical and nursing team were devastated.",{"type":15,"attrs":1862,"content":1863},{"textAlign":53},[1864],{"text":1865,"type":299},"So begins the account of a real patient story that compelled Dr. Matt Inada-Kim and colleagues to tackle the problem of managing sepsis within their practice (Patient Stories, 2020).",{"type":15,"attrs":1867,"content":1868},{"textAlign":53},[1869],{"text":1870,"type":299,"marks":1871},"https://www.patientstories.org.uk/recent-posts/surviving-sepsis-a-human-factors-approach/",[1872],{"type":559,"attrs":1873},{"href":1870,"uuid":53,"anchor":53,"custom":1874,"target":911,"linktype":912},{},{"_uid":1876,"items":1877,"title":1951,"component":1622,"description":1952},"d27e0ee6-d543-4ffe-ba19-0beac7b5077d",[1878],{"_uid":1879,"title":1880,"ctaLeft":1881,"ctaRight":1882,"component":921,"columnLeft":1883,"columnRight":1887},"d1d27db9-bb85-49f3-bb9e-7342f7791eb1","Expand to see a full list of references",[],[],{"type":12,"content":1884},[1885],{"type":15,"attrs":1886},{"textAlign":53},{"type":12,"content":1888},[1889,1894,1899,1904,1908,1913,1925,1934,1939],{"type":15,"attrs":1890,"content":1891},{"textAlign":53},[1892],{"text":1893,"type":299},"Broussard D, Ural K.  Cardiovascular problems in the post-anesthesia care unit (PACU). UpToDate. 2018 June 5, last update.",{"type":15,"attrs":1895,"content":1896},{"textAlign":53},[1897],{"text":1898,"type":299},"Gaieski DF, Mikkelsen ME. Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock. UpToDate. 2018 October, last updated.",{"type":15,"attrs":1900,"content":1901},{"textAlign":53},[1902],{"text":1903,"type":299},"HIROC. Risk reference sheet: Failure to appreciate status changes/deteriorating patients. Acute care. Toronto, ON: HIROC; 2016. https://www.hiroc.com/getmedia/ab1d0552-af52-4b71-b4c1-4ba8b643b27e/2_Failure-to-Appreciate-Status-Change.pdf.aspx?ext=.pdf",{"type":15,"attrs":1905,"content":1906},{"textAlign":53},[1907],{"text":1309,"type":299},{"type":15,"attrs":1909,"content":1910},{"textAlign":53},[1911],{"text":1912,"type":299},"Laporta D. Types of shock encountered in the peri-procedure period. Personal communication; 2018 Marc.",{"type":15,"attrs":1914,"content":1915},{"textAlign":53},[1916,1918],{"text":1917,"type":299},"Nichol A, Ahmed B. Shock: causes, initial assessment, and investigations. Anesth Intens Care Med. 2014: 15 (2): 64-67. ",{"text":1919,"type":299,"marks":1920},"https://doi.org/10.1016/j.mpaic.2013.12.008",[1921],{"type":559,"attrs":1922},{"href":1923,"uuid":53,"anchor":53,"custom":1924,"target":911,"linktype":912},"https://www.anaesthesiajournal.co.uk/article/S1472-0299(13)00320-2/abstract",{},{"type":15,"attrs":1926,"content":1927},{"textAlign":53},[1928,1929],{"text":1358,"type":299},{"text":1360,"type":299,"marks":1930},[1931],{"type":559,"attrs":1932},{"href":1360,"uuid":53,"anchor":53,"custom":1933,"target":911,"linktype":912},{},{"type":15,"attrs":1935,"content":1936},{"textAlign":53},[1937],{"text":1938,"type":299},"Singer M, et. al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association. 2016; 315 (8): 801-810.",{"type":15,"attrs":1940,"content":1941},{"textAlign":53},[1942,1944],{"text":1943,"type":299},"Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013; 369 (18): 1726-1734. doi: 10.1056/NEJMra1208943. Available at: ",{"text":1945,"type":299,"marks":1946},"https://www.nejm.org/doi/10.1056/NEJMra1208943?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov&",[1947],{"type":559,"attrs":1948},{"href":1949,"uuid":53,"anchor":53,"custom":1950,"target":911,"linktype":912},"https://www.nejm.org/doi/10.1056/NEJMra1208943?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov&",{},"References",{"type":12,"content":1953},[1954],{"type":15},{"id":16,"_uid":1956,"items":1957,"component":1985},"74a08931-7302-4df6-b7fd-97a1c17001f4",[1958],{"_uid":1959,"link":1960,"image":1972,"title":1976,"component":1977,"description":1978},"d074a47f-97db-4147-8fae-54b5a95ba719",[1961],{"_uid":1962,"link":1963,"label":1970,"component":1971},"23bf6d2f-df36-4dbe-b20a-6959a74eadf9",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":1967},"e810da59-1dac-470d-a9fa-5791fc96027f","multilink","resources/topics/hospital-harm",{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},"Hospital Harm",147250689243354,"See all resources","simple-link",{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":1975,"is_external_url":290},121293076058734,"https://a-ca.storyblok.com/f/850807391887861/2068x1484/1aea4e8fb2/senior-woman-holding-doctors-hand.webp",{},"Hospital Harm Resources","image-text-colored-item",{"type":12,"content":1979},[1980],{"type":15,"attrs":1981,"content":1982},{"textAlign":53},[1983],{"text":1984,"type":299},"Healthcare Excellence Canada has developed Hospital Harm Improvement Resources – a compilation of resources to support patient safety and improvement efforts.","image-text-colored",[129,150,136,122,143,115,157],[185,192,200],"hec-page-resource-single","procedure-associated-shock","resources/procedure-associated-shock",-18780,[],"2fe6c781-6164-45cb-b763-450bf970bc7f","2025-12-15T18:42:00.801Z",[],[1997],{"path":1998,"name":1999,"lang":469,"published":461},"ressources/choc-lie-a-une-intervention","Choc lié à une intervention",{"name":2001,"created_at":2002,"published_at":2003,"updated_at":2004,"id":2005,"uuid":310,"content":2006,"slug":2981,"full_slug":2982,"sort_by_date":53,"position":2983,"tag_list":2984,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":2985,"first_published_at":2986,"release_id":53,"lang":300,"path":53,"alternates":2987,"default_full_slug":2982,"translated_slugs":2988},"Anemia – Hemorrhage (Health Care / Medication Associated Condition)","2025-12-12T20:28:22.771Z","2026-03-10T16:21:57.012Z","2026-03-10T16:21:57.062Z",122395454645109,{"new":290,"seo":2007,"_uid":493,"hero":2008,"type":174,"topics":2029,"Noindex":290,"content":2030,"audience":2979,"duration":16,"regional":2980,"component":1988},{"_uid":491,"title":2001,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[2009],{"_uid":496,"image":2010,"title":2012,"format":2013,"component":505,"description":2016,"key_learning":2023,"prerequisite":2026},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":2011,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Anemia – Hemorrhage (Health Care / Medication Associated Condition)",{"type":12,"content":2014},[2015],{"type":15},{"type":12,"content":2017},[2018],{"type":15,"attrs":2019,"content":2020},{"textAlign":53},[2021],{"text":2022,"type":299},"Anemia is a decrease in the number of red blood cells (RBCs), hematocrit (Hct), or hemoglobin (Hb) content. Anemia is not a diagnosis; it is a manifestation of an underlying disorder. Anemia can occur as the result of one or more of three basic mechanisms; blood loss, deficient erythropoiesis, and excessive hemolysis (Lichtin, 2017). The focus of this resource is on anemia related to acute blood loss (acute posthemorrhagic anemia) and hemorrhagic disorders due to circulating anticoagulants.",{"type":12,"content":2024},[2025],{"type":15},{"type":12,"content":2027},[2028],{"type":15},[76,8],[2031,2042,2331,2391,2579,2611,2782,2798,2961],{"_uid":522,"link":2032,"image":2033,"title":526,"component":527,"media_type":528,"description":2035},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":2034},{},{"type":12,"content":2036},[2037],{"type":15,"attrs":2038,"content":2039},{"textAlign":53},[2040],{"text":2041,"type":299},"Reduce the incidence of hemorrhagic anemia or hemorrhagic disorders identified during a hospital stay, related to the health care delivered or therapeutic use of anticoagulants.",{"_uid":537,"content":2043,"component":872},[2044],{"_uid":540,"content":2045,"component":871},{"type":12,"content":2046},[2047,2051,2062,2067,2072,2077,2082,2200,2205,2210,2215,2273,2278,2308,2313,2318],{"type":544,"attrs":2048,"content":2049},{"level":546,"textAlign":53},[2050],{"text":549,"type":299},{"type":15,"attrs":2052,"content":2053},{"textAlign":53},[2054,2055,2061],{"text":554,"type":299},{"text":556,"type":299,"marks":2056},[2057],{"type":559,"attrs":2058},{"href":561,"uuid":356,"anchor":53,"custom":2059,"target":563,"linktype":564,"story":2060},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":2063,"content":2064},{"textAlign":53},[2065],{"text":2066,"type":299},"Acute post-hemorrhagic anemia secondary to Gastrointestinal (GI) Bleeding",{"type":15,"attrs":2068,"content":2069},{"textAlign":53},[2070],{"text":2071,"type":299},"Patients may have acute blood loss from GI bleeding. Nosocomial GI bleeding is source of preventable hospital morbidity and mortality (Herzig et al. 2013). Causes of upper GI bleeding include peptic ulcers, gastritis and inflammation of the GI lining from ingested materials. Ulcers are localized erosions of the mucosal lining of the digestive tract and they usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, which causes bleeding. Gastritis and inflammation of the GI lining may be caused by non-steroidal anti-inflammatory drugs (NSAIDs) and steroids (Lanza et al. 2009; Narum et al. 2014). In the ICU, stress-induced mucosal lesions are a risk factor for bleeding (McEvoy & Shander, 2013).",{"type":15,"attrs":2073,"content":2074},{"textAlign":53},[2075],{"text":2076,"type":299},"Acute GI bleeding will appear as vomiting of blood, bloody bowel movements or black, tarry stools. Vomited blood may look like coffee grounds. Other symptoms include fatigue, weakness, shortness of breath, abdominal pain, and pale appearance.",{"type":544,"attrs":2078,"content":2079},{"level":588,"textAlign":53},[2080],{"text":2081,"type":299},"Risk Factors for nosocomial GI bleeding in ICU patients (Guillamondegui et al. 2008; Weinhouse, 2019):",{"type":666,"content":2083},[2084,2091,2098,2110,2117,2123,2130,2137,2144,2151,2158,2165,2172,2179,2186,2193],{"type":669,"content":2085},[2086],{"type":15,"attrs":2087,"content":2088},{"textAlign":53},[2089],{"text":2090,"type":299},"Universally accepted risk factors stress ulceration:",{"type":669,"content":2092},[2093],{"type":15,"attrs":2094,"content":2095},{"textAlign":53},[2096],{"text":2097,"type":299},"Mechanical Ventilation for more than 48 hours",{"type":669,"content":2099},[2100,2105],{"type":15,"attrs":2101,"content":2102},{"textAlign":53},[2103],{"text":2104,"type":299},"Coagulopathy",{"type":544,"attrs":2106,"content":2107},{"level":588,"textAlign":53},[2108],{"text":2109,"type":299},"Other risk factors identified:",{"type":669,"content":2111},[2112],{"type":15,"attrs":2113,"content":2114},{"textAlign":53},[2115],{"text":2116,"type":299},"shock",{"type":669,"content":2118},[2119],{"type":15,"attrs":2120,"content":2121},{"textAlign":53},[2122],{"text":1602,"type":299},{"type":669,"content":2124},[2125],{"type":15,"attrs":2126,"content":2127},{"textAlign":53},[2128],{"text":2129,"type":299},"spinal cord injury",{"type":669,"content":2131},[2132],{"type":15,"attrs":2133,"content":2134},{"textAlign":53},[2135],{"text":2136,"type":299},"multiple trauma",{"type":669,"content":2138},[2139],{"type":15,"attrs":2140,"content":2141},{"textAlign":53},[2142],{"text":2143,"type":299},"head trauma",{"type":669,"content":2145},[2146],{"type":15,"attrs":2147,"content":2148},{"textAlign":53},[2149],{"text":2150,"type":299},"burns over 35 per cent of the total body surface area",{"type":669,"content":2152},[2153],{"type":15,"attrs":2154,"content":2155},{"textAlign":53},[2156],{"text":2157,"type":299},"acute renal failure",{"type":669,"content":2159},[2160],{"type":15,"attrs":2161,"content":2162},{"textAlign":53},[2163],{"text":2164,"type":299},"hepatic failure",{"type":669,"content":2166},[2167],{"type":15,"attrs":2168,"content":2169},{"textAlign":53},[2170],{"text":2171,"type":299},"history of peptic ulcer disease",{"type":669,"content":2173},[2174],{"type":15,"attrs":2175,"content":2176},{"textAlign":53},[2177],{"text":2178,"type":299},"history of upper GI bleed",{"type":669,"content":2180},[2181],{"type":15,"attrs":2182,"content":2183},{"textAlign":53},[2184],{"text":2185,"type":299},"Organ transplantation",{"type":669,"content":2187},[2188],{"type":15,"attrs":2189,"content":2190},{"textAlign":53},[2191],{"text":2192,"type":299},"Glucocorticoid therapy (when combined with other risk factors)",{"type":669,"content":2194},[2195],{"type":15,"attrs":2196,"content":2197},{"textAlign":53},[2198],{"text":2199,"type":299},"Hemorrhagic disorder due to circulating anticoagulants",{"type":15,"attrs":2201,"content":2202},{"textAlign":53},[2203],{"text":2204,"type":299},"Anticoagulation is the mainstay of medical treatment, prevention and reduction of recurrent venous thromboembolism, acute ischemic limbs, acute stroke, stroke prevention in patients with non-valvular atrial fibrillation, and it reduces the incidence of recurrent ischemic events and death in patients with acute coronary syndrome (Christos & Naples, 2016). Unfortunately, however the use of these medications carries significant risk of bleeding or hemorrhage.",{"type":15,"attrs":2206,"content":2207},{"textAlign":53},[2208],{"text":2209,"type":299},"Bleeding, or hemorrhagic disorder, is a possible side effect of anticoagulation therapy. (Carnovale et al. 2015). Anticoagulation therapy includes the use of warfarin (Coumadin), a Vitamin K antagonist, as well as the newer direct oral anticoagulants (DOACs) (Fernandez, 2015). Hemorrhage secondary to the use of vitamin K antagonists varies from one to 12 per cent per year, and is related to other risk factors. The risk of bleeding is highest in the initial few weeks of anticoagulation therapy (Cairns, 2011). As a drug category, anticoagulants are one of the top five drug types associated with patient safety incidents (Cousins, 2006).",{"type":15,"attrs":2211,"content":2212},{"textAlign":53},[2213],{"text":2214,"type":299},"Antithrombotic agents* are included on the Institute for Safe Medication Practice's (ISMP, 2018) high alert medication list due to the significant risk of causing life-threatening bleeding or thrombosis if the appropriate safe practices are not in place. This high risk is due to the complexity of administering this therapy:",{"type":666,"content":2216},[2217,2224,2231,2238,2245,2252,2259,2266],{"type":669,"content":2218},[2219],{"type":15,"attrs":2220,"content":2221},{"textAlign":53},[2222],{"text":2223,"type":299},"Selecting the appropriate agent and determining the appropriate dose",{"type":669,"content":2225},[2226],{"type":15,"attrs":2227,"content":2228},{"textAlign":53},[2229],{"text":2230,"type":299},"Individual patient variability in response to therapy",{"type":669,"content":2232},[2233],{"type":15,"attrs":2234,"content":2235},{"textAlign":53},[2236],{"text":2237,"type":299},"Timing of and use of the appropriate laboratory measures to monitor response",{"type":669,"content":2239},[2240],{"type":15,"attrs":2241,"content":2242},{"textAlign":53},[2243],{"text":2244,"type":299},"Proper adjustment of dose based upon the laboratory parameters and/or clinical response",{"type":669,"content":2246},[2247],{"type":15,"attrs":2248,"content":2249},{"textAlign":53},[2250],{"text":2251,"type":299},"The transition of patients from Heparin therapy to Warfarin",{"type":669,"content":2253},[2254],{"type":15,"attrs":2255,"content":2256},{"textAlign":53},[2257],{"text":2258,"type":299},"Ensuring patient education and compliance",{"type":669,"content":2260},[2261],{"type":15,"attrs":2262,"content":2263},{"textAlign":53},[2264],{"text":2265,"type":299},"Use of these agents in a variety of settings, by various practitioners, and within differing patient populations",{"type":669,"content":2267},[2268],{"type":15,"attrs":2269,"content":2270},{"textAlign":53},[2271],{"text":2272,"type":299},"Interdisciplinary coordination needed between lab, pharmacy, nursing, medical staff, and dietary (Purdue University PharmaTAP, 2008)",{"type":15,"attrs":2274,"content":2275},{"textAlign":53},[2276],{"text":2277,"type":299},"*Antithrombotic agents, include:",{"type":666,"content":2279},[2280,2287,2294,2301],{"type":669,"content":2281},[2282],{"type":15,"attrs":2283,"content":2284},{"textAlign":53},[2285],{"text":2286,"type":299},"anticoagulants (e.g., warfarin, low molecular weight heparin, IV unfractionated heparin)",{"type":669,"content":2288},[2289],{"type":15,"attrs":2290,"content":2291},{"textAlign":53},[2292],{"text":2293,"type":299},"Factor Xa inhibitors (e.g., fondaparinux, apixaban, rivaroxaban) direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran etexilate)",{"type":669,"content":2295},[2296],{"type":15,"attrs":2297,"content":2298},{"textAlign":53},[2299],{"text":2300,"type":299},"thrombolytics (e.g., alteplase, reteplase, tenecteplase)",{"type":669,"content":2302},[2303],{"type":15,"attrs":2304,"content":2305},{"textAlign":53},[2306],{"text":2307,"type":299},"glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)",{"type":15,"attrs":2309,"content":2310},{"textAlign":53},[2311],{"text":2312,"type":299},"Adverse drug events associated with anticoagulants can be reduced by implementing recognized safe practices in high risk areas such as: Use Programmable Pumps and Independent Double-Checks for IV Anticoagulants, Prepare All Heparin Doses and Solutions in the Hospital Pharmacy, and Provide Coagulation Test Results Within Two Hours or at Bedside (IHI, 2020b).",{"type":15,"attrs":2314,"content":2315},{"textAlign":53},[2316],{"text":2317,"type":299},"Patients who are receiving anticoagulant therapy have increased risk of hemorrhage when undergoing medical and surgical procedures (Guidelines and Protocols Advisory Committee 2015). Bleeding that occurs in hospital is associated with increased morbidity, mortality, increased length of stay, increased health care costs and increased hospital readmission (Purdue University PharmaTAP, 2008; Herzig et al. 2013; McEvoy & Shander, 2013).",{"type":15,"attrs":2319,"content":2320},{"textAlign":53},[2321,2323,2330],{"text":2322,"type":299},"For additional information regarding anemia – hemorrhage associated with a medical or surgical procedure, please refer to the Hospital Harm Improvement Resource ",{"text":2324,"type":299,"marks":2325},"Procedure Associated Conditions: Anemia – Hemorrhage",[2326],{"type":559,"attrs":2327},{"href":1614,"uuid":311,"anchor":53,"custom":2328,"target":563,"linktype":564,"story":2329},{},{"name":1617,"id":1618,"uuid":311,"slug":1619,"url":1620,"full_slug":1620,"_stopResolving":461},{"text":937,"type":299},{"_uid":2332,"items":2333,"title":884,"component":1622,"description":2384},"4cd50058-6039-4f5c-937b-e7f3c4004796",[2334,2365],{"_uid":2335,"title":2336,"ctaLeft":2337,"ctaRight":2338,"component":921,"columnLeft":2344,"columnRight":2348},"ee763740-c4c5-4ef7-bd5d-9c2a6bbe174b","Dennis Quaid Recounts Twins' Drug Ordeal",[],[2339],{"_uid":2340,"link":2341,"label":2336,"component":2343},"9f44c7c4-6b26-40e8-b025-ba0a69913051",{"id":16,"url":2342,"target":911,"linktype":912,"fieldtype":1965,"cached_url":2342},"https://www.cbsnews.com/news/dennis-quaid-recounts-twins-drug-ordeal/","simple-link-only",{"type":12,"content":2345},[2346],{"type":15,"attrs":2347},{"textAlign":53},{"type":12,"content":2349},[2350,2355,2360],{"type":15,"attrs":2351,"content":2352},{"textAlign":53},[2353],{"text":2354,"type":299},"[The twins] were supposed to have been given a pediatric blood thinner called Hep-lock to flush out their IV lines and prevent blood clots. But instead, they had been given two doses of Heparin, the adult version of the drug, which is 1,000 times stronger…. \"It was ten units that our kids are supposed to get. They got 10,000. And what it did is, it basically turned their blood to the consistency of water, where they had a complete inability to clot. And they were basically bleeding out at that point.\"",{"type":15,"attrs":2356,"content":2357},{"textAlign":53},[2358],{"text":2359,"type":299},"\"There was blood oozing out of little blood draws on their feet, and things like that, you know, through band-aids,\" he adds….",{"type":15,"attrs":2361,"content":2362},{"textAlign":53},[2363],{"text":2364,"type":299},"And to make matters worse the same avoidable mistake had occurred a year earlier at Methodist Hospital in Indianapolis. Six infants were given multiple adult doses of Heparin instead of the pediatric version; three of the infants survived, three did not….",{"_uid":2366,"title":2367,"ctaLeft":2368,"ctaRight":2369,"component":921,"columnLeft":2374,"columnRight":2377},"a422d018-0b74-48dc-ae62-512e27781ccf","Popular Blood Thinner Causing Deaths, Injuries at Nursing Homes",[],[2370],{"_uid":2371,"link":2372,"label":2367,"component":2343},"b3b2b545-f50c-40b9-b410-0de5fa838fe0",{"id":16,"url":2373,"target":911,"linktype":912,"fieldtype":1965,"cached_url":2373},"https://www.propublica.org/article/popular-blood-thinner-causing-deaths-injuries-at-nursing-homes",{"type":12,"content":2375},[2376],{"type":15},{"type":12,"content":2378},[2379],{"type":15,"attrs":2380,"content":2381},{"textAlign":53},[2382],{"text":2383,"type":299},"Some facilities fail to properly oversee Coumadin. Too much can cause bleeding; too little, clots. Nursing homes are \"a perfect setup for bad things happening,\" one expert says….",{"type":12,"content":2385},[2386],{"type":15,"attrs":2387,"content":2388},{"textAlign":53},[2389],{"text":2390,"type":299},"Hemorrhage is understandably alarming to patients and families. Not only may it be life-threatening, it complicates care and prolongs hospitalization. Anticoagulants such as warfarin and heparin are powerful medications that save lives and prevent further harm. This group of medications also has the potential to cause serious harm if not taken carefully. Patients who are knowledgeable about their medication therapy can help to reduce the risk of adverse drug events (IHI, 2020a).",{"_uid":914,"items":2392,"title":1621,"component":1622,"description":2538},[2393],{"_uid":917,"title":918,"ctaLeft":2394,"ctaRight":2395,"component":921,"columnLeft":2396,"columnRight":2417},[],[],{"type":12,"content":2397},[2398],{"type":15,"attrs":2399,"content":2400},{"textAlign":53},[2401,2407,2413],{"text":928,"type":299,"marks":2402},[2403],{"type":2404,"attrs":2405},"textStyle",{"color":2406},"#000000",{"text":930,"type":299,"marks":2408},[2409],{"type":559,"attrs":2410},{"href":561,"uuid":356,"anchor":53,"custom":2411,"target":563,"linktype":564,"story":2412},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":937,"type":299,"marks":2414},[2415],{"type":2404,"attrs":2416},{"color":2406},{"type":12,"content":2418},[2419,2424],{"type":15,"attrs":2420,"content":2421},{"textAlign":53},[2422],{"text":2423,"type":299},"If your review reveals that your cases of anemia - hemorrhage are linked to specific processes or procedures, you may find these resources helpful:",{"type":666,"content":2425},[2426,2440,2454,2461,2474,2489,2503,2510,2517,2524,2531],{"type":669,"content":2427},[2428],{"type":15,"attrs":2429,"content":2430},{"textAlign":53},[2431,2433],{"text":2432,"type":299},"Institute for Safe Medication Practices (ISMP). ",{"text":2434,"type":299,"marks":2435},"www.ismp.org",[2436],{"type":559,"attrs":2437},{"href":2438,"uuid":53,"anchor":53,"custom":2439,"target":911,"linktype":912},"https://home.ecri.org/pages/ismp",{},{"type":669,"content":2441},[2442],{"type":15,"attrs":2443,"content":2444},{"textAlign":53},[2445,2447],{"text":2446,"type":299},"British Columbia. ",{"text":2448,"type":299,"marks":2449},"BCGuidelines.ca",[2450],{"type":559,"attrs":2451},{"href":2452,"uuid":53,"anchor":53,"custom":2453,"target":911,"linktype":912},"https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines",{},{"type":669,"content":2455},[2456],{"type":15,"attrs":2457,"content":2458},{"textAlign":53},[2459],{"text":2460,"type":299},"National Blood Authority Australia. 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",{"text":2482,"type":299,"marks":2483},"Clinical Guides",[2484],{"type":559,"attrs":2485},{"href":2486,"uuid":53,"anchor":53,"custom":2487,"target":911,"linktype":912},"https://thrombosiscanada.ca/hcp/practice/clinical_guides",{},{"text":937,"type":299},{"type":669,"content":2490},[2491],{"type":15,"attrs":2492,"content":2493},{"textAlign":53},[2494,2496],{"text":2495,"type":299},"American Society of Health-System Pharmacists (ASHP): Gastrointestinal Stress Ulcer Prophylaxis (pending) 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Hemorrhage).",{"type":669,"content":2776},[2777],{"type":15,"attrs":2778,"content":2779},{"textAlign":53},[2780],{"text":2781,"type":299},"The blood transfusion indicator is optional to code in British Columbia.",{"_uid":2783,"content":2784,"component":872},"2550fee5-6a0c-4162-988a-4c480464db28",[2785],{"_uid":2786,"content":2787,"component":871},"d36fbdd0-6f96-4d82-aa8e-4931c3d6c7bb",{"type":12,"content":2788},[2789,2793],{"type":544,"attrs":2790,"content":2791},{"level":546,"textAlign":53},[2792],{"text":1850,"type":299},{"type":15,"attrs":2794,"content":2795},{"textAlign":53},[2796],{"text":2797,"type":299},"​We are looking for an improvement success story related to Anemia - Hemorrhage. If you have one you would like to share, please contact Healthcare Excellence Canada at info@hec-esc.ca. ",{"_uid":1876,"items":2799,"title":1951,"component":1622,"description":2816},[2800],{"_uid":1879,"title":1880,"ctaLeft":2801,"ctaRight":2802,"component":921,"columnLeft":2803,"columnRight":2807},[],[],{"type":12,"content":2804},[2805],{"type":15,"attrs":2806},{"textAlign":53},{"type":12,"content":2808},[2809],{"type":15,"attrs":2810,"content":2811},{"textAlign":53},[2812],{"text":2813,"type":299,"marks":2814},"Add the listing of resources here. ",[2815],{"type":1633},{"type":12,"content":2817},[2818,2828,2833,2845,2850,2862,2874,2879,2884,2889,2894,2899,2910,2915,2927,2939,2951,2956],{"type":15,"attrs":2819,"content":2820},{"textAlign":53},[2821,2823],{"text":2822,"type":299},"Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Cn J Cardiol. 2011; 27 (1), 74-90. doi: 10.1016/j.cjca.2010.11.007. ",{"text":2824,"type":299,"marks":2825},"https://www.onlinecjc.ca/article/S0828-282X%2810%2900008-5/fulltext",[2826],{"type":559,"attrs":2827},{"href":2824,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":15,"attrs":2829,"content":2830},{"textAlign":53},[2831],{"text":2832,"type":299},"Carnovale C, Brusadelli T, Casini ML. Drug-induced anaemia: a decade review of reporting to the Italian Pharmacovigilance data-base. Int Clin J Pharm. 2015, 37 (1), 23-26. doi: 10.1007/s11096-014-0054-3",{"type":15,"attrs":2834,"content":2835},{"textAlign":53},[2836,2838],{"text":2837,"type":299},"Christos S, Naples R. Anticoagulation reversal and treatment strategies in major bleeding: Update 2016. West J Emerg Med. 2016; 17 (3): 264-70. doi: 10.5811/westjem.2016.3.29294. ",{"text":2839,"type":299,"marks":2840},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899056/",[2841],{"type":559,"attrs":2842},{"href":2843,"uuid":53,"anchor":53,"custom":2844,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4899056/",{},{"type":15,"attrs":2846,"content":2847},{"textAlign":53},[2848],{"text":2849,"type":299},"Cousins D, Harris, Safe Medication Practice Team. Risk assessment of anticoagulation therapy. National Patient Safety Agency; 2006. https://www.sps.nhs.uk/wp-content/uploads/2018/02/NRLS-0233-Anticoagulant-tssessment-2006-01-v1.pdf",{"type":15,"attrs":2851,"content":2852},{"textAlign":53},[2853,2855],{"text":2854,"type":299},"Fernández CS, Formiga F, Camafort M, et al. Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovasc Disord. 2015; 15: 143. doi: 10.1186/s12872-015-0137-7. ",{"text":2856,"type":299,"marks":2857},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632329/",[2858],{"type":559,"attrs":2859},{"href":2860,"uuid":53,"anchor":53,"custom":2861,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4632329/",{},{"type":15,"attrs":2863,"content":2864},{"textAlign":53},[2865,2867],{"text":2866,"type":299},"Erratum: Fernández CS, Formiga F, Camafort M, et al. Erratum: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach. BMC Cardiovasc Disord. 2015; 15: 157. doi: 10.1186/s12872-015-0150-x. ",{"text":2868,"type":299,"marks":2869},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653852/",[2870],{"type":559,"attrs":2871},{"href":2872,"uuid":53,"anchor":53,"custom":2873,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4653852/",{},{"type":15,"attrs":2875,"content":2876},{"textAlign":53},[2877],{"text":2878,"type":299},"Guillamondegui OD, Gunter OL Jr, EAST Practice Management Guidelines Committee. Practice management guidelines for stress ulcer prophylaxis. Chicago, IL: Eastern Association for the Surgery of Trauma; 2008. https://www.east.org/education/practice-management-guidelines/stress-ulcer-prophylaxis",{"type":15,"attrs":2880,"content":2881},{"textAlign":53},[2882],{"text":2883,"type":299},"Herzig SJ, Rothberg MB, Feinbloom DB, et al. Risk factors for nosocomial gastrointestinal bleeding and use of acid-suppressive medication in non-critically ill patients. J Gen Intern Med. 2013; 28 (5): 683-690. doi: 10.1007/s11606-012-2296-x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631055/",{"type":15,"attrs":2885,"content":2886},{"textAlign":53},[2887],{"text":2888,"type":299},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",{"type":15,"attrs":2890,"content":2891},{"textAlign":53},[2892],{"text":2893,"type":299},"Institute for Healthcare Improvement (IHI). Educate Patients to Manage Warfarin Therapy at Home. Cambridge, MA: IHI; 2020a. http://www.ihi.org/resources/Pages/Changes/EducatePatientstoManageWarfarinTherapyatHome.aspx",{"type":15,"attrs":2895,"content":2896},{"textAlign":53},[2897],{"text":2898,"type":299},"Institute for Healthcare Improvement (IHI). Changes: Reduce adverse drug events involving anticoagulants. Cambridge, MA: IHI; 2020b. http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingAnticoagulants.aspx",{"type":15,"attrs":2900,"content":2901},{"textAlign":53},[2902,2904],{"text":2903,"type":299},"Institute for Safe Medication Practices (ISMP). ISMP list of high-alert medications in acute care settings. Horsham, PA; ISMP: 2018. ",{"text":2905,"type":299,"marks":2906},"https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf",[2907],{"type":559,"attrs":2908},{"href":2905,"uuid":53,"anchor":53,"custom":2909,"target":911,"linktype":912},{},{"type":15,"attrs":2911,"content":2912},{"textAlign":53},[2913],{"text":2914,"type":299},"Lanza FL, Chan FK, Quigley EM. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104 (3), 728-738. doi: 10.1038/ajg.2009.115.",{"type":15,"attrs":2916,"content":2917},{"textAlign":53},[2918,2920],{"text":2919,"type":299},"Lichtin AE. Etiology of anemia. Merck Manual. 2017.",{"text":2921,"type":299,"marks":2922}," www.msdmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/etiology-of-anemia",[2923],{"type":559,"attrs":2924},{"href":2925,"uuid":53,"anchor":53,"custom":2926,"target":911,"linktype":912},"https://www.msdmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/etiology-of-anemia",{},{"type":15,"attrs":2928,"content":2929},{"textAlign":53},[2930,2932],{"text":2931,"type":299},"McEvoy MT, Shander A. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies. Am J Crit Care. 2013; 22 (6 Suppl): eS1-13. doi: 10.4037/ajcc2013729. ",{"text":2933,"type":299,"marks":2934},"http://ajcc.aacnjournals.org/content/22/6/eS1.long",[2935],{"type":559,"attrs":2936},{"href":2937,"uuid":53,"anchor":53,"custom":2938,"target":911,"linktype":912},"https://aacnjournals.org/ajcconline/article/22/6/eS1/3950/Anemia-Bleeding-and-Blood-Transfusion-in-the",{},{"type":15,"attrs":2940,"content":2941},{"textAlign":53},[2942,2944],{"text":2943,"type":299},"Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open. 2014, 4 (5): e004587. doi: 10.1136/bmjopen-2013-004587. ",{"text":2945,"type":299,"marks":2946},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025450/",[2947],{"type":559,"attrs":2948},{"href":2949,"uuid":53,"anchor":53,"custom":2950,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4025450/",{},{"type":15,"attrs":2952,"content":2953},{"textAlign":53},[2954],{"text":2955,"type":299},"Purdue University PharmaTAP. 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UpToDate. 2018. https://www.uptodate.com/contents/stress-ulcer-prophylaxis-in-the-intensive-care-unit",{"id":16,"_uid":2962,"items":2963,"component":1985},"9b1a166e-b7ff-467c-b700-3fa455451106",[2964],{"_uid":2965,"link":2966,"image":2971,"title":1976,"component":1977,"description":2973},"22ad02f9-4026-44ee-a378-737a3c0ddd43",[2967],{"_uid":2968,"link":2969,"label":1970,"component":1971},"2480becb-0372-431e-a4e6-fbcee21ade88",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":2970},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":2972,"is_external_url":290},{},{"type":12,"content":2974},[2975],{"type":15,"attrs":2976,"content":2977},{"textAlign":53},[2978],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],"anemia-hemorrhage-health-care-medication-associated-condition","resources/anemia-hemorrhage-health-care-medication-associated-condition",-18770,[],"f4827a69-9e18-4bb9-942f-5454abf6aefe","2025-12-12T21:01:18.391Z",[],[2989],{"path":2990,"name":2991,"lang":469,"published":461},"ressources/anemie-hemorragie-affections-liees-aux-soins-de-sante-ou-aux-medicaments","Anémie – hémorragie (Affections liées aux soins de santé ou aux médicaments)",{"name":2993,"created_at":2994,"published_at":2995,"updated_at":2996,"id":2997,"uuid":312,"content":2998,"slug":3797,"full_slug":3798,"sort_by_date":53,"position":3799,"tag_list":3800,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":3801,"first_published_at":3802,"release_id":53,"lang":300,"path":53,"alternates":3803,"default_full_slug":3798,"translated_slugs":3804},"Aspiration Pneumonia","2025-12-12T18:49:34.724Z","2026-03-10T16:22:15.538Z","2026-03-10T16:22:15.588Z",122371173389171,{"new":290,"seo":2999,"_uid":493,"hero":3000,"type":174,"topics":3021,"Noindex":290,"content":3022,"audience":3795,"duration":16,"regional":3796,"component":1988},{"_uid":491,"title":2993,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[3001],{"_uid":496,"image":3002,"title":3004,"format":3005,"component":505,"description":3008,"key_learning":3015,"prerequisite":3018},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":3003,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Aspiration Pneumonia",{"type":12,"content":3006},[3007],{"type":15},{"type":12,"content":3009},[3010],{"type":15,"attrs":3011,"content":3012},{"textAlign":53},[3013],{"text":3014,"type":299},"Nosocomial pneumonia can be classified into various subtypes, the most common of which is aspiration pneumonia (Marik, 2011). Aspiration is defined as the misdirection of oropharyngeal or gastric contents into the larynx and lower respiratory tract. Aspiration pneumonia then results when orogastric secretions colonized with bacteria produce an infectious response in the lungs. Aspiration of sterile contents causes chemical inflammation or aspiration pneumonitis (Marik, 2011).",{"type":12,"content":3016},[3017],{"type":15},{"type":12,"content":3019},[3020],{"type":15},[76,8],[3023,3034,3275,3309,3441,3473,3595,3618,3777],{"_uid":522,"link":3024,"image":3025,"title":526,"component":527,"media_type":528,"description":3027},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":3026},{},{"type":12,"content":3028},[3029],{"type":15,"attrs":3030,"content":3031},{"textAlign":53},[3032],{"text":3033,"type":299},"To prevent aspiration pneumonia and aspiration pneumonitis in hospitalized patients by implementing strategies known to reduce the incidence of aspiration pneumonia and pneumonitis.",{"_uid":537,"content":3035,"component":872},[3036],{"_uid":540,"content":3037,"component":871},{"type":12,"content":3038},[3039,3044,3055,3060,3084,3089,3094,3099,3104,3109,3114,3119,3126,3131,3218,3225,3230],{"type":544,"attrs":3040,"content":3041},{"level":546,"textAlign":53},[3042],{"text":3043,"type":299},"Overview",{"type":15,"attrs":3045,"content":3046},{"textAlign":53},[3047,3048,3054],{"text":554,"type":299},{"text":556,"type":299,"marks":3049},[3050],{"type":559,"attrs":3051},{"href":561,"uuid":356,"anchor":53,"custom":3052,"target":563,"linktype":564,"story":3053},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":3056,"content":3057},{"textAlign":53},[3058],{"text":3059,"type":299},"There are three causes for aspirations that lead to aspiration pneumonia:",{"type":1643,"attrs":3061,"content":3062},{"order":608},[3063,3070,3077],{"type":669,"content":3064},[3065],{"type":15,"attrs":3066,"content":3067},{"textAlign":53},[3068],{"text":3069,"type":299},"Orogastric secretions in patients with marked disturbance of consciousness. For example, acute neurological insult including stroke or head trauma.",{"type":669,"content":3071},[3072],{"type":15,"attrs":3073,"content":3074},{"textAlign":53},[3075],{"text":3076,"type":299},"Misdirected orally ingested liquids and/or foods due to swallowing difficulties secondary to a medical condition or intervention. For example, progressive neurological illnesses including Parkinson's disease, ALS as well as tumours of the head and neck or iatrogenic causes such as head and neck cancer treatments such as surgical ablation, chemoradiation therapy and damage to the laryngeal area following prolonged endotracheal intubation.",{"type":669,"content":3078},[3079],{"type":15,"attrs":3080,"content":3081},{"textAlign":53},[3082],{"text":3083,"type":299},"Misdirected orally ingested liquids and/or foods due to aging process.",{"type":15,"attrs":3085,"content":3086},{"textAlign":1638},[3087],{"text":3088,"type":299},"Pneumonitis is best defined as acute lung injury following the aspiration of regurgitated gastric contents. This syndrome occurs in patients with a marked disturbance of consciousness, such as drug overdose, seizures, and anesthesia. Drug overdose is a common cause of aspiration pneumonitis, occurring in approximately 10 per cent of patients hospitalized following a drug overdose. The risk of aspiration increases with the degree of unconsciousness (as measured by the Glasgow Coma Scale). Historically, the syndrome most commonly associated with aspiration pneumonitis is Mendelson's syndrome (Marik, 2011).",{"type":15,"attrs":3090,"content":3091},{"textAlign":1638},[3092],{"text":3093,"type":299},"Aspiration pneumonia occurs when regurgitated gastric contents or oropharyngeal secretions or food are inadvertently directed into the trachea and subsequently into the lungs. As the bacteria and other microorganisms become part of an infiltrate within the lung tissue, the resulting effect is an infection in the lung (Pace & McCullough, 2010). Approximately half of all healthy adults aspirate small amounts of oropharyngeal secretions during sleep. However, if the mechanical, humoral, or cellular mechanisms are impaired or if the aspirated inoculum is large enough, pneumonia may follow. Any condition that increases the volume and/or bacterial burden of oropharyngeal secretions when the host defense mechanism is impaired may lead to aspiration pneumonia (Marik, 2011). Healthy people commonly aspirate small amounts of oral secretions, but normal defense mechanisms usually clear the inoculum without sequelae. Aspiration of larger amounts, or aspiration in a patient with impaired pulmonary defenses, often causes pneumonia and/or abscess. Elderly patients tend to aspirate because of conditions associated with aging that alter the level of consciousness, sedative use, neurologic disorders, weakness and other disorders. Empyema also occasionally complicates aspiration (Sethi, 2014).",{"type":15,"attrs":3095,"content":3096},{"textAlign":1638},[3097],{"text":3098,"type":299},"Paediatric populations have different causes of dysphagia than in adult populations. These causes include: cerebral palsy; acquired/traumatic brain injury; other neuromuscular disorders; craniofacial malformations; airway malformations; congenital cardiac disease; gastrointestinal disease; ingestional injuries; and preterm birth (Dodrill & Gosa, 2015; Lefton-Greif & Arvedson, 2007).",{"type":15,"attrs":3100,"content":3101},{"textAlign":1638},[3102],{"text":3103,"type":299},"Aspiration pneumonia represents five per cent to 15 per cent of pneumonias in the hospitalized population (DiBardino, 2015). It has been suggested that dysphagia carries a seven-fold increase risk of aspiration pneumonia and is an independent predictor of mortality (Metheny, 2011).",{"type":15,"attrs":3105,"content":3106},{"textAlign":1638},[3107],{"text":3108,"type":299},"Critically ill patients have an increased risk for aspirating oropharyngeal secretions and regurgitated gastric contents. For those who are tube-fed, aspiration of gastric contents is of greater concern. While witnessed large-volume aspirations occur occasionally, small-volume clinically silent aspirations are far more common. Because no bedside tests are currently available to detect microaspirations, efforts to prevent or minimize aspiration take on added importance (American Association of Critical-Care Nurses, 2016). Silent aspiration is frequent in the pediatric population (Lefton-Grief et al, 2006).",{"type":15,"attrs":3110,"content":3111},{"textAlign":1638},[3112],{"text":3113,"type":299},"Aspiration pneumonia generally occurs in elderly, debilitated patients with dysphagia (Marik, 2011). Epidemiological studies have demonstrated that the incidence of pneumonia increases with aging, with the risk being almost six times higher in those over the age of 75, compared to those less than 60 years of age (Marik, 2011).",{"type":15,"attrs":3115,"content":3116},{"textAlign":1638},[3117],{"text":3118,"type":299},"Aspiration pneumonia is the major cause of death in patients with dysphagia resulting from neurological disorders including cerebrovascular accidents, Parkinson's disease, and dementia (Marik, 2011).",{"type":544,"attrs":3120,"content":3121},{"level":546,"textAlign":1638},[3122],{"text":3123,"type":299,"marks":3124},"Risk Factors for Aspiration Pneumonia and Pneumonitis",[3125],{"type":618},{"type":15,"attrs":3127,"content":3128},{"textAlign":1638},[3129],{"text":3130,"type":299},"(DiBardino, 2015; Marik, 2011, American Association of Neuroscience Nurses, 2006)",{"type":1643,"attrs":3132,"content":3133},{"order":608},[3134,3141,3148,3155,3162,3169,3176,3183,3190,3197,3204,3211],{"type":669,"content":3135},[3136],{"type":15,"attrs":3137,"content":3138},{"textAlign":53},[3139],{"text":3140,"type":299},"Dysphagia/swallowing.",{"type":669,"content":3142},[3143],{"type":15,"attrs":3144,"content":3145},{"textAlign":53},[3146],{"text":3147,"type":299},"Altered mental status or decreased alertness and attention span.",{"type":669,"content":3149},[3150],{"type":15,"attrs":3151,"content":3152},{"textAlign":53},[3153],{"text":3154,"type":299},"Esophageal motility disorders/vomiting.",{"type":669,"content":3156},[3157],{"type":15,"attrs":3158,"content":3159},{"textAlign":53},[3160],{"text":3161,"type":299},"Enteral (tube) feeding.",{"type":669,"content":3163},[3164],{"type":15,"attrs":3165,"content":3166},{"textAlign":53},[3167],{"text":3168,"type":299},"Poor oral hygiene, decrease in salivary clearance.",{"type":669,"content":3170},[3171],{"type":15,"attrs":3172,"content":3173},{"textAlign":53},[3174],{"text":3175,"type":299},"Increased impulsiveness or agitation.",{"type":669,"content":3177},[3178],{"type":15,"attrs":3179,"content":3180},{"textAlign":53},[3181],{"text":3182,"type":299},"Use of medications such as psychotropic, neuroleptic, antidepressants, anticholinergic, or phenothiazine drugs.",{"type":669,"content":3184},[3185],{"type":15,"attrs":3186,"content":3187},{"textAlign":53},[3188],{"text":3189,"type":299},"Hyperextended neck or contractures.",{"type":669,"content":3191},[3192],{"type":15,"attrs":3193,"content":3194},{"textAlign":53},[3195],{"text":3196,"type":299},"Facial or neck reconstruction, cancers and their treatments.",{"type":669,"content":3198},[3199],{"type":15,"attrs":3200,"content":3201},{"textAlign":53},[3202],{"text":3203,"type":299},"Long-term intubation.",{"type":669,"content":3205},[3206],{"type":15,"attrs":3207,"content":3208},{"textAlign":53},[3209],{"text":3210,"type":299},"Advancing age due to decreased muscle mass reducing pharyngeal contraction and bolus drive.",{"type":669,"content":3212},[3213],{"type":15,"attrs":3214,"content":3215},{"textAlign":53},[3216],{"text":3217,"type":299},"Supine position.",{"type":544,"attrs":3219,"content":3220},{"level":546,"textAlign":1638},[3221],{"text":3222,"type":299,"marks":3223},"Paediatric Risk Factors for Aspiration Pneumonia",[3224],{"type":618},{"type":15,"attrs":3226,"content":3227},{"textAlign":1638},[3228],{"text":3229,"type":299},"(Weir et al, 2007)",{"type":1643,"attrs":3231,"content":3232},{"order":608},[3233,3240,3247,3254,3261,3268],{"type":669,"content":3234},[3235],{"type":15,"attrs":3236,"content":3237},{"textAlign":53},[3238],{"text":3239,"type":299},"Trisomy 21.",{"type":669,"content":3241},[3242],{"type":15,"attrs":3243,"content":3244},{"textAlign":53},[3245],{"text":3246,"type":299},"Asthma.",{"type":669,"content":3248},[3249],{"type":15,"attrs":3250,"content":3251},{"textAlign":53},[3252],{"text":3253,"type":299},"Gastroesophageal reflux disease (GERD).",{"type":669,"content":3255},[3256],{"type":15,"attrs":3257,"content":3258},{"textAlign":53},[3259],{"text":3260,"type":299},"Lower respiratory tract infection.",{"type":669,"content":3262},[3263],{"type":15,"attrs":3264,"content":3265},{"textAlign":53},[3266],{"text":3267,"type":299},"Moist cough.",{"type":669,"content":3269},[3270],{"type":15,"attrs":3271,"content":3272},{"textAlign":53},[3273],{"text":3274,"type":299},"Multisystem diagnoses.",{"_uid":874,"content":3276,"component":872},[3277],{"_uid":877,"content":3278,"component":871},{"type":12,"content":3279},[3280,3284,3289,3299,3304],{"type":544,"attrs":3281,"content":3282},{"level":546,"textAlign":53},[3283],{"text":884,"type":299},{"type":15,"attrs":3285,"content":3286},{"textAlign":53},[3287],{"text":3288,"type":299},"Aspiration pneumonia and aspiration pneumonitis occurs when foreign material, such as food, drink, gastric secretions and secretions from the mouth are inhaled and cause inflammation in the lungs and bronchial tubes. Aspiration can often be prevented by dietary interventions for dysphagia e.g. adjusting texture, consistency and amount of food and fluids, frequent oral care, post-pyloric tube (tube passes through stomach and into small intestine) feedings, and the semi-recumbent (45 degree angle) position for mechanically ventilated patients (DiBardino, 2015).",{"type":15,"attrs":3290,"content":3291},{"textAlign":53},[3292],{"text":3293,"type":299,"marks":3294},"Patient Story",[3295],{"type":559,"attrs":3296},{"href":3297,"uuid":53,"anchor":53,"custom":3298,"target":911,"linktype":912},"https://www.theguardian.com/society/2013/may/21/disabled-woman-nhs-blunders-ombudsman",{},{"type":15,"attrs":3300,"content":3301},{"textAlign":53},[3302],{"text":3303,"type":299},"A catalogue of mistakes by an out-of-hours GP service and a hospital contributed to the death of a young woman with physical and learning disabilities, the NHS ombudsman says in a highly critical report that has led to fresh claims of prejudicial attitudes leading to poor care for such vulnerable patients.",{"type":15,"attrs":3305,"content":3306},{"textAlign":53},[3307],{"text":3308,"type":299},"The report, by NHS ombudsman Dame Julie Mellor, finds that Tina Papalabropoulos, 23, died in Basildon hospital in Essex of aspiration pneumonia in 2009 after a series of blunders by two NHS organisations. ",{"_uid":914,"items":3310,"title":1621,"component":1622,"description":3401},[3311],{"_uid":917,"title":918,"ctaLeft":3312,"ctaRight":3313,"component":921,"columnLeft":3314,"columnRight":3333},[],[],{"type":12,"content":3315},[3316],{"type":15,"attrs":3317,"content":3318},{"textAlign":53},[3319,3323,3329],{"text":928,"type":299,"marks":3320},[3321],{"type":2404,"attrs":3322},{"color":2406},{"text":930,"type":299,"marks":3324},[3325],{"type":559,"attrs":3326},{"href":561,"uuid":356,"anchor":53,"custom":3327,"target":563,"linktype":564,"story":3328},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":937,"type":299,"marks":3330},[3331],{"type":2404,"attrs":3332},{"color":2406},{"type":12,"content":3334},[3335,3340],{"type":15,"attrs":3336,"content":3337},{"textAlign":53},[3338],{"text":3339,"type":299},"If your review reveals that your cases of aspiration pneumonia are linked to specific processes or procedures, you may find these resources helpful:",{"type":666,"content":3341},[3342,3354,3369,3381,3394],{"type":669,"content":3343},[3344],{"type":15,"attrs":3345,"content":3346},{"textAlign":53},[3347,3349],{"text":3348,"type":299},"American Association of Critical-Care Nurses (AACN). AACN practice alert: Prevention of aspiration in adults. Critical Care Nurse (2016 - updated 2018). ",{"text":3350,"type":299,"marks":3351},"https://www.aacn.org/clinical-resources/practice-alerts/prevention-of-aspiration",[3352],{"type":559,"attrs":3353},{"href":3350,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":3355},[3356],{"type":15,"attrs":3357,"content":3358},{"textAlign":53},[3359,3361,3367],{"text":3360,"type":299},"American Board of Swallowing and Swallowing Disorders. ",{"text":3362,"type":299,"marks":3363},"www.swallowingdisorders.org",[3364],{"type":559,"attrs":3365},{"href":3366,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},"http://www.swallowingdisorders.org/",{"text":3368,"type":299}," ",{"type":669,"content":3370},[3371],{"type":15,"attrs":3372,"content":3373},{"textAlign":53},[3374,3376],{"text":3375,"type":299},"Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee - Guidelines for preventing health-care associated pneumonia. (2003) ",{"text":3377,"type":299,"marks":3378},"http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm",[3379],{"type":559,"attrs":3380},{"href":3377,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":3382},[3383],{"type":15,"attrs":3384,"content":3385},{"textAlign":53},[3386,3388],{"text":3387,"type":299},"Dysphagia Research Society ",{"text":3389,"type":299,"marks":3390},"www.dysphagiaresearch.org",[3391],{"type":559,"attrs":3392},{"href":3393,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},"http://www.dysphagiaresearch.org/",{"type":669,"content":3395},[3396],{"type":15,"attrs":3397,"content":3398},{"textAlign":53},[3399],{"text":3400,"type":299},"NHS Patient Safety Resources. www.nrls.npsa.nhs.uk/resources/?entryid45=59823 ",{"type":12,"content":3402},[3403,3408,3412,3439],{"type":15,"attrs":3404,"content":3405},{"textAlign":53},[3406],{"text":3407,"type":299},"Given the broad range of potential causes of Aspiration Pneumonia, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":3409,"content":3410},{"textAlign":1638},[3411],{"text":1641,"type":299},{"type":1643,"attrs":3413,"content":3414},{"order":608},[3415,3421,3427,3433],{"type":669,"content":3416},[3417],{"type":15,"attrs":3418,"content":3419},{"textAlign":53},[3420],{"text":1652,"type":299},{"type":669,"content":3422},[3423],{"type":15,"attrs":3424,"content":3425},{"textAlign":53},[3426],{"text":1659,"type":299},{"type":669,"content":3428},[3429],{"type":15,"attrs":3430,"content":3431},{"textAlign":53},[3432],{"text":1666,"type":299},{"type":669,"content":3434},[3435],{"type":15,"attrs":3436,"content":3437},{"textAlign":53},[3438],{"text":1673,"type":299},{"type":15,"attrs":3440},{"textAlign":1638},{"_uid":1675,"items":3442,"title":1712,"component":1713,"description":3467},[3443,3449,3455,3461],{"_uid":1678,"image":3444,"title":1683,"component":1684,"description":3446},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":3445,"is_external_url":290},{},{"type":12,"content":3447},[3448],{"type":15},{"_uid":1689,"image":3450,"title":1692,"component":1684,"description":3452},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":3451,"is_external_url":290},{},{"type":12,"content":3453},[3454],{"type":15},{"_uid":1697,"image":3456,"title":1700,"component":1684,"description":3458},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":3457,"is_external_url":290},{},{"type":12,"content":3459},[3460],{"type":15},{"_uid":1705,"image":3462,"title":1708,"component":1684,"description":3464},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":3463,"is_external_url":290},{},{"type":12,"content":3465},[3466],{"type":15},{"type":12,"content":3468},[3469],{"type":15,"attrs":3470,"content":3471},{"textAlign":53},[3472],{"text":1720,"type":299},{"_uid":1722,"items":3474,"title":1818,"component":1622,"description":3576},[3475,3519,3544],{"_uid":1725,"title":1726,"ctaLeft":3476,"ctaRight":3477,"component":921,"columnLeft":3478,"columnRight":3482},[],[],{"type":12,"content":3479},[3480],{"type":15,"attrs":3481},{"textAlign":53},{"type":12,"content":3483},[3484,3492,3511],{"type":15,"attrs":3485,"content":3486},{"textAlign":53},[3487,3490],{"text":1739,"type":299,"marks":3488},[3489],{"type":618},{"text":3491,"type":299},": Condition",{"type":15,"attrs":3493,"content":3494},{"textAlign":53},[3495,3499,3501,3505,3507],{"text":3496,"type":299,"marks":3497},"J69.–",[3498],{"type":618},{"text":3500,"type":299},": Identified as diagnosis type (2) ",{"text":3502,"type":299,"marks":3503},"OR ",[3504],{"type":618},{"text":3506,"type":299},"Identified as diagnosis type (3) AND J95.88 as diagnosis type (2) AND Y60–Y84 ",{"text":3508,"type":299,"marks":3509},"in the same diagnosis cluster",[3510],{"type":618},{"type":15,"attrs":3512,"content":3513},{"textAlign":53},[3514,3517],{"text":2622,"type":299,"marks":3515},[3516],{"type":618},{"text":3518,"type":299},": Abstracts with a length of stay less than 2 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liquids",{"_uid":1783,"title":1784,"ctaLeft":3545,"ctaRight":3546,"component":921,"columnLeft":3547,"columnRight":3551},[],[],{"type":12,"content":3548},[3549],{"type":15,"attrs":3550},{"textAlign":53},{"type":12,"content":3552},[3553,3560,3565],{"type":15,"attrs":3554,"content":3555},{"textAlign":53},[3556,3559],{"text":1797,"type":299,"marks":3557},[3558],{"type":618},{"text":1801,"type":299},{"type":15,"attrs":3561,"content":3562},{"textAlign":53},[3563],{"text":3564,"type":299},"T95.88: Other post procedural respiratory disorders, Includes: Ventilator associated pneumonia (VAP)",{"type":15,"attrs":3566,"content":3567},{"textAlign":53},[3568,3570,3575],{"text":3569,"type":299},"Y60-Y84: Complications of medical and surgical care (refer to Appendix A of the 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Contact ",{"text":3612,"type":299,"marks":3613},"info@hec-esc.ca",[3614],{"type":559,"attrs":3615},{"href":3616,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},"mailto:info@hec-esc.ca",{"text":937,"type":299},{"_uid":1876,"items":3619,"title":1951,"component":1622,"description":3774},[3620],{"_uid":1879,"title":1880,"ctaLeft":3621,"ctaRight":3622,"component":921,"columnLeft":3623,"columnRight":3627},[],[],{"type":12,"content":3624},[3625],{"type":15,"attrs":3626},{"textAlign":53},{"type":12,"content":3628},[3629,3640,3651,3662,3679,3684,3695,3706,3717,3734,3752,3763],{"type":15,"attrs":3630,"content":3631},{"textAlign":53},[3632,3634,3638],{"text":3633,"type":299},"American Association of Critical-Care Nurses (AACN). AACN practice alert: Prevention of aspiration in adults. ",{"text":3635,"type":299,"marks":3636},"Critical Care Nurse.",[3637],{"type":1633},{"text":3639,"type":299}," 2016; 36 (1): e20 – e24. doi: 10.4037/ccn2016831. http://www.aacn.org/wd/practice/docs/practicealerts/aspiration-pa-feb2016ccn-pages.pdf",{"type":15,"attrs":3641,"content":3642},{"textAlign":1638},[3643,3645,3649],{"text":3644,"type":299},"American Association of Neuroscience Nurses. Prevention: aspiration precautions. ",{"text":3646,"type":299,"marks":3647},"Synapse",[3648],{"type":1633},{"text":3650,"type":299},". 2006; 33 (3): 3.",{"type":15,"attrs":3652,"content":3653},{"textAlign":1638},[3654,3656,3660],{"text":3655,"type":299},"DiBardino DM, Wunderink RG. Aspiration pneumonia: A review of modern trends. ",{"text":3657,"type":299,"marks":3658},"J Crit Care",[3659],{"type":1633},{"text":3661,"type":299},". 2015; 30 (1): 40–48. doi: 10.1016/j.jcrc.2014.07.011.",{"type":15,"attrs":3663,"content":3664},{"textAlign":1638},[3665,3667,3671,3673],{"text":3666,"type":299},"Dodrill P, Gosa MM. Pediatric dysphagia: physiology, assessment, and management.  ",{"text":3668,"type":299,"marks":3669},"Ann Nutr Metab",[3670],{"type":1633},{"text":3672,"type":299},". 2015; 66 (Suppl 5): 24-31. doi: 10.1159/000381372. ",{"text":3674,"type":299,"marks":3675},"http://www.karger.com/Article/FullText/381372",[3676],{"type":559,"attrs":3677},{"href":3674,"uuid":53,"anchor":53,"custom":3678,"target":911,"linktype":912},{},{"type":15,"attrs":3680,"content":3681},{"textAlign":1638},[3682],{"text":3683,"type":299},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventVAP.aspx",{"type":15,"attrs":3685,"content":3686},{"textAlign":1638},[3687,3689,3693],{"text":3688,"type":299},"Lefton-Greif MA, Arvedson JC. Pediatric feeding and swallowing disorders: state of health, population trends, and application of the international classification of functioning, disability, and health.  ",{"text":3690,"type":299,"marks":3691},"Semin Speech Lang",[3692],{"type":1633},{"text":3694,"type":299},". 2007; 28 (3): 161-165.",{"type":15,"attrs":3696,"content":3697},{"textAlign":1638},[3698,3700,3704],{"text":3699,"type":299},"Lefton-Greif MA, Carroll JL, Loughlin GM. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors.  ",{"text":3701,"type":299,"marks":3702},"Pediatr Pulmonol.",[3703],{"type":1633},{"text":3705,"type":299}," 2006; 41 (11): 1040-1048.",{"type":15,"attrs":3707,"content":3708},{"textAlign":1638},[3709,3711,3715],{"text":3710,"type":299},"Marik ",{"text":3712,"type":299,"marks":3713},"Curr Opin Pulm Med",[3714],{"type":1633},{"text":3716,"type":299},". 2011, 17 (3):148–154. doi: 10.1097/MCP.0b013e32834397d6PE. Pulmonary aspiration syndromes.",{"type":15,"attrs":3718,"content":3719},{"textAlign":1638},[3720,3722,3726,3728],{"text":3721,"type":299},"Metheny NA. Preventing aspiration in older adults with dysphagia.",{"text":3723,"type":299,"marks":3724}," Med-Surg Matters",[3725],{"type":1633},{"text":3727,"type":299},". 2011; 20 (5): 6-7. ",{"text":3729,"type":299,"marks":3730},"https://consultgeri.org/try-this/general-assessment/issue-20.pdf",[3731],{"type":559,"attrs":3732},{"href":3729,"uuid":53,"anchor":53,"custom":3733,"target":911,"linktype":912},{},{"type":15,"attrs":3735,"content":3736},{"textAlign":1638},[3737,3739,3743,3745],{"text":3738,"type":299},"Pace CC, McCullough GH. The association between oral microorganisms and aspiration pneumonia in the institutionalized elderly: review and recommendations. ",{"text":3740,"type":299,"marks":3741},"Dysphagia",[3742],{"type":1633},{"text":3744,"type":299},". 2010; 25 (4): 307-322. doi: 10.1007/s00455-010-9298-9. ",{"text":3746,"type":299,"marks":3747},"http://link.springer.com/article/10.1007%2Fs00455-010-9298-9",[3748],{"type":559,"attrs":3749},{"href":3750,"uuid":53,"anchor":53,"custom":3751,"target":911,"linktype":912},"http://link.springer.com/article/10.1007/s00455-010-9298-9",{},{"type":15,"attrs":3753,"content":3754},{"textAlign":1638},[3755,3757,3761],{"text":3756,"type":299},"Sethi S. Aspiration pneumonitis and pneumonia. ",{"text":3758,"type":299,"marks":3759},"Merck Manual",[3760],{"type":1633},{"text":3762,"type":299},". 2014. http://www.merckmanuals.com/professional/pulmonary_disorders/pneumonia/aspiration_pneumonitis_and_pneumonia.html",{"type":15,"attrs":3764,"content":3765},{"textAlign":1638},[3766,3768,3772],{"text":3767,"type":299},"Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children.  ",{"text":3769,"type":299,"marks":3770},"Pediatr Pulmonol",[3771],{"type":1633},{"text":3773,"type":299},". 2007; 42: 1024-1031.",{"type":12,"content":3775},[3776],{"type":15},{"id":16,"_uid":3778,"items":3779,"component":1985},"9d2490bb-886b-446a-9715-dbcc15767987",[3780],{"_uid":3781,"link":3782,"image":3787,"title":1976,"component":1977,"description":3789},"de1101a2-e4bc-4937-8b54-20107ecc42c3",[3783],{"_uid":3784,"link":3785,"label":1970,"component":1971},"45c132a0-4bb3-42e9-aa01-262dfa0728a3",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":3786},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":3788,"is_external_url":290},{},{"type":12,"content":3790},[3791],{"type":15,"attrs":3792,"content":3793},{"textAlign":53},[3794],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],"aspiration-pneumonia","resources/aspiration-pneumonia",-18760,[],"8cbef4c4-da9b-4e53-b55d-0b0889e515eb","2025-12-12T18:52:43.464Z",[],[3805],{"path":3806,"name":3807,"lang":469,"published":461},"ressources/pneumonie-par-aspiration","Pneumonie par aspiration",{"name":1617,"created_at":3809,"published_at":3810,"updated_at":3811,"id":1618,"uuid":311,"content":3812,"slug":1619,"full_slug":1620,"sort_by_date":53,"position":4570,"tag_list":4571,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":4572,"first_published_at":4573,"release_id":53,"lang":300,"path":53,"alternates":4574,"default_full_slug":1620,"translated_slugs":4575},"2025-12-12T18:27:48.051Z","2026-03-10T16:23:03.480Z","2026-03-10T16:23:03.526Z",{"new":290,"seo":3813,"_uid":493,"hero":3814,"type":174,"topics":3835,"Noindex":290,"content":3836,"audience":4568,"duration":16,"regional":4569,"component":1988},{"_uid":491,"title":1617,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[3815],{"_uid":496,"image":3816,"title":3818,"format":3819,"component":505,"description":3822,"key_learning":3829,"prerequisite":3832},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":3817,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Anemia – Hemorrhage (Procedure-Associated Conditions)",{"type":12,"content":3820},[3821],{"type":15},{"type":12,"content":3823},[3824],{"type":15,"attrs":3825,"content":3826},{"textAlign":53},[3827],{"text":3828,"type":299},"Hemorrhage or hemorrhagic anemia refers to anemia secondary to acute blood loss associated with a medical or surgical procedure. Bleeding is a potential complication of any surgical procedure, and the risk is proportional to the size and complexity of the surgery. High blood loss is associated with certain types of surgery such as cardiac and liver surgeries, certain orthopaedic procedures (such as hip replacement) and obstetric surgery. Mortality may be greatly increased when severe bleeding occurs during the operative procedure (National Institute for Health and Care Excellence (NICE), 2014).",{"type":12,"content":3830},[3831],{"type":15},{"type":12,"content":3833},[3834],{"type":15},[76,8],[3837,3848,3936,3964,4203,4235,4364,4417,4550],{"_uid":522,"link":3838,"image":3839,"title":526,"component":527,"media_type":528,"description":3841},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":3840},{},{"type":12,"content":3842},[3843],{"type":15,"attrs":3844,"content":3845},{"textAlign":53},[3846],{"text":3847,"type":299},"Reduce the incidence of hemorrhage or hemorrhagic anemia secondary to medical or surgical procedures.",{"_uid":537,"content":3849,"component":872},[3850],{"_uid":540,"content":3851,"component":871},{"type":12,"content":3852},[3853,3857,3868,3873,3917,3922],{"type":544,"attrs":3854,"content":3855},{"level":546,"textAlign":53},[3856],{"text":549,"type":299},{"type":15,"attrs":3858,"content":3859},{"textAlign":53},[3860,3861,3867],{"text":554,"type":299},{"text":556,"type":299,"marks":3862},[3863],{"type":559,"attrs":3864},{"href":561,"uuid":356,"anchor":53,"custom":3865,"target":563,"linktype":564,"story":3866},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":3869,"content":3870},{"textAlign":53},[3871],{"text":3872,"type":299},"A search of patient safety reporting/alert systems uncovered the following incidents of hemorrhage for patients undergoing medical or surgical procedures:",{"type":666,"content":3874},[3875,3882,3889,3896,3903,3910],{"type":669,"content":3876},[3877],{"type":15,"attrs":3878,"content":3879},{"textAlign":53},[3880],{"text":3881,"type":299},"Hemorrhage after liver biopsy (National Patient Safety Agency (NPSA) & National Reporting and Learning Service (NRLS), 2009)",{"type":669,"content":3883},[3884],{"type":15,"attrs":3885,"content":3886},{"textAlign":53},[3887],{"text":3888,"type":299},"Hemorrhage following removal of femoral catheter (NPSA & NRLS, 2010b)",{"type":669,"content":3890},[3891],{"type":15,"attrs":3892,"content":3893},{"textAlign":53},[3894],{"text":3895,"type":299},"Hemorrhage from arteriovenous fistula (NPSA & NRLS, 2011)",{"type":669,"content":3897},[3898],{"type":15,"attrs":3899,"content":3900},{"textAlign":53},[3901],{"text":3902,"type":299},"Hemorrhage following placement of gastrostomy (NPSA & NRLS, 2010a)",{"type":669,"content":3904},[3905],{"type":15,"attrs":3906,"content":3907},{"textAlign":53},[3908],{"text":3909,"type":299},"Hemorrhage during dialysis (Veterans Affairs Central Office, National Center for Patient Safety, 2008)",{"type":669,"content":3911},[3912],{"type":15,"attrs":3913,"content":3914},{"textAlign":53},[3915],{"text":3916,"type":299},"Hemorrhage during/following colonoscopy (Oregon Patient Safety Commission, 2015)",{"type":15,"attrs":3918,"content":3919},{"textAlign":53},[3920],{"text":3921,"type":299},"There is a relationship between pre-operative anemia and hemorrhage during surgical procedures. Iron deficiency is a common cause of pre-operative anemia and it should be corrected at prior to surgery to achieve optimal results (Gombotz, 2012; Theusinger et al., 2014; Theusinger et al., 2007). Bleeding that occurs in hospital as a result of a medical or surgical procedure is associated with increased morbidity, mortality and increased length of stay (Clevenger et al., 2015; Ferraris et al., 2012; Gombotz, 2012; Muñoz et al., 2016; Musallam et al., 2011; Spahn, 2010).",{"type":15,"attrs":3923,"content":3924},{"textAlign":53},[3925,3927,3935],{"text":3926,"type":299},"For additional information regarding Hospital Harm anemia – hemorrhage, please refer to the Hospital Harm Improvement Resource ",{"text":3928,"type":299,"marks":3929},"Anemia – Hemorrhage: Health Care / Medication Associated Condition",[3930],{"type":559,"attrs":3931},{"href":3932,"uuid":310,"anchor":53,"custom":3933,"target":563,"linktype":564,"story":3934},"/resources/anemia-hemorrhage-health-care-medication-associated-condition-",{},{"name":2001,"id":2005,"uuid":310,"slug":2981,"url":2982,"full_slug":2982,"_stopResolving":461},{"text":937,"type":299},{"_uid":874,"content":3937,"component":872},[3938],{"_uid":877,"content":3939,"component":871},{"type":12,"content":3940},[3941,3945,3950,3955,3959],{"type":544,"attrs":3942,"content":3943},{"level":546,"textAlign":53},[3944],{"text":884,"type":299},{"type":15,"attrs":3946,"content":3947},{"textAlign":53},[3948],{"text":3949,"type":299},"​Even mild anemia leads to impaired functional capacity, physical performance and a reduced quality of life. As anemia worsens, tissue hypoxia and organ dysfunction become apparent (Clevenger et al., 2015). Hemorrhage is understandably alarming to patients and families. Not only may it be life-threatening, it complicates care and prolongs hospitalization.",{"type":15,"attrs":3951,"content":3952},{"textAlign":53},[3953],{"text":3954,"type":299},"Patients who experience hemorrhage may require blood transfusions (Spahn, 2010). Risks of blood transfusions include transmission of bacterial or viral infections, febrile transfusion reactions and transfusion-related acute lung injury (Mazer, 2014; Spahn, 2010; Theusinger et al., 2014).",{"type":544,"attrs":3956,"content":3957},{"level":588,"textAlign":53},[3958],{"text":899,"type":299},{"type":15,"attrs":3960,"content":3961},{"textAlign":53},[3962],{"text":3963,"type":299},"We are looking for a patient story related to hemorrhage or hemorrhagic anemia associated with a medical or surgical care. If you have one, please share it with Healthcare Excellence Canada at info@hec-esc.ca.",{"_uid":914,"items":3965,"title":1621,"component":1622,"description":4159},[3966],{"_uid":917,"title":918,"ctaLeft":3967,"ctaRight":3968,"component":921,"columnLeft":3969,"columnRight":3982},[],[],{"type":12,"content":3970},[3971],{"type":15,"attrs":3972,"content":3973},{"textAlign":53},[3974,3975,3981],{"text":928,"type":299},{"text":930,"type":299,"marks":3976},[3977],{"type":559,"attrs":3978},{"href":561,"uuid":356,"anchor":53,"custom":3979,"target":563,"linktype":564,"story":3980},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":937,"type":299},{"type":12,"content":3983},[3984,3988],{"type":15,"attrs":3985,"content":3986},{"textAlign":53},[3987],{"text":2423,"type":299},{"type":666,"content":3989},[3990,4004,4018,4032,4046,4060,4067,4080,4087,4099,4112,4126,4138,4152],{"type":669,"content":3991},[3992],{"type":15,"attrs":3993,"content":3994},{"textAlign":53},[3995,3997],{"text":3996,"type":299},"American Society of Anesthesiologist. 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The estimated cost-savings associated with fewer transfusions in this patient population was $75,000.",{"_uid":4393,"title":4394,"ctaLeft":4395,"ctaRight":4396,"component":921,"columnLeft":4397,"columnRight":4401},"8d6634e1-93b3-4851-b7cc-a77b09e6f538","From blood transfusions, to heart surgery, to lung infections, Dr. Paul Hébert is doing research to improve the way we care for the sickest patients in the hospital",[],[],{"type":12,"content":4398},[4399],{"type":15,"attrs":4400},{"textAlign":53},{"type":12,"content":4402},[4403,4408],{"type":15,"attrs":4404,"content":4405},{"textAlign":53},[4406],{"text":4407,"type":299},"(Ottawa Hospital Research Institute, 2006)",{"type":15,"attrs":4409,"content":4410},{"textAlign":53},[4411],{"text":4412,"type":299},"Dr. Paul Hébert treats the sickest patients in The Ottawa Hospital – three of every 10 patients who arrive in the intensive care unit will never recover….While Dr. Hébert spends about half of his time trying to heal these patients one-by-one, the other half is spent on critical care research that is helping hundreds of thousands of patients in Ottawa and around the world….he found that patients treated aggressively with transfused blood had a higher death rate than patients whose doctors waited to order a transfusion.",{"type":12,"content":4414},[4415],{"type":15,"attrs":4416},{"textAlign":53},{"_uid":1876,"items":4418,"title":1951,"component":1622,"description":4434},[4419],{"_uid":1879,"title":1880,"ctaLeft":4420,"ctaRight":4421,"component":921,"columnLeft":4422,"columnRight":4426},[],[],{"type":12,"content":4423},[4424],{"type":15,"attrs":4425},{"textAlign":53},{"type":12,"content":4427},[4428],{"type":15,"attrs":4429,"content":4430},{"textAlign":53},[4431],{"text":2813,"type":299,"marks":4432},[4433],{"type":1633},{"type":12,"content":4435},[4436,4441,4446,4451,4456,4461,4466,4471,4476,4481,4486,4491,4503,4508,4513,4518,4529,4534,4539],{"type":15,"attrs":4437,"content":4438},{"textAlign":53},[4439],{"text":4440,"type":299},"Clevenger B, Mallett SV, Klein AA, Richards T. Patient blood management to reduce surgical risk. Br J Surg. 2015;102(11):1325-1337. doi:10.1002/bjs.9898",{"type":15,"attrs":4442,"content":4443},{"textAlign":53},[4444],{"text":4445,"type":299},"Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical Outcomes and Transfusion of Minimal Amounts of Blood in the Operating Room. Arch Surg. 2012;147(1):49-55. doi:10.1001/archsurg.2011.790",{"type":15,"attrs":4447,"content":4448},{"textAlign":53},[4449],{"text":4450,"type":299},"Gombotz H. Patient Blood Management: A Patient-Orientated Approach to Blood Replacement with the Goal of Reducing Anemia, Blood Loss and the Need for Blood Transfusion in Elective Surgery. Transfus Med Hemother. 2012;39(2):67-72. doi:10.1159/000337183",{"type":15,"attrs":4452,"content":4453},{"textAlign":53},[4454],{"text":4455,"type":299},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx.",{"type":15,"attrs":4457,"content":4458},{"textAlign":53},[4459],{"text":4460,"type":299},"Mazer CD. Blood conservation in cardiac surgery: Guidelines and controversies. Transfus Apher Sci. 2014;50(1):20-25. doi:10.1016/j.transci.2013.12.008",{"type":15,"attrs":4462,"content":4463},{"textAlign":53},[4464],{"text":4465,"type":299},"Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S. Pre-operative haematological assessment in patients scheduled for major surgery. Anaesthesia. 2016;71(S1):19-28. doi:10.1111/anae.13304",{"type":15,"attrs":4467,"content":4468},{"textAlign":53},[4469],{"text":4470,"type":299},"Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: A retrospective cohort study. Lancet. 2011;378(9800):1396-1407. doi:10.1016/S0140-6736(11)61381-0",{"type":15,"attrs":4472,"content":4473},{"textAlign":53},[4474],{"text":4475,"type":299},"National Institute for Health and Care Excellence (NICE). NICE Publishes Draft Guidance on Tests for Bleeding Problems during and after Cardiac Surgery. London, UK: NICE; 2014. https://www.nice.org.uk/news/press-and-media/nice-publishes-draft-guidance-on-tests-for-bleeding-problems-during-and-after-cardiac-surgery.",{"type":15,"attrs":4477,"content":4478},{"textAlign":53},[4479],{"text":4480,"type":299},"National Patient Safety Agency (NPSA), National Reporting and Learning Service (NRLS). Haemorrhage after Liver Biopsy. 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Patient Safety Alert: Colonoscopies and Red Dot Alerts for Anticoagulants. Portland, OR: Oregon Patient Safety Commission; 2015. https://oregonpatientsafety.org/news-information/news-information/action-alert-colonoscopies-and-red-dot-alerts-for-anticoagulants/553/.",{"type":15,"attrs":4509,"content":4510},{"textAlign":53},[4511],{"text":4512,"type":299},"Ottawa Hospital Research Institute (OHRI). From blood transfusions, to heart surgery, to lung infections, Dr. Paul Hébert is doing research to improve the way we care for the sickest patients in the hospital. OHRI Newsroom. http://www.ohri.ca/newsroom/story/view/751?l=en. Published June 1, 2006.",{"type":15,"attrs":4514,"content":4515},{"textAlign":53},[4516],{"text":4517,"type":299},"Spahn D. Anemia and Patient Blood Management in Hip and Knee Surgery: A Systematic Review of the Literature. 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Blood Transfus. 2014;12(2):195-203. doi:10.2450/2014.0306-13",{"type":15,"attrs":4535,"content":4536},{"textAlign":53},[4537],{"text":4538,"type":299},"Theusinger OM MD, Leyvraz P-F MD, Schanz U MD, Seifert B PhD, Spahn DR MD,FRCA. Treatment of Iron Deficiency Anemia in Orthopedic Surgery with Intravenous Iron: Efficacy and Limits: A Prospective Study. Anesthesiology. 2007;107(6):923-927. doi:10.1097/01.anes.0000291441.10704.82",{"type":15,"attrs":4540,"content":4541},{"textAlign":53},[4542,4544],{"text":4543,"type":299},"Veterans Affairs Central Office, National Center for Patient Safety. Bleeding Episodes During Dialysis. Washington, DC: Veterans Affairs Central Office; 2008. ",{"text":4545,"type":299,"marks":4546},"https://www.patientsafety.va.gov/docs/alerts/BleedingEpisodesDuringDialysisAD09-02.pdf",[4547],{"type":559,"attrs":4548},{"href":4545,"uuid":53,"anchor":53,"custom":4549,"target":911,"linktype":912},{},{"id":16,"_uid":4551,"items":4552,"component":1985},"96232488-0f71-4ef1-868b-fd594b855f28",[4553],{"_uid":4554,"link":4555,"image":4560,"title":1976,"component":1977,"description":4562},"53c10ac2-3930-454d-bc7d-9f9c7af9b8b5",[4556],{"_uid":4557,"link":4558,"label":1970,"component":1971},"8ca27af7-07f5-4422-8ca8-df6c56d7d5a0",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":4559},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":4561,"is_external_url":290},{},{"type":12,"content":4563},[4564],{"type":15,"attrs":4565,"content":4566},{"textAlign":53},[4567],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],-18750,[],"cfe2ce95-769a-413c-88ab-a91c6f4c228b","2025-12-12T18:28:48.577Z",[],[4576],{"path":4577,"name":4578,"lang":469,"published":461},"ressources/anemie-hemorragie-affections-liees-aux-interventions","Anémie – hémorragie (Affections liées aux interventions)",{"name":4580,"created_at":4581,"published_at":4582,"updated_at":4583,"id":4584,"uuid":364,"content":4585,"slug":6386,"full_slug":6387,"sort_by_date":53,"position":6388,"tag_list":6389,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":6390,"first_published_at":6391,"release_id":53,"lang":300,"path":53,"alternates":6392,"default_full_slug":6387,"translated_slugs":6393},"Infections due to Clostridium difficile, MRSA or VRE","2025-12-11T23:10:01.834Z","2026-03-10T16:24:06.050Z","2026-03-10T16:24:06.190Z",122081287578476,{"new":290,"seo":4586,"_uid":493,"hero":4587,"type":174,"topics":4613,"Noindex":290,"content":4614,"audience":6384,"duration":16,"regional":6385,"component":1988},{"_uid":491,"title":4580,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[4588],{"_uid":496,"image":4589,"title":4591,"format":4592,"component":505,"description":4595,"key_learning":4607,"prerequisite":4610},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":4590,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Infections due to Clostridium difficile, MRSA or VRE",{"type":12,"content":4593},[4594],{"type":15},{"type":12,"content":4596},[4597,4602],{"type":15,"attrs":4598,"content":4599},{"textAlign":53},[4600],{"text":4601,"type":299},"Healthcare-associated infections result in a substantial burden of disease in Canadians, and are an important public health problem. They are also a burden on Canada's healthcare system and a barrier to timely access to care for all Canadians (Public Health Agency of Canada 2017, \"Routine\").",{"type":15,"attrs":4603,"content":4604},{"textAlign":53},[4605],{"text":4606,"type":299},"While it is important to prevent, and control the spread of all infections, there are certain, antimicrobial resistant organisms that are more prevalent and pose a great risk in healthcare settings.",{"type":12,"content":4608},[4609],{"type":15},{"type":12,"content":4611},[4612],{"type":15},[76,8],[4615,4626,4751,4798,5555,5587,6068,6090,6164,6366],{"_uid":522,"link":4616,"image":4617,"title":526,"component":527,"media_type":528,"description":4619},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":4618},{},{"type":12,"content":4620},[4621],{"type":15,"attrs":4622,"content":4623},{"textAlign":53},[4624],{"text":4625,"type":299},"Reduce the incidence of infections due to C. difficile, MRSA or VRE.",{"_uid":537,"content":4627,"component":872},[4628],{"_uid":540,"content":4629,"component":871},{"type":12,"content":4630},[4631,4635,4646,4651,4656,4661,4685,4696,4701,4706,4711,4716,4721,4726,4731,4736,4741,4746],{"type":544,"attrs":4632,"content":4633},{"level":546,"textAlign":53},[4634],{"text":549,"type":299},{"type":15,"attrs":4636,"content":4637},{"textAlign":53},[4638,4639,4645],{"text":554,"type":299},{"text":556,"type":299,"marks":4640},[4641],{"type":559,"attrs":4642},{"href":561,"uuid":356,"anchor":53,"custom":4643,"target":563,"linktype":564,"story":4644},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":4647,"content":4648},{"textAlign":53},[4649],{"text":4650,"type":299},"Antimicrobial Resistance (AMR) occurs when microbes (e.g. bacteria, viruses, fungi and parasites) evolve in ways that reduces or eliminates the effectiveness of antimicrobial medicines (e.g. antibiotics, antivirals, antifungals and antiparasitics) to treat infections. When microbes are exposed to antimicrobials, they adapt and become more resistant (Public Health Agency of Canada 2017, \"Tackling\"). (These organisms include (but are not limited to) methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and Clostridium difficile (C. difficile).",{"type":15,"attrs":4652,"content":4653},{"textAlign":53},[4654],{"text":4655,"type":299},"The Public Health Agency of Canada (PHAC) estimates that approximately two per cent of patients admitted to large, academic Canadian hospitals will have acquired an infection with an Antibiotic Resistant Organism (ARO) during the course of their hospital stay (Mitchell et al. 2019) and that at any given time, three to 10 per cent of patients who are hospitalized in Canada will either be infected or be a carrier of an ARO (Martin et al. 2019). According to Dr. Tedros Adhanom Ghebreyesus, Director General, World Health Organisation \"AMR is one of the most urgent health risks of our time and threatens to undo a century of medical progress\" (World Health Organization 2019). Globally, today, 700,000 people die of resistant infections every year; and, if no action is taken, it's estimated that by 2050, 10 million lives are at risk worldwide due to the rise of drug resistant infections (Review on Antimicrobial Resistance, 2016).",{"type":15,"attrs":4657,"content":4658},{"textAlign":53},[4659],{"text":4660,"type":299},"The Government of Canada is com mitted to taking action to prevent, limit, and control the emergence and spread of AMR. The Federal Action Plan on Antimicrobial Resistance and Use in Canada (Public Health Agency of Canada, 2015) outlines 3 pillars of action:",{"type":1643,"attrs":4662,"content":4663},{"order":608},[4664,4671,4678],{"type":669,"content":4665},[4666],{"type":15,"attrs":4667,"content":4668},{"textAlign":53},[4669],{"text":4670,"type":299},"Surveillance: Detecting and monitoring trends and threats in order to inform strategies to reduce the risks and impacts of antimicrobial resistance.",{"type":669,"content":4672},[4673],{"type":15,"attrs":4674,"content":4675},{"textAlign":53},[4676],{"text":4677,"type":299},"Stewardship: Conserving the effectiveness of existing treatments through infection prevention and control guidelines, education and awareness, regulations, and oversight.",{"type":669,"content":4679},[4680],{"type":15,"attrs":4681,"content":4682},{"textAlign":53},[4683],{"text":4684,"type":299},"Innovation: Creating new solutions to counteract loss in antimicrobial effectiveness through research and development (Public Health Agency of Canada, 2015).",{"type":15,"attrs":4686,"content":4687},{"textAlign":53},[4688,4690,4694],{"text":4689,"type":299},"In addition to the Federal Action Plan, a Pan-Canadian Framework for Action (Public Health Agency of Canada 2017, \"Tackling\") outlines a One Health approach from both the human and agriculture perspectives. The framework encompasses the three pillars listed above, as well as a ",{"text":4691,"type":299,"marks":4692},"fourth pillar",[4693],{"type":618},{"text":4695,"type":299}," for Infection Prevention and Control (IPC).  ",{"type":544,"attrs":4697,"content":4698},{"level":588,"textAlign":53},[4699],{"text":4700,"type":299},"Clostridium difficile Infection (CDI)",{"type":15,"attrs":4702,"content":4703},{"textAlign":53},[4704],{"text":4705,"type":299},"Clostridium difficile (C. difficile) is a bacterium that causes mild to severe diarrhea and intestinal conditions like pseudomembranous colitis (inflammation of the colon).",{"type":15,"attrs":4707,"content":4708},{"textAlign":53},[4709],{"text":4710,"type":299},"C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces, and then touch their mouth. This may occur as a result of contamination of the patient environment, of shared equipment, or via the hands of healthcare workers. The elderly, those with other co-morbid illnesses, those who are hospitalized, or who are taking antibiotics, are at a greater risk of infection. Certain antibiotics used over a prolonged period of time increase the chance of developing a C. difficile infection (CDI). Nearly all antibiotics have been implicated in CDI, but broad-spectrum antibiotics and certain antibiotic classes, such as cephalosporins, clindamycin, and fluoroquinolones, seem to have a higher risk for placing patients at risk of CDI. ",{"type":15,"attrs":4712,"content":4713},{"textAlign":53},[4714],{"text":4715,"type":299},"C. difficile spores can exist for five (5) months on hospital surfaces. C. difficile is the most frequent cause of infectious diarrhea in hospitals and long-term care facilities in Canada, as well as in other industrialized countries and it is associated with increased hospital costs, including increased length of stay (Association for Professionals in Infection Control and Epidemiology 2013; Public Health Agency of Canada 2014; McDonald et al. 2018; NICE 2015; Centers for Disease Control and Prevention 2016, \"Clostridium difficile\").",{"type":544,"attrs":4717,"content":4718},{"level":588,"textAlign":53},[4719],{"text":4720,"type":299},"Methicillin-resistant Staphylococcus aureus (MRSA)",{"type":15,"attrs":4722,"content":4723},{"textAlign":53},[4724],{"text":4725,"type":299},"Staphylococcus aureus (Staph) is a type of bacteria that is commonly found on the skin and in the noses of healthy people. Some Staph bacteria are easily treatable while others are not. Staph bacteria that are resistant to the antibiotic methicillin are known as Methicillin-resistant Staphylococcus aureus or MRSA. If left untreated, MRSA infections may develop into serious, life-threatening complications such as infections of the bloodstream, bones and/or lungs (e.g., sepsis, pneumonia, etc.).",{"type":15,"attrs":4727,"content":4728},{"textAlign":53},[4729],{"text":4730,"type":299},"Methicillin-resistant Staphylococcus aureus (MRSA) is commonly found in Canadian hospitals and in the community. On one end of the spectrum, individuals can be colonized (carriers) and asymptomatic. On the other end of the spectrum, MRSA can lead to life-threating infection including septic shock and death. MRSA is spread by skin to skin contact or through contact with items contaminated by the bacteria. Those with weakened immune systems, chronic illnesses, hospitalized or having medical procedures are more at risk of acquiring infection. MRSA has been shown to spread easily in healthcare settings. MRSA can cause infections in a number of places, such as skin and soft tissue, blood, bones, joints, heart valves, lungs, and surgical wounds. (Public Health Agency of Canada 2008; Calfee 2012, Centers for Disease Control and Prevention 2016, \"MRSA\").",{"type":544,"attrs":4732,"content":4733},{"level":588,"textAlign":53},[4734],{"text":4735,"type":299},"Vancomycin-resistant Enterococci (VRE)",{"type":15,"attrs":4737,"content":4738},{"textAlign":53},[4739],{"text":4740,"type":299},"Enterococci are bacteria that live in the human intestine and are often found in the environment. Generally, these bacteria do not cause illness; however, when illness does occur, it can usually be treated with antibiotics. Vancomycin-resistant Enterococci (VRE) are strains of enterococci bacteria that are resistant to the antibiotic vancomycin. A person who is colonized with VRE does NOT have symptoms. A person is considered to be infected with VRE when symptoms ARE present.",{"type":15,"attrs":4742,"content":4743},{"textAlign":53},[4744],{"text":4745,"type":299},"VRE infections occur primarily in healthcare settings among patients with weakened immune systems, chronic illnesses and medical procedures/instrumentation. Those who have been previously treated with vancomycin or other antibiotics for long periods of time; those who have undergone surgical procedures and those with medical devices such as urinary catheters are at a higher risk of becoming infected with VRE. VRE tends to focus on places like the gastrointestinal tract, urinary tract, heart valves, blood, and any prosthetic devices, such as artificial joints, prosthetic heart valves, and intravenous catheters.",{"type":15,"attrs":4747,"content":4748},{"textAlign":53},[4749],{"text":4750,"type":299},"Vancomycin-resistant Enterococci (VRE) is considered a healthcare-associated drug-resistant organism. It can spread from patient to patient when bacteria are carried on the hands of healthcare workers and occasionally through contact with contaminated equipment or other surfaces (e.g. toilet seats, bedrails, door handles, soiled linens, stethoscopes, etc.) (Public Health Agency of Canada 2010; Calfee 2012; Centers for Disease Control and Prevention 2011).",{"_uid":2332,"items":4752,"title":884,"component":1622,"description":4791},[4753,4772],{"_uid":2335,"title":4754,"ctaLeft":4755,"ctaRight":4756,"component":921,"columnLeft":4761,"columnRight":4765},"Marie's Story",[],[4757],{"_uid":4758,"link":4759,"label":4754,"component":2343},"3c7ee6e1-0a04-4e98-8d4a-5e4ddfd1bf32",{"id":16,"url":4760,"target":911,"linktype":912,"fieldtype":1965,"cached_url":4760},"https://www.youtube.com/watch?v=I70uvpAHoRs",{"type":12,"content":4762},[4763],{"type":15,"attrs":4764},{"textAlign":53},{"type":12,"content":4766},[4767],{"type":15,"attrs":4768,"content":4769},{"textAlign":53},[4770],{"text":4771,"type":299},"Video: Infection with Clostridium difficile",{"_uid":4773,"title":4774,"ctaLeft":4775,"ctaRight":4776,"component":921,"columnLeft":4781,"columnRight":4784},"7d8022fd-9388-4c21-a83d-ffc128758567","Ginny's Story",[],[4777],{"_uid":4778,"link":4779,"label":4774,"component":2343},"c9eb4b8d-f25b-4b24-af28-4bb2a34eb8f9",{"id":16,"url":4780,"target":911,"linktype":912,"fieldtype":1965,"cached_url":4780},"https://www.youtube.com/watch?v=s5x1f3_NJX8",{"type":12,"content":4782},[4783],{"type":15},{"type":12,"content":4785},[4786],{"type":15,"attrs":4787,"content":4788},{"textAlign":53},[4789],{"text":4790,"type":299},"Video: Infection with MRSA",{"type":12,"content":4792},[4793],{"type":15,"attrs":4794,"content":4795},{"textAlign":53},[4796],{"text":4797,"type":299},"When patients get an infection while in hospital, it delays healing, extends the patient's length of stay and increases their risk for harm and readmission. By implementing infection prevention and control practices, patients are safer. Organisms can be spread from person to person in the hospital in different ways. Bacteria can be spread between patients on pieces of equipment and on unwashed hands. Since germs can live on many surfaces, staff, family and visitors can spread infections without knowing. Healthcare workers, patients, family, friends and visitors all have a role to play in preventing healthcare-associated infections. Hand hygiene is one of the most important ways to stop the spread of infections (Canadian Patient Safety Institute 2012).",{"_uid":914,"items":4799,"title":1621,"component":1622,"description":5514},[4800],{"_uid":917,"title":918,"ctaLeft":4801,"ctaRight":4802,"component":921,"columnLeft":4803,"columnRight":4816},[],[],{"type":12,"content":4804},[4805],{"type":15,"attrs":4806,"content":4807},{"textAlign":53},[4808,4809,4815],{"text":928,"type":299},{"text":930,"type":299,"marks":4810},[4811],{"type":559,"attrs":4812},{"href":561,"uuid":356,"anchor":53,"custom":4813,"target":563,"linktype":564,"story":4814},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":937,"type":299},{"type":12,"content":4817},[4818,4823,4828,4879,4884,4927,4932,4975,4980,5022,5027,5056,5061,5090,5095,5111,5116,5139,5144,5153,5158,5191,5196,5212,5217,5238,5243,5280,5285,5315,5320,5371,5376,5432,5437,5446,5451,5493,5498],{"type":15,"attrs":4819,"content":4820},{"textAlign":53},[4821],{"text":4822,"type":299},"If your surveillance, outbreak investigation or system review reveals that your cases of C. difficile, MRSA or VRE are linked to breaks in infection prevention and control practices, these resources maybe helpful:  ",{"type":15,"attrs":4824,"content":4825},{"textAlign":53},[4826],{"text":4827,"type":299},"Organizations (Canadian)",{"type":666,"content":4829},[4830,4837,4851,4866],{"type":669,"content":4831},[4832],{"type":15,"attrs":4833,"content":4834},{"textAlign":53},[4835],{"text":4836,"type":299},"Infection Prevention and Control Canada: Resources and Publications https://ipac-canada.org/resources.php",{"type":669,"content":4838},[4839],{"type":15,"attrs":4840,"content":4841},{"textAlign":53},[4842,4844],{"text":4843,"type":299},"Provincial Infection Control Network of British Columbia (PICNet): Guidelines and Toolkits ",{"text":4845,"type":299,"marks":4846},"https://www.picnet.ca/guidelines/",[4847],{"type":559,"attrs":4848},{"href":4849,"uuid":53,"anchor":53,"custom":4850,"target":911,"linktype":912},"https://picnet.ca/guidelines/",{},{"type":669,"content":4852},[4853],{"type":15,"attrs":4854,"content":4855},{"textAlign":53},[4856,4858,4864],{"text":4857,"type":299},"Public Health Agency of Canada, Infection Control Guideline Series ",{"text":4859,"type":299,"marks":4860},"https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections.html",[4861],{"type":559,"attrs":4862},{"href":4859,"uuid":53,"anchor":53,"custom":4863,"target":911,"linktype":912},{},{"text":4865,"type":299},"   ",{"type":669,"content":4867},[4868],{"type":15,"attrs":4869,"content":4870},{"textAlign":53},[4871,4873],{"text":4872,"type":299},"Public Health Ontario: Infection Prevention and Control ",{"text":4874,"type":299,"marks":4875},"https://www.publichealthontario.ca/en/health-topics/infection-prevention-control",[4876],{"type":559,"attrs":4877},{"href":4874,"uuid":53,"anchor":53,"custom":4878,"target":911,"linktype":912},{},{"type":15,"attrs":4880,"content":4881},{"textAlign":53},[4882],{"text":4883,"type":299},"Organizations (International)",{"type":666,"content":4885},[4886,4900,4913],{"type":669,"content":4887},[4888],{"type":15,"attrs":4889,"content":4890},{"textAlign":53},[4891,4893],{"text":4892,"type":299},"World Health Organization: Infection Prevention and Control ",{"text":4894,"type":299,"marks":4895},"https://www.who.int/infection-prevention/en/",[4896],{"type":559,"attrs":4897},{"href":4898,"uuid":53,"anchor":53,"custom":4899,"target":911,"linktype":912},"https://www.who.int/teams/integrated-health-services/infection-prevention-control",{},{"type":669,"content":4901},[4902],{"type":15,"attrs":4903,"content":4904},{"textAlign":53},[4905,4907],{"text":4906,"type":299},"Association for Professionals in Infection Control and Epidemiology: Practice guidance for infection prevention ",{"text":4908,"type":299,"marks":4909},"https://apic.org/Professional-Practice/overview/",[4910],{"type":559,"attrs":4911},{"href":4908,"uuid":53,"anchor":53,"custom":4912,"target":911,"linktype":912},{},{"type":669,"content":4914},[4915],{"type":15,"attrs":4916,"content":4917},{"textAlign":53},[4918,4920],{"text":4919,"type":299},"Centers for Disease Control and Prevention (CDC) : Infection Control ",{"text":4921,"type":299,"marks":4922},"https://www.cdc.gov/infectioncontrol/index.html",[4923],{"type":559,"attrs":4924},{"href":4925,"uuid":53,"anchor":53,"custom":4926,"target":911,"linktype":912},"https://www.cdc.gov/infection-control/hcp/",{},{"type":15,"attrs":4928,"content":4929},{"textAlign":53},[4930],{"text":4931,"type":299},"Infection Prevention and Control Programs (Canadian)",{"type":666,"content":4933},[4934,4948,4962],{"type":669,"content":4935},[4936],{"type":15,"attrs":4937,"content":4938},{"textAlign":53},[4939,4941],{"text":4940,"type":299},"Government of Manitoba. Routine practices and additional precautions: Preventing the transmission of infection in health care. Winnipeg, MB: Government of Manitoba; 2012. Available at: ",{"text":4942,"type":299,"marks":4943},"https://www.gov.mb.ca/health/publichealth/cdc/docs/ipc/rpap.pdf ",[4944],{"type":559,"attrs":4945},{"href":4946,"uuid":53,"anchor":53,"custom":4947,"target":911,"linktype":912},"https://www.gov.mb.ca/health/publichealth/cdc/docs/ipc/rpap.pdf",{},{"type":669,"content":4949},[4950],{"type":15,"attrs":4951,"content":4952},{"textAlign":53},[4953,4955],{"text":4954,"type":299},"Health Quality Ontario. Improvement map: Infection prevention and control. Available at: ",{"text":4956,"type":299,"marks":4957},"http://www.hqontario.ca/portals/0/Modals/qi/en/imap/infection.html ",[4958],{"type":559,"attrs":4959},{"href":4960,"uuid":53,"anchor":53,"custom":4961,"target":911,"linktype":912},"https://www.hqontario.ca/portals/0/Modals/qi/en/imap/infection.html",{},{"type":669,"content":4963},[4964],{"type":15,"attrs":4965,"content":4966},{"textAlign":53},[4967,4969],{"text":4968,"type":299},"Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for infection prevention and control programs in Ontario. Toronto, ON: Public Health Ontario; 2012. Available at: ",{"text":4970,"type":299,"marks":4971},"https://www.publichealthontario.ca/en/Health-Topics/Infection-Prevention-Control/Best-Practices-IPAC",[4972],{"type":559,"attrs":4973},{"href":4970,"uuid":53,"anchor":53,"custom":4974,"target":911,"linktype":912},{},{"type":15,"attrs":4976,"content":4977},{"textAlign":53},[4978],{"text":4979,"type":299},"Infection Prevention and Control Programs (International)",{"type":666,"content":4981},[4982,4995,5008],{"type":669,"content":4983},[4984],{"type":15,"attrs":4985,"content":4986},{"textAlign":53},[4987,4989],{"text":4988,"type":299},"National Institute for Health and Care Excellence (NICE). Healthcare-associated infections. 2016. Available at: ",{"text":4990,"type":299,"marks":4991},"https://www.nice.org.uk/guidance/qs113",[4992],{"type":559,"attrs":4993},{"href":4990,"uuid":53,"anchor":53,"custom":4994,"target":911,"linktype":912},{},{"type":669,"content":4996},[4997],{"type":15,"attrs":4998,"content":4999},{"textAlign":53},[5000,5002],{"text":5001,"type":299},"NICE. Infection prevention and control. 2014. Available at: ",{"text":5003,"type":299,"marks":5004},"https://www.nice.org.uk/guidance/qs61",[5005],{"type":559,"attrs":5006},{"href":5003,"uuid":53,"anchor":53,"custom":5007,"target":911,"linktype":912},{},{"type":669,"content":5009},[5010],{"type":15,"attrs":5011,"content":5012},{"textAlign":53},[5013,5015],{"text":5014,"type":299},"World Health Organization (WHO). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. 2016. Available at ",{"text":5016,"type":299,"marks":5017},"https://www.who.int/publications/i/item/9789241549929 ",[5018],{"type":559,"attrs":5019},{"href":5020,"uuid":53,"anchor":53,"custom":5021,"target":911,"linktype":912},"https://www.who.int/publications/i/item/9789241549929",{},{"type":15,"attrs":5023,"content":5024},{"textAlign":53},[5025],{"text":5026,"type":299},"Routine Practices and Additional Precautions (Canadian)",{"type":666,"content":5028},[5029,5042],{"type":669,"content":5030},[5031],{"type":15,"attrs":5032,"content":5033},{"textAlign":53},[5034,5036],{"text":5035,"type":299},"Public Health Agency of Canada (PHAC). Routine practices and additional precautions for preventing the transmission of infection in healthcare settings. 2017. Available at: ",{"text":5037,"type":299,"marks":5038},"https://www.canada.ca/en/public-health/services/publications/diseases-conditions/routine-practices-precautions-healthcare-associated-infections.html",[5039],{"type":559,"attrs":5040},{"href":5037,"uuid":53,"anchor":53,"custom":5041,"target":911,"linktype":912},{},{"type":669,"content":5043},[5044],{"type":15,"attrs":5045,"content":5046},{"textAlign":53},[5047,5049],{"text":5048,"type":299},"Provincial Infectious Diseases Advisory Committee (PIDAC). Routine practices and additional precautions in all health care settings. Public Health Ontario; 2012. 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Available at: https://www.cdc.gov/mrsa/healthcare/patient/index.html",{"type":669,"content":5508},[5509],{"type":15,"attrs":5510,"content":5511},{"textAlign":53},[5512],{"text":5513,"type":299},"CDC. Clostridium difficile infection information for patients. CDC; 2015. Available at:  https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html",{"type":12,"content":5515},[5516,5524,5528],{"type":15,"attrs":5517,"content":5518},{"textAlign":53},[5519,5520,5523],{"text":1629,"type":299},{"text":4580,"type":299,"marks":5521},[5522],{"type":1633},{"text":1635,"type":299},{"type":15,"attrs":5525,"content":5526},{"textAlign":1638},[5527],{"text":1641,"type":299},{"type":1643,"attrs":5529,"content":5530},{"order":608},[5531,5537,5543,5549],{"type":669,"content":5532},[5533],{"type":15,"attrs":5534,"content":5535},{"textAlign":53},[5536],{"text":1652,"type":299},{"type":669,"content":5538},[5539],{"type":15,"attrs":5540,"content":5541},{"textAlign":53},[5542],{"text":1659,"type":299},{"type":669,"content":5544},[5545],{"type":15,"attrs":5546,"content":5547},{"textAlign":53},[5548],{"text":1666,"type":299},{"type":669,"content":5550},[5551],{"type":15,"attrs":5552,"content":5553},{"textAlign":53},[5554],{"text":1673,"type":299},{"_uid":1675,"items":5556,"title":1712,"component":1713,"description":5581},[5557,5563,5569,5575],{"_uid":1678,"image":5558,"title":1683,"component":1684,"description":5560},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":5559,"is_external_url":290},{},{"type":12,"content":5561},[5562],{"type":15},{"_uid":1689,"image":5564,"title":1692,"component":1684,"description":5566},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":5565,"is_external_url":290},{},{"type":12,"content":5567},[5568],{"type":15},{"_uid":1697,"image":5570,"title":1700,"component":1684,"description":5572},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":5571,"is_external_url":290},{},{"type":12,"content":5573},[5574],{"type":15},{"_uid":1705,"image":5576,"title":1708,"component":1684,"description":5578},{"id":1680,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1681,"copyright":16,"fieldtype":288,"meta_data":5577,"is_external_url":290},{},{"type":12,"content":5579},[5580],{"type":15},{"type":12,"content":5582},[5583],{"type":15,"attrs":5584,"content":5585},{"textAlign":53},[5586],{"text":1720,"type":299},{"_uid":1722,"items":5588,"title":1818,"component":1622,"description":6050},[5589,5730],{"_uid":1725,"title":1726,"ctaLeft":5590,"ctaRight":5591,"component":921,"columnLeft":5592,"columnRight":5596},[],[],{"type":12,"content":5593},[5594],{"type":15,"attrs":5595},{"textAlign":53},{"type":12,"content":5597},[5598,5608,5615,5624,5630,5635,5640,5647,5656,5665,5674,5680,5685,5692,5701,5710,5715,5720,5726],{"type":15,"attrs":5599,"content":5600},{"textAlign":53},[5601,5605],{"text":1739,"type":299,"marks":5602},[5603,5604],{"type":618},{"type":1633},{"text":1744,"type":299,"marks":5606},[5607],{"type":1633},{"type":15,"attrs":5609,"content":5610},{"textAlign":53},[5611],{"text":5612,"type":299,"marks":5613},"C. difficile ",[5614],{"type":618},{"type":15,"attrs":5616,"content":5617},{"textAlign":53},[5618,5622],{"text":5619,"type":299,"marks":5620},"A04.7",[5621],{"type":618},{"text":5623,"type":299},": Identified as diagnosis type (2)",{"type":15,"attrs":5625,"content":5626},{"textAlign":53},[5627],{"text":2622,"type":299,"marks":5628},[5629],{"type":618},{"type":15,"attrs":5631,"content":5632},{"textAlign":53},[5633],{"text":5634,"type":299},"Abstracts with age on admission less than 1 year",{"type":15,"attrs":5636,"content":5637},{"textAlign":53},[5638],{"text":5639,"type":299},"Abstracts with a length of stay less than 3 days",{"type":15,"attrs":5641,"content":5642},{"textAlign":53},[5643],{"text":5644,"type":299,"marks":5645},"MRSA",[5646],{"type":618},{"type":15,"attrs":5648,"content":5649},{"textAlign":53},[5650,5654],{"text":5651,"type":299,"marks":5652},"A04.10",[5653],{"type":618},{"text":5655,"type":299},": Identified as diagnosis type (2) AND U82.1 as diagnosis type (1) or (2) in the same diagnosis cluster OR Identified as diagnosis type (3) AND U82.1 as diagnosis type (1) or (2) AND T80.2, T81.4, T82.6, T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7 or T88.0 as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster OR Identified as diagnosis type (3) AND U82.1 as diagnosis type (1) or (2) AND O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3 or O08.0– as diagnosis type (2) in the same diagnosis cluster OR Identified as diagnosis type (3) AND U82.1 as diagnosis type (1) or (2) AND O98.502 or O98.802 as diagnosis type (M), (1), (2), (W), (X) or (Y) in the same diagnosis cluster",{"type":15,"attrs":5657,"content":5658},{"textAlign":53},[5659,5663],{"text":5660,"type":299,"marks":5661},"A49.0, J15.2, G00.3, L00, M00.0–",[5662],{"type":618},{"text":5664,"type":299},": Identified as diagnosis type (2) AND U82.1 as diagnosis type (1) or (2) in the same diagnosis cluster",{"type":15,"attrs":5666,"content":5667},{"textAlign":53},[5668,5672],{"text":5669,"type":299,"marks":5670},"B95.6",[5671],{"type":618},{"text":5673,"type":299},": Identified as diagnosis type (3) AND U82.1 as diagnosis type (1) or (2) AND a site of infection code* as diagnosis type (2) in the same diagnosis cluster",{"type":15,"attrs":5675,"content":5676},{"textAlign":53},[5677],{"text":2622,"type":299,"marks":5678},[5679],{"type":618},{"type":15,"attrs":5681,"content":5682},{"textAlign":53},[5683],{"text":5684,"type":299},"Abstracts with a length of stay less than 2 days",{"type":15,"attrs":5686,"content":5687},{"textAlign":53},[5688],{"text":5689,"type":299,"marks":5690},"VRE",[5691],{"type":618},{"type":15,"attrs":5693,"content":5694},{"textAlign":53},[5695,5699],{"text":5696,"type":299,"marks":5697},"A41.80*, A40.21",[5698],{"type":618},{"text":5700,"type":299},": Identified as diagnosis type (2) AND U83.0 as diagnosis type (1) or (2) in the same diagnosis cluster OR Identified as diagnosis type (3) AND U83.0 as diagnosis type (1) or (2) AND T80.2, T81.4, T82.6, T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7 or T88.0 as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster OR Identified as diagnosis type (3) AND U83.0 as diagnosis type (1) or (2) AND O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3 or O08.0– as diagnosis type (2) in the same diagnosis cluster OR Identified as diagnosis type (3) AND U83.0 as diagnosis type (1) or (2) AND O98.502 or O98.802 as diagnosis type (M), (1), (2), (W), (X) or (Y) in the same diagnosis cluster",{"type":15,"attrs":5702,"content":5703},{"textAlign":53},[5704,5708],{"text":5705,"type":299,"marks":5706},"B96.81*, B95.21ǂ",[5707],{"type":618},{"text":5709,"type":299},": Identified as diagnosis type (3) AND U83.0 as diagnosis type (1) or (2) AND a site of infection code* as diagnosis type (2) in the same diagnosis cluster",{"type":15,"attrs":5711,"content":5712},{"textAlign":53},[5713],{"text":5714,"type":299},"* Before 2018-2019 data",{"type":15,"attrs":5716,"content":5717},{"textAlign":53},[5718],{"text":5719,"type":299},"ǂ Starting with 2018-2019 data",{"type":15,"attrs":5721,"content":5722},{"textAlign":53},[5723],{"text":2622,"type":299,"marks":5724},[5725],{"type":618},{"type":15,"attrs":5727,"content":5728},{"textAlign":53},[5729],{"text":5684,"type":299},{"_uid":1757,"title":1758,"ctaLeft":5731,"ctaRight":5732,"component":921,"columnLeft":5733,"columnRight":5737},[],[],{"type":12,"content":5734},[5735],{"type":15,"attrs":5736},{"textAlign":53},{"type":12,"content":5738},[5739,5746,5754,5763,5772,5780,5789,5798,5807,5816,5825,5834,5843,5852,5861,5870,5879,5888,5897,5906,5915,5924,5933,5942,5951,5960,5969,5978,5987,5996,6005,6014,6023,6039],{"type":15,"attrs":5740,"content":5741},{"textAlign":53},[5742,5745],{"text":1739,"type":299,"marks":5743},[5744],{"type":618},{"text":1744,"type":299},{"type":15,"attrs":5747,"content":5748},{"textAlign":53},[5749,5752],{"text":5619,"type":299,"marks":5750},[5751],{"type":618},{"text":5753,"type":299},": Enterocolitis due to Clostridium difficile",{"type":15,"attrs":5755,"content":5756},{"textAlign":53},[5757,5761],{"text":5758,"type":299,"marks":5759},"A41.0",[5760],{"type":618},{"text":5762,"type":299},": Sepsis due to Staphylococcus aureus",{"type":15,"attrs":5764,"content":5765},{"textAlign":53},[5766,5770],{"text":5767,"type":299,"marks":5768},"A41.80, A40.21",[5769],{"type":618},{"text":5771,"type":299},": Sepsis due to Enterococcus",{"type":15,"attrs":5773,"content":5774},{"textAlign":53},[5775,5778],{"text":5669,"type":299,"marks":5776},[5777],{"type":618},{"text":5779,"type":299},": Staphylococcus aureus as the cause of diseases classified to other chapters",{"type":15,"attrs":5781,"content":5782},{"textAlign":53},[5783,5787],{"text":5784,"type":299,"marks":5785},"B96.81, B95.21",[5786],{"type":618},{"text":5788,"type":299},": Enterococcus as the cause of diseases classified to other chapters",{"type":15,"attrs":5790,"content":5791},{"textAlign":53},[5792,5796],{"text":5793,"type":299,"marks":5794},"A49.0",[5795],{"type":618},{"text":5797,"type":299},": Staphylococcal infection, unspecified site",{"type":15,"attrs":5799,"content":5800},{"textAlign":53},[5801,5805],{"text":5802,"type":299,"marks":5803},"J15.2",[5804],{"type":618},{"text":5806,"type":299},": Pneumonia due to Staphylococcus",{"type":15,"attrs":5808,"content":5809},{"textAlign":53},[5810,5814],{"text":5811,"type":299,"marks":5812},"G00.3",[5813],{"type":618},{"text":5815,"type":299},": Staphylococcal meningitis",{"type":15,"attrs":5817,"content":5818},{"textAlign":53},[5819,5823],{"text":5820,"type":299,"marks":5821},"L00",[5822],{"type":618},{"text":5824,"type":299},": Staphylococcal scalded skin syndrome",{"type":15,"attrs":5826,"content":5827},{"textAlign":53},[5828,5832],{"text":5829,"type":299,"marks":5830},"O03.0",[5831],{"type":618},{"text":5833,"type":299},": Spontaneous abortion, incomplete, complicated by genital tract and pelvic infection",{"type":15,"attrs":5835,"content":5836},{"textAlign":53},[5837,5841],{"text":5838,"type":299,"marks":5839},"O03.5",[5840],{"type":618},{"text":5842,"type":299},": Spontaneous abortion, complete or unspecified, complicated by genital tract and pelvic infection",{"type":15,"attrs":5844,"content":5845},{"textAlign":53},[5846,5850],{"text":5847,"type":299,"marks":5848},"O04.0",[5849],{"type":618},{"text":5851,"type":299},": Medical abortion, incomplete, complicated by genital tract and pelvic infection",{"type":15,"attrs":5853,"content":5854},{"textAlign":53},[5855,5859],{"text":5856,"type":299,"marks":5857},"O05.0",[5858],{"type":618},{"text":5860,"type":299},": Other abortion, incomplete, complicated by genital tract and pelvic infection",{"type":15,"attrs":5862,"content":5863},{"textAlign":53},[5864,5868],{"text":5865,"type":299,"marks":5866},"O05.5:",[5867],{"type":618},{"text":5869,"type":299}," Other abortion, complete or unspecified, complicated by genital tract and pelvic infection",{"type":15,"attrs":5871,"content":5872},{"textAlign":53},[5873,5877],{"text":5874,"type":299,"marks":5875},"O07.3",[5876],{"type":618},{"text":5878,"type":299},": Failed attempted abortion, complicated",{"type":15,"attrs":5880,"content":5881},{"textAlign":53},[5882,5886],{"text":5883,"type":299,"marks":5884},"O08.0–",[5885],{"type":618},{"text":5887,"type":299},": Complication following abortion and ectopic and molar pregnancy; genital tract and pelvic infection",{"type":15,"attrs":5889,"content":5890},{"textAlign":53},[5891,5895],{"text":5892,"type":299,"marks":5893},"O98.502",[5894],{"type":618},{"text":5896,"type":299},": Other viral diseases complicating pregnancy, childbirth and the puerperium; delivered with mention of postpartum complication",{"type":15,"attrs":5898,"content":5899},{"textAlign":53},[5900,5904],{"text":5901,"type":299,"marks":5902},"O98.802",[5903],{"type":618},{"text":5905,"type":299},": Other maternal infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium; delivered with mention of postpartum complication",{"type":15,"attrs":5907,"content":5908},{"textAlign":53},[5909,5913],{"text":5910,"type":299,"marks":5911},"T80.2",[5912],{"type":618},{"text":5914,"type":299},": Infections following infusion, transfusion and therapeutic injection",{"type":15,"attrs":5916,"content":5917},{"textAlign":53},[5918,5922],{"text":5919,"type":299,"marks":5920},"T81.4",[5921],{"type":618},{"text":5923,"type":299},": Infection following a procedure, not elsewhere classified",{"type":15,"attrs":5925,"content":5926},{"textAlign":53},[5927,5931],{"text":5928,"type":299,"marks":5929},"T82.6",[5930],{"type":618},{"text":5932,"type":299},": Infection and inflammatory reaction due to cardiac valve prosthesis",{"type":15,"attrs":5934,"content":5935},{"textAlign":53},[5936,5940],{"text":5937,"type":299,"marks":5938},"T82.7–",[5939],{"type":618},{"text":5941,"type":299},": Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts",{"type":15,"attrs":5943,"content":5944},{"textAlign":53},[5945,5949],{"text":5946,"type":299,"marks":5947},"T83.5",[5948],{"type":618},{"text":5950,"type":299},": Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system",{"type":15,"attrs":5952,"content":5953},{"textAlign":53},[5954,5958],{"text":5955,"type":299,"marks":5956},"T83.6",[5957],{"type":618},{"text":5959,"type":299},": Infection and inflammatory reaction due to prosthetic device, implant and graft in genital tract",{"type":15,"attrs":5961,"content":5962},{"textAlign":53},[5963,5967],{"text":5964,"type":299,"marks":5965},"T84.5–",[5966],{"type":618},{"text":5968,"type":299},": Infection and inflammatory reaction due to internal joint prosthesis",{"type":15,"attrs":5970,"content":5971},{"textAlign":53},[5972,5976],{"text":5973,"type":299,"marks":5974},"T84.6–",[5975],{"type":618},{"text":5977,"type":299},": Infection and inflammatory reaction due to internal fixation device (any site)",{"type":15,"attrs":5979,"content":5980},{"textAlign":53},[5981,5985],{"text":5982,"type":299,"marks":5983},"T84.7",[5984],{"type":618},{"text":5986,"type":299},": Infection and inflammatory reaction due to other internal orthopedic prosthetic devices, implants and grafts",{"type":15,"attrs":5988,"content":5989},{"textAlign":53},[5990,5994],{"text":5991,"type":299,"marks":5992},"T85.7",[5993],{"type":618},{"text":5995,"type":299},": Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts",{"type":15,"attrs":5997,"content":5998},{"textAlign":53},[5999,6003],{"text":6000,"type":299,"marks":6001},"T88.0",[6002],{"type":618},{"text":6004,"type":299},": Infection following immunization",{"type":15,"attrs":6006,"content":6007},{"textAlign":53},[6008,6012],{"text":6009,"type":299,"marks":6010},"U82.1",[6011],{"type":618},{"text":6013,"type":299},": Resistance to methicillin",{"type":15,"attrs":6015,"content":6016},{"textAlign":53},[6017,6021],{"text":6018,"type":299,"marks":6019},"U83.0",[6020],{"type":618},{"text":6022,"type":299},": Resistance to vancomycin",{"type":15,"attrs":6024,"content":6025},{"textAlign":53},[6026,6030,6032,6038],{"text":6027,"type":299,"marks":6028},"Y60–Y84",[6029],{"type":618},{"text":6031,"type":299},": Complications of medical or surgical care (refer to Appendix A of the",{"text":6033,"type":299,"marks":6034}," Hospital Harm Indicator General Methodology Notes",[6035],{"type":559,"attrs":6036},{"href":1816,"uuid":53,"anchor":53,"custom":6037,"target":911,"linktype":912},{},{"text":2737,"type":299},{"type":15,"attrs":6040,"content":6041},{"textAlign":53},[6042,6044,6049],{"text":6043,"type":299},"*For the descriptions of site of infection codes, please see Appendix B of the ",{"text":2731,"type":299,"marks":6045},[6046],{"type":559,"attrs":6047},{"href":1816,"uuid":53,"anchor":53,"custom":6048,"target":911,"linktype":912},{},{"text":937,"type":299},{"type":12,"content":6051},[6052,6060],{"type":15,"attrs":6053,"content":6054},{"textAlign":53},[6055,6056],{"text":1825,"type":299},{"text":6057,"type":299,"marks":6058},"B18: Infections due to Clostridium difficile, MRSA or VRE",[6059],{"type":618},{"type":15,"attrs":6061,"content":6062},{"textAlign":53},[6063,6066],{"text":1834,"type":299,"marks":6064},[6065],{"type":618},{"text":6067,"type":299},": Bacterial infections identified during a hospital stay due to Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE).",{"_uid":6069,"content":6070,"component":872},"8051def3-e1e0-4bd4-99f7-0b7d1bab60c6",[6071],{"_uid":6072,"content":6073,"component":871},"e549aa38-c0f1-49ca-8ee1-eccfae4fcdfc",{"type":12,"content":6074},[6075,6080,6085],{"type":544,"attrs":6076,"content":6077},{"level":546,"textAlign":53},[6078],{"text":6079,"type":299},"Surveillance, Outbreak Management",{"type":15,"attrs":6081,"content":6082},{"textAlign":53},[6083],{"text":6084,"type":299},"HAI surveillance should be performed to guide infection prevention and control interventions and detect outbreaks, with timely feedback of results to healthcare workers and stakeholders and through national networks (World Health Organization 2016).",{"type":15,"attrs":6086,"content":6087},{"textAlign":53},[6088],{"text":6089,"type":299},"Outbreak Management Outbreaks of both infectious and noninfectious adverse events can occur in any healthcare setting and pose a threat to patient safety. Regardless of scope, investigation of a potential outbreak involves certain epidemiological components. Cooperation between healthcare epidemiologists, infection preventionists, and public health experts is important in effectively managing outbreak responses in healthcare settings. The ultimate goal of any outbreak investigation is to identify probable contributing factors and to stop or reduce the risk for future occurrences (Campbell, 2014). ",{"_uid":4365,"items":6091,"title":1850,"component":1622,"description":6160},[6092,6131],{"_uid":4368,"title":6093,"ctaLeft":6094,"ctaRight":6095,"component":921,"columnLeft":6100,"columnRight":6104},"Volunteers and Patients as Hand Hygiene \"Partners in Care\"",[],[6096],{"_uid":6097,"link":6098,"label":6093,"component":2343},"0f24a440-6fb7-4ef1-801c-013fd5451604",{"id":16,"url":6099,"target":911,"linktype":912,"fieldtype":1965,"cached_url":6099},"https://healthstandards.org/leading-practice/volunteers-and-patients-as-hand-hygiene-partners-in-care/",{"type":12,"content":6101},[6102],{"type":15,"attrs":6103},{"textAlign":53},{"type":12,"content":6105},[6106,6111,6116,6121,6126],{"type":15,"attrs":6107,"content":6108},{"textAlign":53},[6109],{"text":6110,"type":299},"Island Health, British Columbia",{"type":15,"attrs":6112,"content":6113},{"textAlign":53},[6114],{"text":6115,"type":299},"Patient engagement in hand hygiene (HH) is one of Island Health's strategies for improving the patient experience and decreasing healthcare associated infections that can result in excess length of stay, morbidity and mortality. It is well known that volunteers contribute greatly to personalizing, humanizing and demystifying the hospital experience, so it was only fitting that Island Health would engage volunteers educated in proper hand hygiene by its own infection control practitioners to supplement the existing independent auditors working to engage patients in their own education on hand hygiene.",{"type":15,"attrs":6117,"content":6118},{"textAlign":53},[6119],{"text":6120,"type":299},"During the volunteer's visit, the patient, their visitors and their family are taught how and why to do proper hand hygiene. The patient is then asked to participate in a perception survey and monitor their healthcare workers (HCW) HH practices before and after moments of care. The survey is not a tool to measure accuracy but to support existing HH results and includes the engagement of physicians and all staff on the unit.",{"type":15,"attrs":6122,"content":6123},{"textAlign":53},[6124],{"text":6125,"type":299},"The results of the six-month pilot indicated that the vast majority of patient commentary on the survey cards expressed satisfaction with survey participation and HCW hand hygiene practices.  Patients learned proper HH practices and were given the opportunity to observe and ask their HCWs to clean their hands before and after care. While the project was not specifically designed as an intervention for improving HH rates among healthcare providers, interestingly we found HH Rates at the pilot units have increased dramatically.",{"type":15,"attrs":6127,"content":6128},{"textAlign":53},[6129],{"text":6130,"type":299},"The goal of this initiative is to foster HH culture at Island Health by providing HH education to patients as well as engaging patients and healthcare providers in improving HH practice. The ultimate goal is to improve patient safety (Health Standards Organization 2014).",{"_uid":4393,"title":6132,"ctaLeft":6133,"ctaRight":6134,"component":921,"columnLeft":6139,"columnRight":6143},"Toronto East General Antimicrobial Stewardship Program (ASP)",[],[6135],{"_uid":6136,"link":6137,"label":6132,"component":2343},"7ace3d3a-fcd1-4520-af7b-e217a310c84f",{"id":16,"url":6138,"target":911,"linktype":912,"fieldtype":1965,"cached_url":6138},"https://healthstandards.org/leading-practice/toronto-east-general-antimicrobial-stewardship-program-asp/",{"type":12,"content":6140},[6141],{"type":15,"attrs":6142},{"textAlign":53},{"type":12,"content":6144},[6145,6150,6155],{"type":15,"attrs":6146,"content":6147},{"textAlign":53},[6148],{"text":6149,"type":299},"Toronto East General Hospital (TEGH) / Michael Garron Hospital, Ontario",{"type":15,"attrs":6151,"content":6152},{"textAlign":53},[6153],{"text":6154,"type":299},"An estimated 30-80 per cent of antimicrobials used in hospitals are unnecessary. Antimicrobial overuse promotes the development of superbugs like C. Difficile, Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and Extended Spectrum B-lactamase producing bacteria (ESBL). Prior attempts to reduce antimicrobial use with antimicrobial guidelines or formulary restrictions (i.e., limiting which antimicrobials can be used) have demonstrated little success in reducing unnecessary antimicrobial use. A model of prospective audit and feedback was utilized as the basis for the TEGH Antimicrobial Stewardship Program (ASP) quality improvement intervention. The selection of this model was based on available evidence and the feedback elicited from the healthcare team.",{"type":15,"attrs":6156,"content":6157},{"textAlign":53},[6158],{"text":6159,"type":299},"During the process of prospective audit and feedback an individual patient's antimicrobials are reviewed by the ASP with feedback and education provided directly to care providers. Since the implementation of the TEGH ASP there has been a 30 per cent reduction in antimicrobial costs and significant reductions in the use of broad spectrum antimicrobial agents. Patient outcome data has demonstrated stability in mortality rates and average length of stay, with some wards demonstrating a reduction in seven-day readmission rates. Institutional rates of hospital acquired C. Difficile have also significantly decreased from an average monthly rate of 0.67/1000 patient-days to 0.42/1000 patient days since ASP implementation (Health Standards Organization 2012).",{"type":12,"content":6161},[6162],{"type":15,"attrs":6163},{"textAlign":53},{"_uid":1876,"items":6165,"title":1951,"component":1622,"description":6363},[6166],{"_uid":1879,"title":1880,"ctaLeft":6167,"ctaRight":6168,"component":921,"columnLeft":6169,"columnRight":6173},[],[],{"type":12,"content":6170},[6171],{"type":15,"attrs":6172},{"textAlign":53},{"type":12,"content":6174},[6175,6180,6185,6195,6200,6205,6210,6215,6220,6230,6235,6240,6252,6257,6269,6279,6290,6302,6313,6324,6336,6347,6358],{"type":15,"attrs":6176,"content":6177},{"textAlign":53},[6178],{"text":6179,"type":299},"Association for Professionals in Infection Control and Epidemiology (APIC).  APIC Implementation Guide: Guide to preventing Clostridium difficile infections. Washington DC: APIC; 2013. Available at: http://apic.org/Resource_/EliminationGuideForm/59397fc6-3f90-43d1-9325-e8be75d86888/File/2013CDiffFinal.pdf",{"type":15,"attrs":6181,"content":6182},{"textAlign":53},[6183],{"text":6184,"type":299},"Calfee DP. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and other Gram-positives in healthcare.  Curr Opin Infect Dis. 2012; 25(4): 385-394. doi: 10.1097/QCO.0b013e3283553441",{"type":15,"attrs":6186,"content":6187},{"textAlign":53},[6188,6190],{"text":6189,"type":299},"Campbell EA. Outbreak investigations. In: APIC Text of Infection Control and Epidemiology Online (ATO). Arlington, VA: Association for Professionals in Infection Control and Epidemiology, INC. (APIC); 2014. ",{"text":5257,"type":299,"marks":6191},[6192],{"type":559,"attrs":6193},{"href":5257,"uuid":53,"anchor":53,"custom":6194,"target":911,"linktype":912},{},{"type":15,"attrs":6196,"content":6197},{"textAlign":53},[6198],{"text":6199,"type":299},"Canadian Patient Safety Institute (CPSI). How to help prevent healthcare-associated infections: A patient and family guide. Edmonton, AB: CPSI; 2012. ",{"type":15,"attrs":6201,"content":6202},{"textAlign":53},[6203],{"text":6204,"type":299},"Centers for Disease Control and Prevention (CDC). Clostridium difficile infection. CDC; 2016. https://www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html",{"type":15,"attrs":6206,"content":6207},{"textAlign":53},[6208],{"text":6209,"type":299},"Centers for Disease Control and Prevention. https://www.cdc.gov/hai/organisms/mrsa-infection.html ",{"type":15,"attrs":6211,"content":6212},{"textAlign":53},[6213],{"text":6214,"type":299},"Centers for Disease Control and Prevention. VRE in healthcare settings. CDC; 2011. https://www.cdc.gov/hai/organisms/vre/vre.html",{"type":15,"attrs":6216,"content":6217},{"textAlign":53},[6218],{"text":6219,"type":299},"Health Standards Organization (HS0). Leading Practices Toronto East General Antimicrobial Stewardship Program (ASP). Health Standards Organization; 2012 https://healthstandards.org/leading-practice/toronto-east-general-antimicrobial-stewardship-program-asp/",{"type":15,"attrs":6221,"content":6222},{"textAlign":53},[6223,6225],{"text":6224,"type":299},"Health Standards Organization (HS0). Leading Practices Volunteers and Patients as Hand Hygiene \"Partners in Care\". Health Standards Organization; 2014 ",{"text":6099,"type":299,"marks":6226},[6227],{"type":559,"attrs":6228},{"href":6099,"uuid":53,"anchor":53,"custom":6229,"target":911,"linktype":912},{},{"type":15,"attrs":6231,"content":6232},{"textAlign":53},[6233],{"text":6234,"type":299},"Institute for Healthcare Improvement (IHI). How-to guide: Prevent catheter-associated urinary tract infections. Cambridge, MA: IHI; 2011. Available at : http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssociatedUrinaryTractInfection.aspx",{"type":15,"attrs":6236,"content":6237},{"textAlign":53},[6238],{"text":6239,"type":299},"Martin, P., C. Abou, V. William, K. Bush, M. Dyck, Z. Hirji et al. 2019. Prevalence of Antibiotic-Resistant Organisms in Canadian Hospitals. Comparison of Point-Prevalence Survey Results from 2010, 2012, and 2016. Infection Control and Hospital Epidemiology 40(1): 53–59. doi:10.1017/ice.2018.279.",{"type":15,"attrs":6241,"content":6242},{"textAlign":53},[6243,6245],{"text":6244,"type":299},"McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018; 66(7): 987-994. doi:10.1093/cid/cix1085. Available at: ",{"text":6246,"type":299,"marks":6247},"https://academic.oup.com/cid/article/66/7/e1/4855916",[6248],{"type":559,"attrs":6249},{"href":6250,"uuid":53,"anchor":53,"custom":6251,"target":911,"linktype":912},"https://academic.oup.com/cid/article/66/7/e1/4855916?login=false",{},{"type":15,"attrs":6253,"content":6254},{"textAlign":53},[6255],{"text":6256,"type":299},"Mitchell R, G. Taylor, W. Rudnick, S. Alexandre, K. Bush, L. Forrester et al. 2019. Trends in Health Care-Associated Infections in Acute Care Hospitals in Canada: An Analysis of Repeated Point-Prevalence Surveys. CMAJ;191 (36): E981–88. doi:10.1503/cmaj.190361.",{"type":15,"attrs":6258,"content":6259},{"textAlign":53},[6260,6262],{"text":6261,"type":299},"National Institute for Health and Care Excellence (NICE). Clostridium difficile infection: Risk with broad-spectrum antibiotics. NICE Evidence Summary; 2015. Available at: ",{"text":6263,"type":299,"marks":6264},"https://www.nice.org.uk/advice/esmpb1/chapter/Key-points-from-the-evidence  ",[6265],{"type":559,"attrs":6266},{"href":6267,"uuid":53,"anchor":53,"custom":6268,"target":911,"linktype":912},"https://www.nice.org.uk/advice/esmpb1/chapter/Key-points-from-the-evidence",{},{"type":15,"attrs":6270,"content":6271},{"textAlign":53},[6272,6274],{"text":6273,"type":299},"Public Health Agency of Canada (PHAC). Routine practices and additional precautions for preventing the transmission of infection in healthcare settings. Ottawa, ON: PHAC; 2017. Available at: ",{"text":5037,"type":299,"marks":6275},[6276],{"type":559,"attrs":6277},{"href":5037,"uuid":53,"anchor":53,"custom":6278,"target":911,"linktype":912},{},{"type":15,"attrs":6280,"content":6281},{"textAlign":53},[6282,6284],{"text":6283,"type":299},"Public Health Agency of Canada (PHAC). Tackling antimicrobial resistance and antimicrobial use: A pan-Canadian framework for action. Ottawa, ON: PHAC; 2017. Available at: ",{"text":6285,"type":299,"marks":6286},"https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/tackling-antimicrobial-resistance-use-pan-canadian-framework-action.html",[6287],{"type":559,"attrs":6288},{"href":6285,"uuid":53,"anchor":53,"custom":6289,"target":911,"linktype":912},{},{"type":15,"attrs":6291,"content":6292},{"textAlign":53},[6293,6295],{"text":6294,"type":299},"Public Health Agency of Canada (PHAC).   Federal action plan on antimicrobial resistance and use in Canada: Building on the Federal framework for action. Ottawa, ON: PHAC; 2015. Available at: ",{"text":6296,"type":299,"marks":6297},"http://healthycanadians.gc.ca/alt/pdf/publications/drugs-products-medicaments-produits/antibiotic-resistance-antibiotique/action-plan-daction-eng.pdf",[6298],{"type":559,"attrs":6299},{"href":6300,"uuid":53,"anchor":53,"custom":6301,"target":911,"linktype":912},"https://healthycanadians.gc.ca/alt/pdf/publications/drugs-products-medicaments-produits/antibiotic-resistance-antibiotique/action-plan-daction-eng.pdf",{},{"type":15,"attrs":6303,"content":6304},{"textAlign":53},[6305,6307],{"text":6306,"type":299},"Public Health Agency of Canada (PHAC).   Fact sheet - Clostridium difficile (C. difficile). Ottawa, ON: PHAC; 2014. Available at: ",{"text":6308,"type":299,"marks":6309},"https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html",[6310],{"type":559,"attrs":6311},{"href":6308,"uuid":53,"anchor":53,"custom":6312,"target":911,"linktype":912},{},{"type":15,"attrs":6314,"content":6315},{"textAlign":53},[6316,6318],{"text":6317,"type":299},"Public Health Agency of Canada (PHAC).  Fact Sheet - Vancomycin-resistant Enterococci (VRE). Ottawa, ON: PHAC; 2010. Available at: ",{"text":6319,"type":299,"marks":6320},"https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/vancomycin-resistant-enterococci.html",[6321],{"type":559,"attrs":6322},{"href":6319,"uuid":53,"anchor":53,"custom":6323,"target":911,"linktype":912},{},{"type":15,"attrs":6325,"content":6326},{"textAlign":53},[6327,6329],{"text":6328,"type":299},"Public Health Agency of Canada (PHAC). Fact Sheet - Methicillin-Resistant Staphylococcus aureus. Ottawa, ON: PHAC; 2008. Available at: ",{"text":6330,"type":299,"marks":6331},"http://www.phac-aspc.gc.ca/id-mi/mrsa-eng.php ",[6332],{"type":559,"attrs":6333},{"href":6334,"uuid":53,"anchor":53,"custom":6335,"target":911,"linktype":912},"https://www.canada.ca/en/public-health.html",{},{"type":15,"attrs":6337,"content":6338},{"textAlign":53},[6339,6341],{"text":6340,"type":299},"Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: Final report and recommendations. UK; 2016. Available at: ",{"text":6342,"type":299,"marks":6343},"https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf",[6344],{"type":559,"attrs":6345},{"href":6342,"uuid":53,"anchor":53,"custom":6346,"target":911,"linktype":912},{},{"type":15,"attrs":6348,"content":6349},{"textAlign":53},[6350,6352],{"text":6351,"type":299},"World Health Organization (WHO). News release. In the face of slow progress, WHO offers a new tool and sets a target to accelerate action against antimicrobial resistance. WHO. Geneva. 2019.  Available at: ",{"text":6353,"type":299,"marks":6354},"https://www.who.int/news-room/detail/18-06-2019-in-the-face-of-slow-progress-who-offers-a-new-tool-and-sets-a-target-to-accelerate-action-against-antimicrobial-resistance",[6355],{"type":559,"attrs":6356},{"href":6353,"uuid":53,"anchor":53,"custom":6357,"target":911,"linktype":912},{},{"type":15,"attrs":6359,"content":6360},{"textAlign":53},[6361],{"text":6362,"type":299},"World Health Organization (WHO). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. WHO; 2016. Available at: http://www.who.int/infection-prevention/publications/ipc-components-guidelines/en/",{"type":12,"content":6364},[6365],{"type":15},{"id":16,"_uid":6367,"items":6368,"component":1985},"99bb7801-340c-45a6-b7a1-99b8b65a3a33",[6369],{"_uid":6370,"link":6371,"image":6376,"title":1976,"component":1977,"description":6378},"40ea92b7-3890-4d23-9a42-dbe96177cf35",[6372],{"_uid":6373,"link":6374,"label":1970,"component":1971},"b216f663-ee05-4344-947f-d11a285b59dd",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":6375},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":6377,"is_external_url":290},{},{"type":12,"content":6379},[6380],{"type":15,"attrs":6381,"content":6382},{"textAlign":53},[6383],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],"infections-due-to-clostridium-difficile-mrsa-or-vre","resources/infections-due-to-clostridium-difficile-mrsa-or-vre",-18740,[],"4d6989c2-1241-4265-9a11-501773349987","2025-12-12T22:19:30.358Z",[],[6394],{"path":6395,"name":6396,"lang":469,"published":461},"ressources/infections-a-clostridium-difficile-a-sarm-ou-aux-erv","Infections à Clostridium difficile, à SARM ou aux ERV",{"name":6398,"created_at":6399,"published_at":6400,"updated_at":6401,"id":6402,"uuid":365,"content":6403,"slug":7149,"full_slug":7150,"sort_by_date":53,"position":7151,"tag_list":7152,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":7153,"first_published_at":7154,"release_id":53,"lang":300,"path":53,"alternates":7155,"default_full_slug":7150,"translated_slugs":7156},"Infusion, Transfusion and Injection Complications","2025-12-11T22:11:12.916Z","2026-03-10T16:27:20.485Z","2026-03-10T16:27:20.528Z",122066833142622,{"new":290,"seo":6404,"_uid":493,"hero":6405,"type":174,"topics":6426,"Noindex":290,"content":6427,"audience":7147,"duration":16,"regional":7148,"component":1988},{"_uid":491,"title":6398,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[6406],{"_uid":496,"image":6407,"title":6409,"format":6410,"component":505,"description":6413,"key_learning":6420,"prerequisite":6423},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":6408,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Infusion, Transfusion and Injection Complications",{"type":12,"content":6411},[6412],{"type":15},{"type":12,"content":6414},[6415],{"type":15,"attrs":6416,"content":6417},{"textAlign":53},[6418],{"text":6419,"type":299},"Complications following infusion, transfusion and therapeutic injection.",{"type":12,"content":6421},[6422],{"type":15},{"type":12,"content":6424},[6425],{"type":15},[76,8],[6428,6439,6539,6582,6783,6815,6957,7010,7129],{"_uid":522,"link":6429,"image":6430,"title":526,"component":527,"media_type":528,"description":6432},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":6431},{},{"type":12,"content":6433},[6434],{"type":15,"attrs":6435,"content":6436},{"textAlign":53},[6437],{"text":6438,"type":299},"Reduce the incidence of complications following infusion, transfusion and therapeutic injection.",{"_uid":537,"content":6440,"component":872},[6441],{"_uid":540,"content":6442,"component":871},{"type":12,"content":6443},[6444,6448,6459,6464,6469,6474,6479,6484,6489,6494,6499,6504,6509,6514,6519,6524,6529,6534],{"type":544,"attrs":6445,"content":6446},{"level":546,"textAlign":53},[6447],{"text":549,"type":299},{"type":15,"attrs":6449,"content":6450},{"textAlign":53},[6451,6452,6458],{"text":554,"type":299},{"text":556,"type":299,"marks":6453},[6454],{"type":559,"attrs":6455},{"href":561,"uuid":356,"anchor":53,"custom":6456,"target":563,"linktype":564,"story":6457},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":544,"attrs":6460,"content":6461},{"level":588,"textAlign":53},[6462],{"text":6463,"type":299},"Air embolism following infusion, transfusion and therapeutic injection",{"type":15,"attrs":6465,"content":6466},{"textAlign":53},[6467],{"text":6468,"type":299},"An air embolism is a bubble that becomes trapped in a blood vessel and blocks the vessel. It is a rare but potentially fatal event. The seriousness of the blockage depends on which part of the body the affected blood vessel supplies blood to, and the size of the air bubble. For example, an air embolism in the arteries leading to the brain may cause a decreased level of consciousness, dizziness, slurred speech, seizures, and/or a stroke. An air embolism that travels to the coronary arteries may cause a myocardial infarction or an arrhythmia. An air embolism that travels to the lungs may cause a pulmonary embolism (Gordy & Rowell 2013; National Health Service 2015).",{"type":544,"attrs":6470,"content":6471},{"level":588,"textAlign":53},[6472],{"text":6473,"type":299},"Vascular complications following infusion, transfusion and therapeutic injection",{"type":15,"attrs":6475,"content":6476},{"textAlign":53},[6477],{"text":6478,"type":299},"Phlebitis refers to inflammation of the vein and it may be a complication of peripheral cannulation. Phlebitis may be painful, and it compromises future venous access. Other symptoms include warmth, tenderness, erythema or palpable venous cord. If it is bacterial and untreated, it may lead to a bloodstream infection. Phlebitis may be localized to the insertion site or travel along the vein. It may occur during catheterization or up to 48 hours after cannula removal (Ray-Burruel et al. 2014).",{"type":544,"attrs":6480,"content":6481},{"level":588,"textAlign":53},[6482],{"text":6483,"type":299},"ABO incompatibility reaction",{"type":15,"attrs":6485,"content":6486},{"textAlign":53},[6487],{"text":6488,"type":299},"Acute hemolytic transfusion reaction is a possible complication of a blood transfusion. It may be associated with ABO-incompatibility, other blood group incompatibilities (there are 29 blood group systems, in addition to ABO, that may cause incompatibility), and with rare cases when group O platelets with high titers of anti-A and/or anti-B are transfused to a non-group O recipient (Callum et al. 2016; Fung et al. 2007).",{"type":15,"attrs":6490,"content":6491},{"textAlign":53},[6492],{"text":6493,"type":299},"ABO-incompatibility is the most common cause of morbidity from RBC transfusion. The reaction is often due to a clerical error, or an error in patient identification. Half of all errors are due to administering properly labelled blood to the wrong patient, while other errors are the result of improper labelling of samples or testing errors. One in 38,000 red cell transfusions are ABO-incompatible due to transfusing the wrong blood to a patient, and less than 10 per cent of ABO-incompatible transfusions result in a fatal outcome. The risk of death correlates with the amount of incompatible blood transfused (Callum et al. 2016).",{"type":15,"attrs":6495,"content":6496},{"textAlign":53},[6497],{"text":6498,"type":299},"Symptoms of hemolytic reaction include back pain, bloody urine, chills, fainting or dizziness, fever, flank pain and flushing of the skin (National Heart Lung and Blood Institute 2011; Transfusion reaction 2016).",{"type":544,"attrs":6500,"content":6501},{"level":588,"textAlign":53},[6502],{"text":6503,"type":299},"Rh incompatibility reaction",{"type":15,"attrs":6505,"content":6506},{"textAlign":53},[6507],{"text":6508,"type":299},"Rh is known as the D antigen. Less than 15 per cent of the population do not have this antigen expressed on their red blood cells and are typed as D negative, more commonly known as Rh negative.  If an Rh negative person is exposed to Rh positive blood, either by a blood transfusion or their fetus during pregnancy, a small percentage will form an antibody to the D antigen (Anti-D). If the patient does develop anti-D, subsequent exposures to Rh positive blood products can produce a hemolytic reaction (Ontario Regional Blood Coordinating Network 2016).",{"type":15,"attrs":6510,"content":6511},{"textAlign":53},[6512],{"text":6513,"type":299},"In the case of pregnancy, if an Rh negative mother develops Anti-D during her first pregnancy with an Rh positive baby, her second or subsequent babies could suffer devastating effects as the anti-D in her plasma may attack the D-antigen on the surface of the baby's red cells causing hemolysis. This is a known cause of hemolytic disease of the fetus and newborn (HDFN). An infant with HDFN may show signs of anemia, jaundice, hypotonia, lethargy, or in some cases, brain damage or even death can occur. The administration of Rh Immune globulin (Rhogam) during prenatal care can reduce the likelihood of developing Anti-D, which would affect future pregnancies (Ontario Regional Blood Coordinating Network 2016).",{"type":544,"attrs":6515,"content":6516},{"level":588,"textAlign":53},[6517],{"text":6518,"type":299},"Anaphylaxis to serum",{"type":15,"attrs":6520,"content":6521},{"textAlign":53},[6522],{"text":6523,"type":299},"Anaphylactic shock can result from a blood transfusion. It is the most severe form of allergic reaction and accounts for approximately three per cent of transfusion associated fatalities (Food and Drug Administration, 2009). The occurrence rate for anaphylaxis is rare at one in 40,000. The vast majority of anaphylactic reactions are unexplained (Callum et al. 2016). ",{"type":15,"attrs":6525,"content":6526},{"textAlign":53},[6527],{"text":6528,"type":299},"Anaphylactic/anaphylactoid reactions usually begins within one to 45 minutes of the start of the infusion and are associated with cutaneous reactions (urticaria), hypotension, hypoxia, hoarseness, stridor, wheezing, chest pain, dyspnea, anxiety, feelings of impending doom, gastrointestinal symptoms (nausea, vomiting) and rarely death (Callum et al. 2016).",{"type":544,"attrs":6530,"content":6531},{"level":588,"textAlign":53},[6532],{"text":6533,"type":299},"Other serum reactions",{"type":15,"attrs":6535,"content":6536},{"textAlign":53},[6537],{"text":6538,"type":299},"Urticaria may present as one lesion or be widespread lesions. Urticaria may be associated with pruritus, erythema, flushing or mild upper respiratory symptoms (cough, wheezing), nausea, vomiting, abdominal cramps or diarrhea (Callum et al., 2016). Minor allergic reactions affecting the skin with occurrence of hives, rash, and urticaria are far more common occurring at a rate of one in 100 blood products transfused (Callum et al., 2016). ",{"_uid":874,"content":6540,"component":872},[6541],{"_uid":877,"content":6542,"component":871},{"type":12,"content":6543},[6544,6548,6553,6558,6562,6572,6577],{"type":544,"attrs":6545,"content":6546},{"level":546,"textAlign":53},[6547],{"text":884,"type":299},{"type":15,"attrs":6549,"content":6550},{"textAlign":53},[6551],{"text":6552,"type":299},"Air embolism is an uncommon, but potentially catastrophic, event that occurs as a consequence of the entry of air into the vasculature (O'Dowd & Kelley 2019)",{"type":15,"attrs":6554,"content":6555},{"textAlign":53},[6556],{"text":6557,"type":299},"Patients experiencing acute hemolytic transfusion reactions most often present with fever, chills and hemoglobinuria. Less common symptoms are pain, hypotension, nausea/vomiting, dyspnea, renal failure and disseminated intravascular coagulation (Callum et al. 2016).",{"type":544,"attrs":6559,"content":6560},{"level":588,"textAlign":53},[6561],{"text":3293,"type":299},{"type":15,"attrs":6563,"content":6564},{"textAlign":53},[6565],{"text":6566,"type":299,"marks":6567},"Blood on their hands: man dies after transfusion mix-up at Coney Island Hospital",[6568],{"type":559,"attrs":6569},{"href":6570,"uuid":53,"anchor":53,"custom":6571,"target":911,"linktype":912},"https://nypost.com/2013/07/14/blood-on-their-hands-man-dies-after-transfusion-mix-up-at-coney-island-hospital/",{},{"type":15,"attrs":6573,"content":6574},{"textAlign":53},[6575],{"text":6576,"type":299},"\"There's bad blood at Coney Island Hospital — and it's deadly. A 40-year-old male patient died at the city-run hospital last week after receiving the wrong type blood during a transfusion, The Post has learned. Transfusions that don't match a patient's blood type — giving Type-A to a person who is Type-B, for example — causes the body to attack the new red blood cells, a violent and painful reaction that can lead to shock and a fatal kidney shutdown. \"The blood was mislabeled in the lab. It wasn't a nursing issue,\" said one hospital professional who spoke yesterday on condition of anonymity. \"It shouldn't have happened; it's just carelessness. It's a huge problem,\" he added. A source said the fatal error occurred in the hospital's sixth-floor lab, where blood drawn from patients is screened and 'typed'. A technician labeled the patient's blood as the wrong type, and the patient was given the wrong blood during a transfusion.\"",{"type":15,"attrs":6578,"content":6579},{"textAlign":53},[6580],{"text":6581,"type":299},"(Italiano  2013)",{"_uid":914,"items":6583,"title":1621,"component":1622,"description":6742},[6584],{"_uid":917,"title":918,"ctaLeft":6585,"ctaRight":6586,"component":921,"columnLeft":6587,"columnRight":6608},[],[],{"type":12,"content":6588},[6589],{"type":15,"attrs":6590,"content":6591},{"textAlign":53},[6592,6596,6604],{"text":928,"type":299,"marks":6593},[6594],{"type":2404,"attrs":6595},{"color":2406},{"text":930,"type":299,"marks":6597},[6598,6602],{"type":559,"attrs":6599},{"href":561,"uuid":356,"anchor":53,"custom":6600,"target":563,"linktype":564,"story":6601},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"type":6603},"underline",{"text":937,"type":299,"marks":6605},[6606],{"type":2404,"attrs":6607},{"color":2406},{"type":12,"content":6609},[6610,6615],{"type":15,"attrs":6611,"content":6612},{"textAlign":53},[6613],{"text":6614,"type":299},"If your review reveals that your events are linked to specific processes or procedures, you may find these resources helpful:",{"type":666,"content":6616},[6617,6631,6645,6652,6666,6680,6694,6708,6715,6728],{"type":669,"content":6618},[6619],{"type":15,"attrs":6620,"content":6621},{"textAlign":53},[6622,6624],{"text":6623,"type":299},"Canadian Blood Services, Professional Education ",{"text":6625,"type":299,"marks":6626},"www.transfusionmedicine.ca",[6627],{"type":559,"attrs":6628},{"href":6629,"uuid":53,"anchor":53,"custom":6630,"target":911,"linktype":912},"https://professionaleducation.blood.ca/en",{},{"type":669,"content":6632},[6633],{"type":15,"attrs":6634,"content":6635},{"textAlign":53},[6636,6638],{"text":6637,"type":299},"Choosing Wisely Canada: Transfusion Medicine ",{"text":6639,"type":299,"marks":6640},"http://www.choosingwiselycanada.org/recommendations/transfusion-medicine/",[6641],{"type":559,"attrs":6642},{"href":6643,"uuid":53,"anchor":53,"custom":6644,"target":911,"linktype":912},"https://choosingwiselycanada.org/recommendation/transfusion-medicine/",{},{"type":669,"content":6646},[6647],{"type":15,"attrs":6648,"content":6649},{"textAlign":53},[6650],{"text":6651,"type":299},"Infusion Nursing Standards of Practice",{"type":669,"content":6653},[6654],{"type":15,"attrs":6655,"content":6656},{"textAlign":53},[6657,6659],{"text":6658,"type":299},"National Institute for Health and Care Excellence (NICE), Acute and Critical Care, ",{"text":6660,"type":299,"marks":6661},"https://www.nice.org.uk/guidance/service-delivery--organisation-and-staffing/acute-and-critical-care",[6662],{"type":559,"attrs":6663},{"href":6664,"uuid":53,"anchor":53,"custom":6665,"target":911,"linktype":912},"https://www.nice.org.uk/guidance/health-and-social-care-delivery/acute-and-critical-care",{},{"type":669,"content":6667},[6668],{"type":15,"attrs":6669,"content":6670},{"textAlign":53},[6671,6673],{"text":6672,"type":299},"National Institute for Health and Care Excellence (NICE), Hospitals ",{"text":6674,"type":299,"marks":6675},"https://www.nice.org.uk/guidance/settings/hospitals ",[6676],{"type":559,"attrs":6677},{"href":6678,"uuid":53,"anchor":53,"custom":6679,"target":911,"linktype":912},"https://www.nice.org.uk/guidance/settings/hospitals",{},{"type":669,"content":6681},[6682],{"type":15,"attrs":6683,"content":6684},{"textAlign":53},[6685,6687],{"text":6686,"type":299},"Norfolk D (Ed). 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If patients are anemic, they are referred to the Blood Conservation Clinic (BCC) four to six weeks preoperatively for consideration of IV iron or Eprex. The project involved an interprofessional team that included Anesthesia, Hematology, Nursing, and Orthopaedic Surgeons. A preoperative blood conservation algorithm was designed and broad staff education was conducted. Patient education materials were also developed. Transfusion rates during the study period were 3.6 per cent compared to 5.1 per cent previously. The estimated cost-savings associated with fewer transfusions in this patient population was $75,000 (Health Standards Organization 2013).",{"_uid":4393,"title":6988,"ctaLeft":6989,"ctaRight":6990,"component":921,"columnLeft":6995,"columnRight":6999},"Sainte-Justine UHC, Quebec",[],[6991],{"_uid":6992,"link":6993,"label":6988,"component":2343},"763619dc-6bf9-40e5-b3f6-23f898974288",{"id":16,"url":6994,"target":911,"linktype":912,"fieldtype":1965,"cached_url":6994},"https://healthstandards.org/leading-practice/transfusion-practice-certificate-at-sainte-justine-uhc/",{"type":12,"content":6996},[6997],{"type":15,"attrs":6998},{"textAlign":53},{"type":12,"content":7000},[7001],{"type":15,"attrs":7002,"content":7003},{"textAlign":53},[7004],{"text":7005,"type":299},"With a focus on providing quality care, the Transfusional Medicine Committee at Sainte-Justine UHC put forth a recommendation to introduce transfusion practice certification for all transfusion staff. Thereby, a transfusion practice training and certification program was implemented at Sainte-Justine UHC in 2005. Sainte-Justine is the first hospital centre to have implemented a certification of such calibre. The program seeks to decrease the number of transfusion accidents and promote professional development among nursing staff. Certification applies to nurses, transfusion inhalotherapists, perfusionists and phlebotomists. Licensed Practical Nurses will be included next. With recertification taking place every two years, an internal study was conducted to evaluate the suitability of maintaining this program within the organization (Health Standards Organization  2012).",{"type":12,"content":7007},[7008],{"type":15,"attrs":7009},{"textAlign":53},{"_uid":1876,"items":7011,"title":1951,"component":1622,"description":7123},[7012],{"_uid":1879,"title":1880,"ctaLeft":7013,"ctaRight":7014,"component":921,"columnLeft":7015,"columnRight":7019},[],[],{"type":12,"content":7016},[7017],{"type":15,"attrs":7018},{"textAlign":53},{"type":12,"content":7020},[7021,7030,7035,7040,7052,7062,7072,7077,7082,7093,7103,7111],{"type":15,"attrs":7022,"content":7023},{"textAlign":53},[7024,7026],{"text":7025,"type":299},"Callum JL, Pinkerton PH, Lima A, et al. Bloody Easy 4: Blood transfusions, blood alternatives and transfusion reactions. A guide to transfusion medicine. Fourth Edition. Ontario Regional Blood Coordinating Network; 2016. ",{"text":6723,"type":299,"marks":7027},[7028],{"type":559,"attrs":7029},{"href":6723,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":15,"attrs":7031,"content":7032},{"textAlign":53},[7033],{"text":7034,"type":299},"Food and Drug Administration (FDA). Fatalities reported to FDA following blood collection and transfusion: Annual summary for fiscal year 2009. FDA; 2012. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm204763.htm",{"type":15,"attrs":7036,"content":7037},{"textAlign":53},[7038],{"text":7039,"type":299},"Fung MK, Downes KA, Shulman IA. Transfusion of platelets containing ABO-incompatible plasma: a survey of 3156 North American laboratories. Arch Pathol Lab Med. 2007;131(6):909-916. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282007%29131%5B909%3ATOPCAP%5D2.0.CO%3B2",{"type":15,"attrs":7041,"content":7042},{"textAlign":53},[7043,7045],{"text":7044,"type":299},"Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013;3(1):73-76 doi:10.4103/2229-5151.109428. ",{"text":7046,"type":299,"marks":7047},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665124/",[7048],{"type":559,"attrs":7049},{"href":7050,"uuid":53,"anchor":53,"custom":7051,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC3665124/","[object Object]",{"type":15,"attrs":7053,"content":7054},{"textAlign":53},[7055,7057],{"text":7056,"type":299},"Health Standards Organization (HSO)  Best practice in patient blood management in a surgical patient population. Health Standards Organization 2013. 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Cambridge, MA: IHI;2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",{"type":15,"attrs":7078,"content":7079},{"textAlign":53},[7080],{"text":7081,"type":299},"National Health Service. Air embolism. 2015. http://www.nhs.uk/Conditions/Air-embolism/Pages/Introduction.aspx",{"type":15,"attrs":7083,"content":7084},{"textAlign":53},[7085,7087],{"text":7086,"type":299},"National Heart, Lung and Blood Institute. What is Rh Incompatibility National Institutes of Health; 2011. ",{"text":7088,"type":299,"marks":7089},"https://www.nhlbi.nih.gov/health/health-topics/topics/rh",[7090],{"type":559,"attrs":7091},{"href":7092,"uuid":53,"anchor":53,"custom":7051,"target":911,"linktype":912},"https://www.nhlbi.nih.gov/health/blood-tests",{"type":15,"attrs":7094,"content":7095},{"textAlign":53},[7096,7098],{"text":7097,"type":299},"O'Dowd LC, Kelley MA. Air Embolism. Up to Date; 2019. ",{"text":7099,"type":299,"marks":7100},"https://www.uptodate.com/contents/air-embolism#H1",[7101],{"type":559,"attrs":7102},{"href":7099,"uuid":53,"anchor":53,"custom":7051,"target":911,"linktype":912},{"type":15,"attrs":7104,"content":7105},{"textAlign":53},[7106,7107],{"text":6734,"type":299},{"text":6736,"type":299,"marks":7108},[7109],{"type":559,"attrs":7110},{"href":6740,"uuid":53,"anchor":53,"custom":7051,"target":911,"linktype":912},{"type":15,"attrs":7112,"content":7113},{"textAlign":53},[7114,7116,7121],{"text":7115,"type":299},"Ray-Barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract. 2014;20(2):191-202doi:10.1111/jep.12107. ",{"text":7117,"type":299,"marks":7118},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237185/",[7119],{"type":559,"attrs":7120},{"href":7117,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"text":7122,"type":299},"  ",{"type":12,"content":7124},[7125,7127],{"type":15,"attrs":7126},{"textAlign":53},{"type":15,"attrs":7128},{"textAlign":53},{"id":16,"_uid":7130,"items":7131,"component":1985},"97d797e1-124d-4c97-8917-38d5f68c2f22",[7132],{"_uid":7133,"link":7134,"image":7139,"title":1976,"component":1977,"description":7141},"0216e6d3-978a-46f9-bddb-6f61c17747d9",[7135],{"_uid":7136,"link":7137,"label":1970,"component":1971},"81859942-e474-4e3c-8a1f-5ae8a5405983",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":7138},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":7140,"is_external_url":290},{},{"type":12,"content":7142},[7143],{"type":15,"attrs":7144,"content":7145},{"textAlign":53},[7146],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],"infusion-transfusion-and-injection-complications","resources/infusion-transfusion-and-injection-complications",-18730,[],"7f01b629-2132-43eb-9445-d2ae8050134b","2025-12-11T22:14:29.851Z",[],[7157],{"path":7158,"name":7159,"lang":469,"published":461},"ressources/complications-consecutives-a-une-injection-une-perfusion-ou-une-transfusion","Complications consécutives à une injection, une perfusion ou une transfusion ",{"name":1546,"created_at":7161,"published_at":7162,"updated_at":7163,"id":1553,"uuid":380,"content":7164,"slug":1554,"full_slug":1555,"sort_by_date":53,"position":8571,"tag_list":8572,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":8573,"first_published_at":8574,"release_id":53,"lang":300,"path":53,"alternates":8575,"default_full_slug":1555,"translated_slugs":8576},"2025-12-11T17:52:00.944Z","2026-03-10T16:30:23.940Z","2026-03-10T16:30:23.995Z",{"new":290,"seo":7165,"_uid":493,"hero":7166,"type":174,"topics":7187,"Noindex":290,"content":7188,"audience":8569,"duration":16,"regional":8570,"component":1988},{"_uid":491,"title":1546,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[7167],{"_uid":496,"image":7168,"title":7170,"format":7171,"component":505,"description":7174,"key_learning":7181,"prerequisite":7184},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":7169,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Obstetric Hemorrhage",{"type":12,"content":7172},[7173],{"type":15},{"type":12,"content":7175},[7176],{"type":15,"attrs":7177,"content":7178},{"textAlign":53},[7179],{"text":7180,"type":299},"Postpartum hemorrhage is the leading cause of maternal death worldwide, with an estimated mortality rate of 140 000 per year, or one maternal death every four minutes. PPH occurs in five per cent of all deliveries and is responsible for a major part of maternal mortality. The majority of these deaths occur within four hours of delivery, which indicates that they are a consequence of the third stage of labour. Nonfatal PPH results in further interventions, such as uterine exploration, evacuation or surgical procedures. Other implications include: iron deficiency anemia, exposure to blood products, coagulopathy, and organ damage with associated hypotension and shock which has the potential to jeopardize future fertility (Leduc et al. 2018).",{"type":12,"content":7182},[7183],{"type":15},{"type":12,"content":7185},[7186],{"type":15},[76,8],[7189,7200,7305,7328,7643,7675,8415,8441,8551],{"_uid":522,"link":7190,"image":7191,"title":526,"component":527,"media_type":528,"description":7193},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":7192},{},{"type":12,"content":7194},[7195],{"type":15,"attrs":7196,"content":7197},{"textAlign":53},[7198],{"text":7199,"type":299},"To prevent obstetrical hemorrhage from the pelvic area, genital tract, or perineum following vaginal delivery and from surgical incision after an instrument-assisted delivery or Caesarean section.",{"_uid":537,"content":7201,"component":872},[7202],{"_uid":540,"content":7203,"component":871},{"type":12,"content":7204},[7205,7209,7220,7225,7234,7239,7244,7287,7296],{"type":544,"attrs":7206,"content":7207},{"level":546,"textAlign":53},[7208],{"text":3043,"type":299},{"type":15,"attrs":7210,"content":7211},{"textAlign":53},[7212,7213,7219],{"text":554,"type":299},{"text":556,"type":299,"marks":7214},[7215],{"type":559,"attrs":7216},{"href":561,"uuid":356,"anchor":53,"custom":7217,"target":563,"linktype":564,"story":7218},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":7221,"content":7222},{"textAlign":53},[7223],{"text":7224,"type":299},"Despite the use of uterotonics and active management of third stage of labour to prevent PPH, increases in PPH rates have been reported from high income countries, including Canada, the United States, the United Kingdom and Australia. Rates of severe PPH and of transfusion for treatment also appear to be rising. Rates of postpartum hemorrhage and severe postpartum hemorrhage continued to increase in Canada between 2003 and 2010 [from 3.9 per cent in 2003 to 5.0 per cent in 2010] and occurred in most provinces and territories. The increase could not be explained by maternal, fetal, or obstetric factors. Routine audits of severe postpartum hemorrhage are recommended for ensuring optimal management and patient safety (Mehrabadi et al. 2014).",{"type":15,"attrs":7226,"content":7227},{"textAlign":53},[7228,7232],{"text":7229,"type":299,"marks":7230},"Primary Postpartum Hemorrhage (PPH)",[7231],{"type":618},{"text":7233,"type":299}," is defined as excessive bleeding that occurs within the first 24 hours after delivery. Traditionally the definition of PPH has been blood loss in excess of 500 mL after vaginal delivery and in excess of 1000 mL after abdominal delivery. For clinical purposes, any blood loss that has the potential to produce hemodynamic instability should be considered PPH. The amount of blood loss required to cause hemodynamic instability will depend on the pre-existing condition of the woman. Hemodynamic compromise is more likely to occur when conditions such as anemia (e.g., iron deficiency, thalassemia) or volume-contracted states (e.g., dehydration, gestational hypertension with proteinuria) (Leduc et al. 2018) are present.",{"type":15,"attrs":7235,"content":7236},{"textAlign":53},[7237],{"text":7238,"type":299},"PPH is one of the few obstetric complications with an effective preventive intervention and it is generally assumed that by preventing and treating PPH, most PPH-associated deaths could be avoided (Mathai et al. 2007; WHO 2012). Specifically, 54-93% of maternal deaths due to obstetric hemorrhage may be prevented.  Imprecise healthcare provider estimation of actual blood loss during birth and the immediate postpartum period is the leading cause of delayed response to hemorrhage (The American College of Obstetricians and Gynecologists 2019).  Blood loss is difficult to estimate and is frequently underestimated when volumes are high and overestimated when volumes are low (The American College of Obstetricians and Gynecologists 2019; Lyndon et al. 2015).",{"type":15,"attrs":7240,"content":7241},{"textAlign":53},[7242],{"text":7243,"type":299},"There are several possible reasons for severe bleeding during and after the third stage of labour, often referred to as the four T's:",{"type":666,"content":7245},[7246,7257,7267,7277],{"type":669,"content":7247},[7248],{"type":15,"attrs":7249,"content":7250},{"textAlign":53},[7251,7255],{"text":7252,"type":299,"marks":7253},"T",[7254],{"type":618},{"text":7256,"type":299},"one or uterine atony: abnormalities of uterine contraction;",{"type":669,"content":7258},[7259],{"type":15,"attrs":7260,"content":7261},{"textAlign":53},[7262,7265],{"text":7252,"type":299,"marks":7263},[7264],{"type":618},{"text":7266,"type":299},"issue:  retained placenta, products of conception;",{"type":669,"content":7268},[7269],{"type":15,"attrs":7270,"content":7271},{"textAlign":53},[7272,7275],{"text":7252,"type":299,"marks":7273},[7274],{"type":618},{"text":7276,"type":299},"rauma of the genital tract: lacerations of the cervix, vagina or perineum; uterine rupture; uterine inversion; and",{"type":669,"content":7278},[7279],{"type":15,"attrs":7280,"content":7281},{"textAlign":53},[7282,7285],{"text":7252,"type":299,"marks":7283},[7284],{"type":618},{"text":7286,"type":299},"hrombin: abnormalities of coagulation due to pre-existing states such as haemophilia A and von Willebrand's Disease, or acquired in pregnancy such as Immune Thrombocytopenic Purpura (ITP) or Disseminated Intravascular Coagulation (DIC) (Leduc, et al. 2018).",{"type":15,"attrs":7288,"content":7289},{"textAlign":53},[7290,7294],{"text":7291,"type":299,"marks":7292},"Secondary PPH",[7293],{"type":618},{"text":7295,"type":299}," is defined as excessive vaginal bleeding from 24 hours after delivery, to up to six weeks postpartum. Most cases of secondary PPH are due to retained products of conception,  infection, subinvolution of the placental site and inherited coagulation defects such as von Willebrand (The American College of Obstetricians and Gynecologist 2017).",{"type":15,"attrs":7297,"content":7298},{"textAlign":53},[7299,7303],{"text":7300,"type":299,"marks":7301},"Instrumentation and Caesarean Section",[7302],{"type":618},{"text":7304,"type":299},": Some obstetrical interventions are found to consistently be associated with higher rates of blood loss at the time of delivery thus predisposing patients to developing PPH. Included interventions are instrumental deliveries, episiotomy and caesarean sections, with emergency caesarean sections associated with higher rates of blood loss. It is important to note that more recent studies suggest that some obstetrical interventions increase the likelihood of PPH in a subsequent pregnancy, and that the recent increase in PPH in developed countries, which cannot seem to be wholly explained by factors related to the current pregnancy and delivery, may be due to more distal contributory factors (Roberts et al. 2009; Briley et al. 2014).",{"_uid":874,"content":7306,"component":872},[7307],{"_uid":877,"content":7308,"component":871},{"type":12,"content":7309},[7310,7314,7319,7323],{"type":544,"attrs":7311,"content":7312},{"level":546,"textAlign":53},[7313],{"text":884,"type":299},{"type":15,"attrs":7315,"content":7316},{"textAlign":53},[7317],{"text":7318,"type":299},"By following the recommended strategies for active management of the third stage of labour, a hospital team can reduce the incidence of harm and/or death from obstetrical hemorrhage.",{"type":544,"attrs":7320,"content":7321},{"level":588,"textAlign":53},[7322],{"text":3293,"type":299},{"type":15,"attrs":7324,"content":7325},{"textAlign":53},[7326],{"text":7327,"type":299},"Melissa Price, the patient representative on the hemorrhage task force, had a late postpartum hemorrhage. Melissa ended up with a hysterectomy and about 12 units of blood transfused. While in the Emergency Department, Melissa recalls asking the nurses how they could tell how much blood she was losing – the nurses never weighed the blood, and dumped it from a bed pan into a portable toilet. After Melissa's obstetrician got the bleeding to stop, she was left alone behind a curtain and checked on infrequently. Melissa recalls the feeling sheer panic when the bleeding started up again with 'enormous clots'… \"I screamed and I will never forget the look on the nurse's face when she lifted up that blanket. After that, ER staff was running around everywhere. Rushing to call my OB, rushing to get an OR suite, rushing to figure out how to get my insulin pump turned off. I just kept thinking, God give them more time. They need more time to save me.\" (Lyndon et al. 2015).",{"_uid":914,"items":7329,"title":1621,"component":1622,"description":7603},[7330],{"_uid":917,"title":918,"ctaLeft":7331,"ctaRight":7332,"component":921,"columnLeft":7333,"columnRight":7346},[],[],{"type":12,"content":7334},[7335],{"type":15,"attrs":7336,"content":7337},{"textAlign":53},[7338,7339,7345],{"text":928,"type":299},{"text":930,"type":299,"marks":7340},[7341],{"type":559,"attrs":7342},{"href":561,"uuid":356,"anchor":53,"custom":7343,"target":563,"linktype":564,"story":7344},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":937,"type":299},{"type":12,"content":7347},[7348,7353],{"type":15,"attrs":7349,"content":7350},{"textAlign":53},[7351],{"text":7352,"type":299},"If your review reveals that your cases of obstetric Hemorrhage are linked to specific processes or procedures, you may find these resources helpful:",{"type":666,"content":7354},[7355,7367,7379,7391,7409,7416,7423,7435,7447,7459,7471,7483,7495,7502,7509,7521,7533,7545,7557,7575,7582,7589,7596],{"type":669,"content":7356},[7357],{"type":15,"attrs":7358,"content":7359},{"textAlign":53},[7360,7362],{"text":7361,"type":299},"Association of Ontario Midwives. ",{"text":7363,"type":299,"marks":7364},"https://www.ontariomidwives.ca/",[7365],{"type":559,"attrs":7366},{"href":7363,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7368},[7369],{"type":15,"attrs":7370,"content":7371},{"textAlign":53},[7372,7374],{"text":7373,"type":299},"Postpartum Hemorrhage. 2016. ",{"text":7375,"type":299,"marks":7376},"https://www.ontariomidwives.ca/sites/default/files/CPG%20full%20guidelines/CPG-Postpartum-hemorrhage-PUB.pdf",[7377],{"type":559,"attrs":7378},{"href":7375,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7380},[7381],{"type":15,"attrs":7382,"content":7383},{"textAlign":53},[7384,7386],{"text":7385,"type":299},"American College of Obstetricians and Gynecologists (ACOG). ",{"text":7387,"type":299,"marks":7388},"https://www.acog.org/",[7389],{"type":559,"attrs":7390},{"href":7387,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7392},[7393],{"type":15,"attrs":7394,"content":7395},{"textAlign":53},[7396,7398,7402,7404],{"text":7397,"type":299},"Obstetrics & Gynecology. ",{"text":7399,"type":299,"marks":7400},"ACOG Practice Bulletin: Postpartum Hemorrhage",[7401],{"type":1633},{"text":7403,"type":299},". 2017. DOI: ",{"text":7405,"type":299,"marks":7406},"https://journals.lww.com/greenjournal/Abstract/2017/10000/Practice_Bulletin_No__183__Postpartum_Hemorrhage.56.aspx",[7407],{"type":559,"attrs":7408},{"href":7405,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7410},[7411],{"type":15,"attrs":7412,"content":7413},{"textAlign":53},[7414],{"text":7415,"type":299},"Obstetric Hemorrhage Bundle, Guidance Documents, and Additional Resources https://www.acog.org/About-ACOG/ACOG-Districts/District-II/SMI-OB-Hemorrhage?IsMobileSet=false",{"type":669,"content":7417},[7418],{"type":15,"attrs":7419,"content":7420},{"textAlign":53},[7421],{"text":7422,"type":299},"Committee Opinion: Preparing for Clinical Emergencies in Obstetrics and Gynecology. 2014. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Patient-Safety-and-Quality-Improvement/co590.pdf?dmc=1&ts=20200212T1519391856",{"type":669,"content":7424},[7425],{"type":15,"attrs":7426,"content":7427},{"textAlign":53},[7428,7430],{"text":7429,"type":299},"Committee Opinion: Quantitative Blood Loss in Obstetric Hemorrhage.  2019. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co794.pdf?dmc=1&ts=20200212T1515359038",{"text":7431,"type":299,"marks":7432},"  ",[7433],{"type":2404,"attrs":7434},{"color":16},{"type":669,"content":7436},[7437],{"type":15,"attrs":7438,"content":7439},{"textAlign":53},[7440,7442],{"text":7441,"type":299},"Association of Women's Health Obstetric Neonatal Nurses (AWHONN). ",{"text":7443,"type":299,"marks":7444},"https://awhonn.org/",[7445],{"type":559,"attrs":7446},{"href":7443,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7448},[7449],{"type":15,"attrs":7450,"content":7451},{"textAlign":53},[7452,7454],{"text":7453,"type":299},"Postpartum Hemorrhage. ",{"text":7455,"type":299,"marks":7456},"http://pphproject.org/",[7457],{"type":559,"attrs":7458},{"href":7455,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7460},[7461],{"type":15,"attrs":7462,"content":7463},{"textAlign":53},[7464,7466],{"text":7465,"type":299},"California Maternal Quality Care Collaborative. ",{"text":7467,"type":299,"marks":7468},"https://www.cmqcc.org/",[7469],{"type":559,"attrs":7470},{"href":7467,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7472},[7473],{"type":15,"attrs":7474,"content":7475},{"textAlign":53},[7476,7478],{"text":7477,"type":299},"OB Hemorrhage Toolkit V 2.0. 2015. ",{"text":7479,"type":299,"marks":7480},"https://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage-toolkit",[7481],{"type":559,"attrs":7482},{"href":7479,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7484},[7485],{"type":15,"attrs":7486,"content":7487},{"textAlign":53},[7488,7490],{"text":7489,"type":299},"Institute for Healthcare Improvement (IHI).  ",{"text":1297,"type":299,"marks":7491},[7492],{"type":559,"attrs":7493},{"href":7494,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},"http://www.ihi.org/",{"type":669,"content":7496},[7497],{"type":15,"attrs":7498,"content":7499},{"textAlign":53},[7500],{"text":7501,"type":299},"How-to Guide: Prevent obstetrical adverse events. 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventObstetricalAdverseEvents.aspx",{"type":669,"content":7503},[7504],{"type":15,"attrs":7505,"content":7506},{"textAlign":53},[7507],{"text":7508,"type":299},"National Institute for Health and Care Excellence (NICE) www.nice.org.uk",{"type":669,"content":7510},[7511],{"type":15,"attrs":7512,"content":7513},{"textAlign":53},[7514,7516],{"text":7515,"type":299},"Intrapartum care for healthy women and babies: Clinical guideline [CG190]. Published date:  2014 Last updated: 2017 ",{"text":7517,"type":299,"marks":7518},"https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-stage-of-labour",[7519],{"type":559,"attrs":7520},{"href":7517,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7522},[7523],{"type":15,"attrs":7524,"content":7525},{"textAlign":53},[7526,7528],{"text":7527,"type":299},"The Global Library of Women’s Medicine. ",{"text":7529,"type":299,"marks":7530},"https://www.glowm.com/",[7531],{"type":559,"attrs":7532},{"href":7529,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7534},[7535],{"type":15,"attrs":7536,"content":7537},{"textAlign":53},[7538,7540],{"text":7539,"type":299},"A Comprehensive Textbook of Postpartum Hemorrhage 2nd Edition. ",{"text":7541,"type":299,"marks":7542},"https://www.glowm.com/resource_contents/resource_doc/675",[7543],{"type":559,"attrs":7544},{"href":7541,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7546},[7547],{"type":15,"attrs":7548,"content":7549},{"textAlign":53},[7550,7552],{"text":7551,"type":299},"The Society of Obstetricians and Gynaecologists of Canada (SOGC) - ",{"text":7553,"type":299,"marks":7554},"https://www.sogc.org/en/",[7555],{"type":559,"attrs":7556},{"href":7553,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7558},[7559],{"type":15,"attrs":7560,"content":7561},{"textAlign":53},[7562,7564,7568,7570],{"text":7563,"type":299},"Journal of Obstetrics and Gynaecology of Canada (JOGC).  ",{"text":7565,"type":299,"marks":7566},"No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage",[7567],{"type":1633},{"text":7569,"type":299},". 2018. ",{"text":7571,"type":299,"marks":7572},"https://www.jogc.com/article/S1701-2163(18)30766-7/fulltext",[7573],{"type":559,"attrs":7574},{"href":7571,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":912},{"type":669,"content":7576},[7577],{"type":15,"attrs":7578,"content":7579},{"textAlign":53},[7580],{"text":7581,"type":299},"World Health Organization",{"type":669,"content":7583},[7584],{"type":15,"attrs":7585,"content":7586},{"textAlign":53},[7587],{"text":7588,"type":299},"WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. https://www.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf?ua=1",{"type":669,"content":7590},[7591],{"type":15,"attrs":7592,"content":7593},{"textAlign":53},[7594],{"text":7595,"type":299},"Uterotonics for the prevention of postpartum haemorrhage.  2018. http://apps.who.int/iris/bitstream/handle/10665/277276/9789241550420-eng.pdf?ua=1&ua=1",{"type":669,"content":7597},[7598],{"type":15,"attrs":7599,"content":7600},{"textAlign":53},[7601],{"text":7602,"type":299},"WHO Recommendations: Uterotonics for the prevention of postpartum haemorrhage Power Point Presentation. https://www.who.int/reproductivehealth/uterotonics-for-PPH-prevention-slidedoc.pptx?ua=1",{"type":12,"content":7604},[7605,7610,7614,7641],{"type":15,"attrs":7606,"content":7607},{"textAlign":53},[7608],{"text":7609,"type":299},"Given the broad range of potential causes of obstetrical hemorrhage, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate 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Rounds: Ob Team Stat: Developing a better L&D rapid response team",{"type":15,"attrs":8432,"content":8433},{"textAlign":53},[8434],{"text":8435,"type":299},"The recommended 30 minute \"decision to incision\" response time to obstetric emergency is not adequate to prevent adverse outcomes in certain scenarios. Improving on the current sequential team activation response to emergency, Allan Bombard, M.D., along with Karyn Almyrde, BSN and Val Catanzarite, MD Phd, developed the \"Ob Team Stat\" rapid response team. They utilized the Lockheed Martin \"Skunk Works\" approach to team project development, often employed in the business world. \"Ob Team Stat\" employs a simultaneous team activation approach to obstetric emergency. The system is activated by any team member, who simultaneously overhead pages and beeps the L&D charge nurse, in-house obstetrician, anesthesiologist, OR surgical team, neonatalogist, and NICU team.",{"type":15,"attrs":8437,"content":8438},{"textAlign":53},[8439],{"text":8440,"type":299},"After approval for a new hospital procedure, the team concept was discussed and refined through the Hospital Committees of all the team members and those they would interact with, and then put into operation within a week. Review of six months of data after \"Ob Stat Team\" introduction revealed the time from team activation to delivery had a mean of 10.9+/- 4.0 minutes, with a range of four to 19 minutes. In a team activation for uterine rupture during a VBAC, delivery was within six minutes and 30 seconds from onset of bradycardia. A different approach to problem solving by a small team, followed by continual monitoring and adaptation of the \"Ob Stat Team\" dramatically improved response times to obstetric emergencies compared with other institutions (Catanzarite, Almryde, Bombard 2007).",{"_uid":1876,"items":8442,"title":1951,"component":1622,"description":8548},[8443],{"_uid":1879,"title":1880,"ctaLeft":8444,"ctaRight":8445,"component":921,"columnLeft":8446,"columnRight":8450},[],[],{"type":12,"content":8447},[8448],{"type":15,"attrs":8449},{"textAlign":53},{"type":12,"content":8451},[8452,8457,8462,8473,8484,8489,8500,8510,8521,8532,8543],{"type":15,"attrs":8453,"content":8454},{"textAlign":53},[8455],{"text":8456,"type":299},"American College of Obstetricians and Gynecologists (ACOG). Committee on Obstetric Practice. ACOG Committee Opinion: Quantitative Blood Loss in Obstetric Hemorrhage-Number 794.  Obstet Gynecol. 2019; 134 (6): 150-156.",{"type":15,"attrs":8458,"content":8459},{"textAlign":53},[8460],{"text":8461,"type":299},"American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists, number 183, October 2017: Postpartum Hemorrhage.  Obstet Gynecol. 2017; 130 (4): 168-186.",{"type":15,"attrs":8463,"content":8464},{"textAlign":53},[8465,8467],{"text":8466,"type":299},"Briley A, Seed PT, Tydeman G, et al. Reporting errors, incidence and risk factors for postpartum haemorrhage (PPH) and progression to severe PPH: a prospective observational study. BJOG. 2014; 121 (7): 876–888. doi: 10.1111/1471-0528.12588. ",{"text":8468,"type":299,"marks":8469},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282054/",[8470],{"type":559,"attrs":8471},{"href":8468,"uuid":53,"anchor":53,"custom":8472,"target":911,"linktype":912},{},{"type":15,"attrs":8474,"content":8475},{"textAlign":53},[8476,8478],{"text":8477,"type":299},"Catanzarite V, Almryde K, Bombard A. Grand Rounds: Ob Team Stat: Developing a better L&D rapid response team. California Maternal Quality Care Collaborative. 2007.  ",{"text":8479,"type":299,"marks":8480},"https://www.cmqcc.org/resource/grand-rounds-ob-team-stat-developing-better-ld-rapid-response-team",[8481],{"type":559,"attrs":8482},{"href":8479,"uuid":53,"anchor":53,"custom":8483,"target":911,"linktype":912},{},{"type":15,"attrs":8485,"content":8486},{"textAlign":53},[8487],{"text":8488,"type":299},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent obstetrical adverse events. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventObstetricalAdverseEvents.aspx",{"type":15,"attrs":8490,"content":8491},{"textAlign":53},[8492,8494],{"text":8493,"type":299},"Leduc D, Senikas V, Lalonde AB. Clinical Practice Obstetrics Committee. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can. 2018; 40 (12): 841-855. ",{"text":8495,"type":299,"marks":8496},"https://doi.org/10.1016/j.jogc.2018.09.024",[8497],{"type":559,"attrs":8498},{"href":8495,"uuid":53,"anchor":53,"custom":8499,"target":911,"linktype":912},{},{"type":15,"attrs":8501,"content":8502},{"textAlign":53},[8503,8505],{"text":8504,"type":299},"Lyndon A, Lagrew D, Shields L, Main E, Cape V. Improving health care response to obstetric hemorrhage, version 2.0: A California toolkit to transform maternity care. California Maternal Quality Care Collaborative. 2015. ",{"text":7479,"type":299,"marks":8506},[8507],{"type":559,"attrs":8508},{"href":7479,"uuid":53,"anchor":53,"custom":8509,"target":911,"linktype":912},{},{"type":15,"attrs":8511,"content":8512},{"textAlign":53},[8513,8515],{"text":8514,"type":299},"Mathai M, Gülmezoglu AM, Hill S. Saving women's lives: Evidence-based recommendations for the prevention of postpartum haemorrhage. Bull World Health Organ. 2007; 85 (4):322–323. doi:10.2471/BLT.07.041962  ",{"text":8516,"type":299,"marks":8517},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636323/",[8518],{"type":559,"attrs":8519},{"href":8516,"uuid":53,"anchor":53,"custom":8520,"target":911,"linktype":912},{},{"type":15,"attrs":8522,"content":8523},{"textAlign":53},[8524,8526],{"text":8525,"type":299},"Mehrabadi A, Liu S, Bartholomew S, et al. Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010.  J Obstet Gynaecol Can. 2014; 36 (1): 21–33. ",{"text":8527,"type":299,"marks":8528},"http://www.jogc.com/article/S1701-2163(15)30680-0/fulltext",[8529],{"type":559,"attrs":8530},{"href":8527,"uuid":53,"anchor":53,"custom":8531,"target":911,"linktype":912},{},{"type":15,"attrs":8533,"content":8534},{"textAlign":53},[8535,8537],{"text":8536,"type":299},"Roberts CL, Ford JB, Algert CS, Bell JC, Simpson JM, Morris JM. Trends in adverse maternal outcomes during childbirth: A population-based study of severe maternal morbidity. BMC Pregnancy Childbirth. 2009; 9: 7. doi:10.1186/1471-2393-9-7. ",{"text":8538,"type":299,"marks":8539},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653462/",[8540],{"type":559,"attrs":8541},{"href":8538,"uuid":53,"anchor":53,"custom":8542,"target":911,"linktype":912},{},{"type":15,"attrs":8544,"content":8545},{"textAlign":53},[8546],{"text":8547,"type":299},"World Health Organization (WHO).  WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2012. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/",{"type":12,"content":8549},[8550],{"type":15},{"id":16,"_uid":8552,"items":8553,"component":1985},"15501beb-7a34-4703-a0e3-1bc83d8495f2",[8554],{"_uid":8555,"link":8556,"image":8561,"title":1976,"component":1977,"description":8563},"5814c9d2-cc5a-435f-8feb-90250a4fd2a1",[8557],{"_uid":8558,"link":8559,"label":1970,"component":1971},"127c1d69-5983-4c49-ba9e-bde6072c6acf",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":8560},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":8562,"is_external_url":290},{},{"type":12,"content":8564},[8565],{"type":15,"attrs":8566,"content":8567},{"textAlign":53},[8568],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],-18720,[],"c754552b-2c3f-4f68-8ee5-fe2849c9f8e6","2025-12-11T17:52:33.984Z",[],[8577],{"path":8578,"name":8579,"lang":469,"published":461},"ressources/hemorragie-obstetricale","Hémorragie obstétricale",{"name":8581,"created_at":8582,"published_at":8583,"updated_at":8584,"id":8585,"uuid":376,"content":8586,"slug":9498,"full_slug":9499,"sort_by_date":53,"position":9500,"tag_list":9501,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":9502,"first_published_at":9503,"release_id":53,"lang":300,"path":53,"alternates":9504,"default_full_slug":9499,"translated_slugs":9505},"Medication Incidents","2025-12-11T14:52:52.140Z","2026-03-10T16:32:00.341Z","2026-03-10T16:32:00.384Z",121959105274709,{"new":290,"seo":8587,"_uid":493,"hero":8588,"type":174,"topics":8609,"Noindex":290,"content":8610,"audience":9496,"duration":16,"regional":9497,"component":1988},{"_uid":491,"title":8581,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[8589],{"_uid":496,"image":8590,"title":8592,"format":8593,"component":505,"description":8596,"key_learning":8603,"prerequisite":8606},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":8591,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Medication Incidents",{"type":12,"content":8594},[8595],{"type":15},{"type":12,"content":8597},[8598],{"type":15,"attrs":8599,"content":8600},{"textAlign":53},[8601],{"text":8602,"type":299},"Medication incidents are defined as: \"any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Medication incidents may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labeling/packaging/nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use\" (ISMP Canada, Definitions 2016). Medication safety is a shared responsibility among the healthcare team members, staff, and organizational leadership.",{"type":12,"content":8604},[8605],{"type":15},{"type":12,"content":8607},[8608],{"type":15},[76,8],[8611,8626,8749,8777,8996,9028,9245,9281,9478],{"_uid":522,"link":8612,"image":8613,"title":526,"component":527,"media_type":528,"description":8615},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":8614},{},{"type":12,"content":8616},[8617],{"type":15,"attrs":8618,"content":8619},{"textAlign":53},[8620],{"text":8621,"type":299,"marks":8622},"To prevent medication-related events involving incorrect administration or dosage of medications during a hospital stay.",[8623],{"type":2404,"attrs":8624},{"color":8625},"#575757",{"_uid":537,"content":8627,"component":872},[8628],{"_uid":540,"content":8629,"component":871},{"type":12,"content":8630},[8631,8635,8646,8651,8656,8661,8675,8680,8685,8690,8695,8700,8705,8742,8747],{"type":544,"attrs":8632,"content":8633},{"level":546,"textAlign":53},[8634],{"text":549,"type":299},{"type":15,"attrs":8636,"content":8637},{"textAlign":53},[8638,8639,8645],{"text":554,"type":299},{"text":556,"type":299,"marks":8640},[8641],{"type":559,"attrs":8642},{"href":561,"uuid":356,"anchor":53,"custom":8643,"target":563,"linktype":564,"story":8644},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":8647,"content":8648},{"textAlign":53},[8649],{"text":8650,"type":299},"In the Canadian Adverse Events Study, drug- and fluid-related events were the second-most common type of adverse event (Baker et al., 2004). The Institute of Medicine (IOM) Committee on Identifying and Preventing Medication Errors estimated that at least 1.5 million preventable adverse drug events (ADEs) occur each year in the United States (Aspden et al. 2006). The Institute of Medicine report, To Err is Human: Building a Safer Health System, identified medication events as the most common type of adverse event in healthcare and highlighted that in the U.S., preventable medication events resulted in up to 7,000 deaths per year in hospitals and tens of thousands more in outpatient facilities.",{"type":15,"attrs":8652,"content":8653},{"textAlign":53},[8654],{"text":8655,"type":299},"A study by Lucian Leape and colleagues identified the frequency of occurrence of error at each stage of the hospital medication use process: prescribing 39 per cent, order processing and transcription 12 per cent, dispensing 11 per cent and administration 38 per cent. Nearly half of the prescribing errors were intercepted by nurses and pharmacists and about one third of transcription errors were identified and corrected prior to administration. However, only two per cent of errors occurring at the administration stage were intercepted (Leape et al. 1995). Several more recent studies have assessed the prevalence of medication incidents and cost to the health care system (Bell et al. 2011; Bishop et al. 2015; Scales et al. 2016; Lee et al. 2010).",{"type":544,"attrs":8657,"content":8658},{"level":588,"textAlign":53},[8659],{"text":8660,"type":299},"High Alert Medications",{"type":15,"attrs":8662,"content":8663},{"textAlign":53},[8664,8666,8673],{"text":8665,"type":299},"High-alert (or high-hazard) medications are medications that bear a heightened risk of causing significant patient harm when they are used in error. The Institute for Safe Medication Practices (ISMP) reports that, although mistakes may not be more common in the use of these medications, when errors do occur, the impact on the patient can be significant (ISMP 2011). Examples of high-alert medications include anticoagulants, hypoglycemic agents, opioids, concentrated electrolytes, cancer chemotherapy and paralyzing agents. For a complete list, see ",{"text":8667,"type":299,"marks":8668},"ISMP High-Alert Medications in Acute Care Settings",[8669],{"type":559,"attrs":8670},{"href":8671,"uuid":53,"anchor":53,"custom":8672,"target":911,"linktype":912},"https://home.ecri.org/blogs/ismp-resources/high-alert-medications-in-acute-care-settings",{},{"text":8674,"type":299},". Known safe practices can reduce the potential for harm as per IHI's \"Implement High Alert Medication Safety Processes\" (IHI 2012).",{"type":544,"attrs":8676,"content":8677},{"level":588,"textAlign":53},[8678],{"text":8679,"type":299},"Medication Reconciliation",{"type":15,"attrs":8681,"content":8682},{"textAlign":53},[8683],{"text":8684,"type":299},"Communicating effectively about medications is a critical component of delivering safe care. By identifying and resolving medication discrepancies, the likelihood of adverse events occurring within health care organizations across the continuum of care will be reduced (Accreditation Canada et al. 2012).",{"type":15,"attrs":8686,"content":8687},{"textAlign":53},[8688],{"text":8689,"type":299},"Medication reconciliation is a three-step process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care (Safer Healthcare Now! 2017). Medication reconciliation requires a systematic and comprehensive review of all the medications a patient is taking to ensure that medications being added, changed or discontinued are carefully evaluated. It is an essential component of medication management and will inform and enable prescribers to make the most appropriate prescribing decisions for the patient. The literature regarding the potential impact of medication reconciliation continues to expand. The reconciling process has been demonstrated to be a powerful strategy to reduce ADEs as patients move from one level of care to another (Alex et al. 2016; Boockvar et al. 2011; Eggnik et al. 2010; Vira et al. 2006; Whittington, Cohen 2004; Rozich et al. 2004; Mekonned et al. 2016; Michels, Meisel 2003).",{"type":544,"attrs":8691,"content":8692},{"level":588,"textAlign":53},[8693],{"text":8694,"type":299},"Never Events",{"type":15,"attrs":8696,"content":8697},{"textAlign":53},[8698],{"text":8699,"type":299},"(Canadian Patient Safety Institute, 2015)",{"type":15,"attrs":8701,"content":8702},{"textAlign":53},[8703],{"text":8704,"type":299},"A Never Events Report for Hospital Care in Canada includes Five Pharmaceutical Never Events that result in serious patient harm or death, and that can be prevented by using organizational checks and balances:",{"type":666,"content":8706},[8707,8714,8721,8728,8735],{"type":669,"content":8708},[8709],{"type":15,"attrs":8710,"content":8711},{"textAlign":53},[8712],{"text":8713,"type":299},"Wrong-route administration of chemotherapy agents, such as vincristine administered intrathecally (injected into the spinal canal).",{"type":669,"content":8715},[8716],{"type":15,"attrs":8717,"content":8718},{"textAlign":53},[8719],{"text":8720,"type":299},"Intravenous administration of a concentrated potassium solution.",{"type":669,"content":8722},[8723],{"type":15,"attrs":8724,"content":8725},{"textAlign":53},[8726],{"text":8727,"type":299},"Inadvertent injection of epinephrine intended for topical use.",{"type":669,"content":8729},[8730],{"type":15,"attrs":8731,"content":8732},{"textAlign":53},[8733],{"text":8734,"type":299},"Overdose of hydromorphone by administration of a higher-concentration solution than intended (e.g., 10 times the dosage by drawing from a 10 mg/mL solution instead of a 1 mg/mL solution, or not accounting for needed dilution/ dosage adjustment).",{"type":669,"content":8736},[8737],{"type":15,"attrs":8738,"content":8739},{"textAlign":53},[8740],{"text":8741,"type":299},"Neuromuscular blockade without sedation, airway control and ventilation capability.",{"type":15,"attrs":8743,"content":8744},{"textAlign":53},[8745],{"text":8746,"type":299},"Capturing information about the incidence of never events and sharing the learning from reviews of incidents will be key to following system safety progress over time.",{"type":15,"attrs":8748},{"textAlign":53},{"_uid":874,"content":8750,"component":872},[8751],{"_uid":877,"content":8752,"component":871},{"type":12,"content":8753},[8754,8758,8763,8767,8772],{"type":544,"attrs":8755,"content":8756},{"level":546,"textAlign":53},[8757],{"text":884,"type":299},{"type":15,"attrs":8759,"content":8760},{"textAlign":53},[8761],{"text":8762,"type":299},"Patients and families can play an important role in reducing errors and harm to the patient when they understand what medications the patient is taking and why (IHI, 2012).",{"type":544,"attrs":8764,"content":8765},{"level":588,"textAlign":53},[8766],{"text":3293,"type":299},{"type":15,"attrs":8768,"content":8769},{"textAlign":53},[8770],{"text":8771,"type":299},"One son-in-law's pursuit to change the system.",{"type":15,"attrs":8773,"content":8774},{"textAlign":53},[8775],{"text":8776,"type":299},"Claire Friedman was not the typical mother-in-law of sitcoms and punchlines. She was active, vibrant and loved by friends and family. 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They are passionate in assisting staff and teams with the implementation of medication reconciliation (MedRec). As a means to maintain the momentum for MedRec, they acknowledge and commend the staff for their hard work and dedication with this patient safety initiative. They recognize that quality MedRec can be unsuccessful if it is not kept at the forefront. However through persistence and use of a quality improvement framework which includes conducting small tests of change, constant monitoring, and evaluation - MedRec processes are becoming established and embedded in Horizon's organizational culture.  ….. (Canadian Patient Safety Institute 2015).",{"type":544,"attrs":9267,"content":9268},{"level":588,"textAlign":53},[9269],{"text":9270,"type":299,"marks":9271},"Toolkit for Safe Implementation of Insulin Pens",[9272],{"type":559,"attrs":9273},{"href":9274,"uuid":53,"anchor":53,"custom":9275,"target":911,"linktype":912},"https://healthstandards.org/leading-practice/toolkit-for-safe-implementation-of-insulin-pens/",{},{"type":15,"attrs":9277,"content":9278},{"textAlign":53},[9279],{"text":9280,"type":299},"Insulin safety is a key priority nationally for healthcare organizations, the Institute for Safe Medication Practice (ISMP) Canada and provincial governments. 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",{"text":9325,"type":299,"marks":9326},"http://jama.jamanetwork.com/article.aspx?articleid=1104261",[9327],{"type":559,"attrs":9328},{"href":9329,"uuid":53,"anchor":53,"custom":9330,"target":911,"linktype":912},"https://jamanetwork.com/journals/jama/fullarticle/1104261",{},{"type":15,"attrs":9332,"content":9333},{"textAlign":53},[9334],{"text":9335,"type":299},"Bishop MA, Cohen BA, Billings LK, Thomas EV. Reducing errors through discharge medication reconciliation by pharmacy services. Am J Health Syst Pharm. 2015; 72 (17 Suppl 2): S120-S16. doi: 10.2146/sp150021.",{"type":15,"attrs":9337,"content":9338},{"textAlign":53},[9339,9341],{"text":9340,"type":299},"Boockvar KS, Blum S, Kugler A, et al. Effect of admission medication reconciliation on adverse drug events from admission medication changes. Arch Intern Med. 2011; 171 (9): 860-861. doi: 10.1001/archinternmed.2011.163. ",{"text":9342,"type":299,"marks":9343},"http://archinte.jamanetwork.com/article.aspx?articleid=487036",[9344],{"type":559,"attrs":9345},{"href":9346,"uuid":53,"anchor":53,"custom":9347,"target":911,"linktype":912},"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/487036",{},{"type":15,"attrs":9349,"content":9350},{"textAlign":53},[9351,9353,9365],{"text":9352,"type":299},"Canadian Patient Safety Institute. ",{"text":9354,"type":299,"marks":9355},"Never Events for Hospital Care in Canada Safer Care for Patients. 2015",[9356],{"type":559,"attrs":9357},{"href":9358,"uuid":377,"anchor":53,"custom":9359,"target":563,"linktype":564,"story":9360},"/resources/never-events-for-hospital-care-in-canada",{},{"name":9361,"id":9362,"uuid":377,"slug":9363,"url":9364,"full_slug":9364,"_stopResolving":461},"Never Events for Hospital Care in Canada",113881462050616,"never-events-for-hospital-care-in-canada","resources/never-events-for-hospital-care-in-canada",{"text":937,"type":299},{"type":15,"attrs":9367,"content":9368},{"textAlign":53},[9369],{"text":9370,"type":299},"Canadian Patient Safety Institute. Implementing MedRec at Horizon Health Network. 2015. https://www.patientsafetyinstitute.ca/en/NewsAlerts/News/Pages/Implementing-MedRec-at-Horizon-Health-Network.aspx ",{"type":15,"attrs":9372,"content":9373},{"textAlign":53},[9374,9376],{"text":9375,"type":299},"Eggink RN, Lenderink AW, Widdershoven JWMG, van den Bemt PMLA. The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci. 2010; 32 (6): 759-766. doi: 10.1007/s11096-010-9433-6. ",{"text":9377,"type":299,"marks":9378},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993887/",[9379],{"type":559,"attrs":9380},{"href":9381,"uuid":53,"anchor":53,"custom":9382,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC2993887/",{},{"type":15,"attrs":9384,"content":9385},{"textAlign":53},[9386,9388],{"text":9387,"type":299},"Health Standards Organization (HS0). Leading Practices Hamilton Health Sciences Toolkit for Safe Implementation of Insulin Pens. Health Standards Organization; 2012.",{"text":9389,"type":299,"marks":9390}," https://healthstandards.org/leading-practice/toolkit-for-safe-implementation-of-insulin-pens ",[9391],{"type":559,"attrs":9392},{"href":9274,"uuid":53,"anchor":53,"custom":9393,"target":911,"linktype":912},{},{"type":15,"attrs":9395,"content":9396},{"textAlign":53},[9397,9399],{"text":9398,"type":299},"Institute for Safe Medication Practices (ISMP). ISMP list of high-alert medications in acute care settings. ISMP; 2011. ",{"text":8898,"type":299,"marks":9400},[9401],{"type":559,"attrs":9402},{"href":8671,"uuid":53,"anchor":53,"custom":9403,"target":911,"linktype":912},{},{"type":15,"attrs":9405,"content":9406},{"textAlign":53},[9407],{"text":9408,"type":299},"ISMP Canada. Definitions of terms. 2016. https://www.ismp-canada.org/definitions.htm",{"type":15,"attrs":9410,"content":9411},{"textAlign":53},[9412],{"text":9413,"type":299},"Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events: ADE prevention study group. JAMA. 1995; 274 (1): 35-43.",{"type":15,"attrs":9415,"content":9416},{"textAlign":53},[9417],{"text":9418,"type":299},"Lee JY, Leblanc K, Fernandes OA, Huh JH, et al. Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry. Ann Pharmacother. 2010 Dec;44(12):1887-95.",{"type":15,"attrs":9420,"content":9421},{"textAlign":53},[9422,9424],{"text":9423,"type":299},"Mekonned AB, McLachlan AJ, Brien JE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016; 6 (2): e010003. doi: 10.1136/bmjopen-2015-010003. ",{"text":9425,"type":299,"marks":9426},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769405/",[9427],{"type":559,"attrs":9428},{"href":9429,"uuid":53,"anchor":53,"custom":9430,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC4769405/",{},{"type":15,"attrs":9432,"content":9433},{"textAlign":53},[9434],{"text":9435,"type":299},"Michels RD, Meisel SB. Program using pharmacy technicians to obtain medication histories. Am J Health-Sys Pharm. 2003; 60 (19): 1982-1986.",{"type":15,"attrs":9437,"content":9438},{"textAlign":53},[9439],{"text":9440,"type":299},"Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay ME, Resar RK. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004; 30 (1): 5-14.",{"type":15,"attrs":9442,"content":9443},{"textAlign":53},[9444,9446],{"text":9445,"type":299},"Safer Healthcare Now! Medication Reconciliation Getting Started Kit. Canadian Patient Safety Institute; 2017. ",{"text":9447,"type":299,"marks":9448},"https://era.library.ualberta.ca/items/3c229b9d-af36-4741-8353-25d190610b07",[9449],{"type":559,"attrs":9450},{"href":9451,"uuid":53,"anchor":53,"custom":9452,"target":911,"linktype":912},"https://ualberta.scholaris.ca/items/8caf70c5-1f05-431f-9ec3-684f4217f272",{},{"type":15,"attrs":9454,"content":9455},{"textAlign":53},[9456],{"text":9457,"type":299},"Scales DC, Fischer HD, Li P, et al. Unintentional continuation of medications intended for acute illness after hospital discharge: A population-based cohort study. J Gen Intern Med. 2016; 31 (2): 196-202. doi: 10.1007/s11606-015-3501-5.",{"type":15,"attrs":9459,"content":9460},{"textAlign":53},[9461,9463],{"text":9462,"type":299},"Vira T, Colquhoun M, Etchells EE. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006; 15 (2): 122-126. ",{"text":9464,"type":299,"marks":9465},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464829/",[9466],{"type":559,"attrs":9467},{"href":9468,"uuid":53,"anchor":53,"custom":9469,"target":911,"linktype":912},"https://pmc.ncbi.nlm.nih.gov/articles/PMC2464829/",{},{"type":15,"attrs":9471,"content":9472},{"textAlign":53},[9473],{"text":9474,"type":299},"Whittington J, Cohen H. OSF healthcare's journey in patient safety. Qual Manag Health Care. 2004; 13 (1): 53-59.",{"type":12,"content":9476},[9477],{"type":15},{"id":16,"_uid":9479,"items":9480,"component":1985},"b6903cc9-93e3-47e5-9e4d-ec2c377dfca0",[9481],{"_uid":9482,"link":9483,"image":9488,"title":1976,"component":1977,"description":9490},"152a4949-f88e-4b5b-9db4-f8b5eaa971f7",[9484],{"_uid":9485,"link":9486,"label":1970,"component":1971},"eca5a514-a977-47a0-b2ec-5b11abd0c0f0",{"id":1964,"url":16,"linktype":564,"fieldtype":1965,"cached_url":1966,"story":9487},{"name":1968,"id":1969,"uuid":1964,"slug":9,"url":1966,"full_slug":1966,"_stopResolving":461},{"id":1973,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1974,"copyright":16,"fieldtype":288,"meta_data":9489,"is_external_url":290},{},{"type":12,"content":9491},[9492],{"type":15,"attrs":9493,"content":9494},{"textAlign":53},[9495],{"text":1984,"type":299},[129,150,136,122,143,115,157],[185,192,200],"medication-incidents","resources/medication-incidents",-18710,[],"e5551c74-9dbc-43a8-98d1-089d907e88d3","2025-12-11T15:22:05.005Z",[],[9506],{"path":9507,"name":9508,"lang":469,"published":461},"ressources/incidents-medicamenteux","Incidents Médicamenteux",{"name":9510,"created_at":9511,"published_at":9512,"updated_at":9513,"id":9514,"uuid":443,"content":9515,"slug":10572,"full_slug":10573,"sort_by_date":53,"position":10574,"tag_list":10575,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":10576,"first_published_at":10577,"release_id":53,"lang":300,"path":53,"alternates":10578,"default_full_slug":10573,"translated_slugs":10579},"Viral Gastroenteritis","2025-12-10T22:13:15.620Z","2026-03-10T16:32:17.555Z","2026-03-10T16:32:17.622Z",121713441330003,{"new":290,"seo":9516,"_uid":493,"hero":9517,"type":174,"topics":9538,"Noindex":290,"content":9539,"audience":10570,"duration":16,"regional":10571,"component":1988},{"_uid":491,"title":9510,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[9518],{"_uid":496,"image":9519,"title":9521,"format":9522,"component":505,"description":9525,"key_learning":9532,"prerequisite":9535},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":9520,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Viral Gastroenteritis",{"type":12,"content":9523},[9524],{"type":15},{"type":12,"content":9526},[9527],{"type":15,"attrs":9528,"content":9529},{"textAlign":53},[9530],{"text":9531,"type":299},"Gastroenteritis is an inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea (Centers for Disease Control and Prevention (CDC) 2010). Infections that cause gastrointestinal illness (GI) may be caused by a variety of agents including bacteria, viruses and protozoa. Outbreaks of infectious GI can be devastating and lead to significant increased costs, increased patient morbidity, and in some instances patient mortality. The most important characteristic of pathogens responsible for infectious gastroenteritis is their ability to be rapidly transmitted in healthcare settings among individuals who often are highly susceptible. Episodes of infectious gastroenteritis account for a significant proportion of all patients/residents/clients in healthcare settings who develop diarrhea with or without nausea and/or vomiting (Provincial Infection Control Network of British Columbia 2016).",{"type":12,"content":9533},[9534],{"type":15},{"type":12,"content":9536},[9537],{"type":15},[76,8],[9540,9551,9694,9750,10028,10060,10217,10253,10552],{"_uid":522,"link":9541,"image":9542,"title":526,"component":527,"media_type":528,"description":9544},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":9543},{},{"type":12,"content":9545},[9546],{"type":15,"attrs":9547,"content":9548},{"textAlign":53},[9549],{"text":9550,"type":299},"Reduce the incidence of viral gastroenteritis.",{"_uid":537,"content":9552,"component":872},[9553],{"_uid":540,"content":9554,"component":871},{"type":12,"content":9555},[9556,9560,9571,9575,9579,9584,9589,9594,9599,9604,9609,9614,9619,9624,9629,9634,9639,9644,9649,9654,9684,9689],{"type":544,"attrs":9557,"content":9558},{"level":546,"textAlign":53},[9559],{"text":3043,"type":299},{"type":15,"attrs":9561,"content":9562},{"textAlign":53},[9563,9564,9570],{"text":554,"type":299},{"text":556,"type":299,"marks":9565},[9566],{"type":559,"attrs":9567},{"href":561,"uuid":356,"anchor":53,"custom":9568,"target":563,"linktype":564,"story":9569},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":544,"attrs":9572,"content":9573},{"level":588,"textAlign":53},[9574],{"text":9510,"type":299},{"type":15,"attrs":9576,"content":9577},{"textAlign":53},[9578],{"text":9531,"type":299},{"type":15,"attrs":9580,"content":9581},{"textAlign":53},[9582],{"text":9583,"type":299},"Healthcare-associated infections (HAIs) are defined as infections that occur as a result of healthcare interventions in any healthcare setting where care is delivered (Provincial Infectious Diseases Advisory Committee (PIDAC) & Ontario Agency for Health Protection and Promotion 2012). HAIs, such as gastroenteritis, result in a substantial burden of disease in Canadians, and are an important hospital and public health concern in Canada (PIDAC & Ontario Agency for Health Protection and Promotion 2014; Public Health Agency of Canada (PHAC), 2012)",{"type":15,"attrs":9585,"content":9586},{"textAlign":53},[9587],{"text":9588,"type":299},"The Clinical Group \"Viral Gastroenteritis\" in the Hospital Harm Indictor focuses only hospital associated gastroenteritis caused by viral agents such as rotavirus, norovirus, adenovirus.",{"type":544,"attrs":9590,"content":9591},{"level":588,"textAlign":53},[9592],{"text":9593,"type":299},"Rotaviral enteritis",{"type":15,"attrs":9595,"content":9596},{"textAlign":53},[9597],{"text":9598,"type":299},"Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. According to WHO estimates in 2013 about 215,000 children aged under five years die each year from vaccine-preventable rotavirus infections; the vast majority of these children live in low-income countries (World Health Organization (WHO) 2018).",{"type":15,"attrs":9600,"content":9601},{"textAlign":53},[9602],{"text":9603,"type":299},"Rotavirus disease is characterized by vomiting and watery diarrhea for three to eight days. Fever and abdominal pain also are common. Additional symptoms include loss of appetite and dehydration. Symptoms usually start about two days after a person is exposed to rotavirus. Vomiting and watery diarrhea can last three to eight days. (CDC 2019b).",{"type":15,"attrs":9605,"content":9606},{"textAlign":53},[9607],{"text":9608,"type":299},"Rotavirus infections are generally more severe and clinically significant in children aged three to 35 months. Adults tend to be asymptomatic and/or may demonstrate subclinical infection. Immunocompromised individuals are susceptible to developing more severe disease manifestations (PHAC 2010).",{"type":15,"attrs":9610,"content":9611},{"textAlign":53},[9612],{"text":9613,"type":299},"Chances of spread of infection within hospitals are high. Nosocomial infections are common and are a major cause of diarrhoea in newborns and infants. Several outbreaks have been observed in geriatric groups within hospitals. The most common mode of transmission for rotavirus is through faecal-oral spread, either from person-to-person or contact with contaminated environmental surfaces. The possibility of spread through faecally contaminated food and water also exists. Transmission through respiratory droplets has also been suggested; however, more investigation is required. Health Canada has approved RotaTeq and Rotarix vaccines in Canada; however, they are not part of the routine immunization programs that are currently available (PHAC 2010).",{"type":544,"attrs":9615,"content":9616},{"level":588,"textAlign":53},[9617],{"text":9618,"type":299},"Acute gastroenteropathy due to Norwalk agent",{"type":15,"attrs":9620,"content":9621},{"textAlign":53},[9622],{"text":9623,"type":299},"Norovirus is the official genus name for the group of viruses provisionally described as \"Norwalk-like viruses\" (CDC 2011). Norovirus causes acute gastroenteritis (CDC 2019c).",{"type":15,"attrs":9625,"content":9626},{"textAlign":53},[9627],{"text":9628,"type":299},"Norovirus illness is usually brief in people who are otherwise healthy. Young children, the elderly, and people with other medical illnesses are most at risk for more severe or prolonged infection. Like all viral infections, noroviruses are not affected by treatment with antibiotics (CDC 2010).",{"type":15,"attrs":9630,"content":9631},{"textAlign":53},[9632],{"text":9633,"type":299},"Norovirus is characterized by rapid onset of nausea, vomiting, diarrhea, abdominal cramps, abdominal pain, mucus in stool, malaise, headache, and fever (PHAC 2017). Diarrhea is more common in children and vomiting is more common in adults. In some cases, people develop dehydration because they are unable to drink enough liquids to replace the liquids they lost from frequent vomiting and diarrhea (CDC 2010).",{"type":15,"attrs":9635,"content":9636},{"textAlign":53},[9637],{"text":9638,"type":299},"Up to 30 per cent of Norovirus infections are asymptomatic, however, these individuals are able to transmit the virus (PHAC 2017). Noroviruses are found in the feces and vomit of infected people (CDC 2010). Norovirus transmission is usually person to person through the fecal-oral route. It can also be transmitted through the environment, contaminated surfaces, food, water, fomites, and aerosols (PHAC 2017).",{"type":15,"attrs":9640,"content":9641},{"textAlign":53},[9642],{"text":9643,"type":299},"Norovirus infections are very contagious and spread very rapidly. Healthcare facilities and other institutional settings (e.g., daycare centers, schools, etc.) are particularly at-risk for outbreaks because of increased person-to-person contact (CDC 2010; PHAC 2017).",{"type":544,"attrs":9645,"content":9646},{"level":588,"textAlign":53},[9647],{"text":9648,"type":299},"Adenovirus",{"type":15,"attrs":9650,"content":9651},{"textAlign":53},[9652],{"text":9653,"type":299},"Adenoviruses can cause a wide range of illnesses such as common cold or flu-like symptoms, fever, sore throat, pneumonia, conjunctivitis, and acute gastroenteritis. Adenoviruses can cause mild to severe illness, though serious illness is less common. People with weakened immune systems, or existing respiratory or cardiac disease, are at higher risk of developing severe illness from an adenovirus infection. Adenoviruses are usually spread from an infected person to others through:",{"type":666,"content":9655},[9656,9663,9670,9677],{"type":669,"content":9657},[9658],{"type":15,"attrs":9659,"content":9660},{"textAlign":53},[9661],{"text":9662,"type":299},"close personal contact, such as touching or shaking hands",{"type":669,"content":9664},[9665],{"type":15,"attrs":9666,"content":9667},{"textAlign":53},[9668],{"text":9669,"type":299},"the air by coughing and sneezing",{"type":669,"content":9671},[9672],{"type":15,"attrs":9673,"content":9674},{"textAlign":53},[9675],{"text":9676,"type":299},"touching an object or surface with adenoviruses on it, then touching your mouth, nose, or eyes before washing your hands",{"type":669,"content":9678},[9679],{"type":15,"attrs":9680,"content":9681},{"textAlign":53},[9682],{"text":9683,"type":299},"an infected person's stool, for example, during diaper changing.",{"type":15,"attrs":9685,"content":9686},{"textAlign":53},[9687],{"text":9688,"type":299},"Adenoviruses are resistant to many common disinfectants and can remain infectious for long periods on environmental surfaces and medical instruments.",{"type":15,"attrs":9690,"content":9691},{"textAlign":53},[9692],{"text":9693,"type":299},"Some people infected with adenoviruses, especially those who have weakened immune systems, can have ongoing infections in their tonsils, adenoids, and intestines that do not cause symptoms. They can shed the virus for weeks or longer. (CDC 2019a)",{"_uid":874,"content":9695,"component":872},[9696],{"_uid":877,"content":9697,"component":871},{"type":12,"content":9698},[9699,9703,9708,9713,9718,9722,9734,9739],{"type":544,"attrs":9700,"content":9701},{"level":546,"textAlign":53},[9702],{"text":884,"type":299},{"type":15,"attrs":9704,"content":9705},{"textAlign":53},[9706],{"text":9707,"type":299},"When patients get an infection while in hospital, it delays healing, extends the patient's length of stay and increases their risk for harm and readmission. By implementing infection prevention and control practices, patients are safer.  ",{"type":15,"attrs":9709,"content":9710},{"textAlign":53},[9711],{"text":9712,"type":299},"Viruses can be spread from person to person in the hospital in different ways. Most bacteria and viruses are usually spread between patients on pieces of equipment and on unwashed hands. Since germs can live on many surfaces, staff, family and visitors can spread infections without knowing.  Healthcare workers, patients, family, friends and visitors all have a role to play in preventing healthcare-associated infections. ",{"type":15,"attrs":9714,"content":9715},{"textAlign":53},[9716],{"text":9717,"type":299},"Hand hygiene is one of the most important ways to stop the spread of infections (Canadian Patient Safety Institute 2012).",{"type":544,"attrs":9719,"content":9720},{"level":588,"textAlign":53},[9721],{"text":899,"type":299},{"type":15,"attrs":9723,"content":9724},{"textAlign":53},[9725,9727,9733],{"text":9726,"type":299},"We are looking for a patient story related to viral gastroenteritis associated.  If you have one, please share it with the Canadian Patient Safety Institute at ",{"text":3612,"type":299,"marks":9728},[9729],{"type":559,"attrs":9730},{"href":3612,"uuid":53,"anchor":53,"custom":9731,"target":563,"linktype":9732},{},"email",{"text":937,"type":299},{"type":544,"attrs":9735,"content":9736},{"level":588,"textAlign":53},[9737],{"text":9738,"type":299},"Gastroenteritis in the News",{"type":15,"attrs":9740,"content":9741},{"textAlign":53},[9742,9744],{"text":9743,"type":299},"Norovirus outbreak affects 10 patients in Duncan hospital (Adam Chan 2019). ",{"text":9745,"type":299,"marks":9746},"https://www.victoriabuzz.com/2019/01/norovirus-outbreak-affects-10-patients-in-duncan-hospital/",[9747],{"type":559,"attrs":9748},{"href":9745,"uuid":53,"anchor":53,"custom":9749,"target":911,"linktype":912},{},{"_uid":914,"items":9751,"title":1621,"component":1622,"description":9985},[9752],{"_uid":917,"title":918,"ctaLeft":9753,"ctaRight":9754,"component":921,"columnLeft":9755,"columnRight":9770},[],[],{"type":12,"content":9756},[9757],{"type":15,"attrs":9758,"content":9759},{"textAlign":53},[9760,9761,9769],{"text":928,"type":299},{"text":930,"type":299,"marks":9762},[9763,9767,9768],{"type":559,"attrs":9764},{"href":561,"uuid":356,"anchor":53,"custom":9765,"target":563,"linktype":564,"story":9766},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"type":618},{"type":6603},{"text":937,"type":299},{"type":12,"content":9771},[9772,9777,9784,9879,9886],{"type":15,"attrs":9773,"content":9774},{"textAlign":53},[9775],{"text":9776,"type":299},"If your outbreak investigation or system review reveals that your cases of viral gastroenteritis are linked to breaks in infection prevention and control practices, these resources maybe helpful: ",{"type":15,"attrs":9778,"content":9779},{"textAlign":1638},[9780],{"text":9781,"type":299,"marks":9782},"Infection Prevention and Control",[9783],{"type":618},{"type":666,"content":9785},[9786,9799,9812,9826,9839,9853,9866],{"type":669,"content":9787},[9788],{"type":15,"attrs":9789,"content":9790},{"textAlign":53},[9791,9793],{"text":9792,"type":299},"Association for Professionals in Infection Control and Epidemiology: Practice guidance for infection prevention ",{"text":4908,"type":299,"marks":9794},[9795,9798],{"type":559,"attrs":9796},{"href":4908,"uuid":53,"anchor":53,"custom":9797,"target":911,"linktype":912},{},{"type":6603},{"type":669,"content":9800},[9801],{"type":15,"attrs":9802,"content":9803},{"textAlign":53},[9804,9806],{"text":9805,"type":299},"Centers for Disease Control and 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