Best Practices

Updated on October 30, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.6 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

  2. Provincial Infectious Diseases Advisory Committee. Best Practices for Hand Hygiene in All Health Care Settings.

    Toronto: Ministry of Long-Term Care/Provincial Infectious Diseases Advisory Committee; 2010 Dec [cited 2015 Oct 28].
    Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

  3. Provincial Infectious Diseases Advisory Committee. Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices in All Health Care Settings.

    Toronto: Ministry of Long-Term Care/Provincial Infectious Diseases Advisory Committee; 2010 Feb [cited 2015 Oct 28].
    Available from: http://www.publichealthontario.ca/en/eRepository/PIDAC_Cleaning_Disinfection_and_Sterilization_2013.pdf

  4. Safer Healthcare Now! A New Approach to Controlling Superbugs: Getting Started Kit.

    Safer Healthcare Now!; 2010 Sept [cited 2015 Oct 28].
    Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/NACS%20Getting%20Started%20Kit.pdf


Updated on October 30, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate:


Targets/ Benchmarks How is This Indicator Used?
Outcome CDI rate per 1,000 patient days Number of patients newly diagnosed with hospital-acquired CDI during the reporting period x 1,000
Number of patient days in the reporting period.

(Patient days are the number of days spent in a hospital for all patients)
Targets: As low as possible (set by individual institutions)

Provincial benchmarks*:
See Table 2 in QIP Benchmark and Target Setting: Updates
Quality improvement

QIP indicator

Publicly reported by HQO

Run Charts

Collected measures can be presented graphically by plugging the monthly results into a run chart.


Clostridium Difficile Tools
QI Tools


For a more comprehensive list of tools and resources, visit the following links on our HQO website:



Clostridium Difficile Resources
QI Resources


Updated on October 30, 2015


More than 200,000 patients get infections every while receiving healthcare in Canada, and more than 8,000 of these patients die as a result.1 In addition to the need for improved patient safety and care, treatment costs are high and infections acquired in hospitals divert limited hospital and health care resources. Ontarians will continue to bear the cost of unnecessary deaths, longer hospital stays, increased health care costs, and more disability unless hospital acquired infections are eliminated.2 Ensuring the use of safe, effective and ethical infection prevention and control measures is an important health care goal.

Call to Action

In 2011, the average hospital-acquired C. difficile rate was 0.36 per 1,000 bed days in Ontario, or 250 cases per month across the province.3 Since 1997 mortality rates attributable to Clostridium difficile infection have more than tripled in Canada.1 Continued vigilance with prevention and infection control practice is needed to ensure rates do not increase.5

  1. Public Health Agency of Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2013.

    Infectious Disease – The Never-ending Threat.
    Available from: http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/infections-eng.php Accessed 2015 Oct 6

  2. Gardam MA, Lemieux C, Reason P, van Dijk M, Goel V. Healthcare associated infections as patient safety indicators.

    HealthCare Papers. 2009;9(3):8-24.

  3. Health Quality Ontario. Quality Monitor 2011.

    Toronto: Health Quality Ontario; 2011 Sept [cited 2012 Nov 7].
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2011-en.pdf

  4. Health Quality Ontario. Public Reporting: Patient Safety [Internet].

    Toronto: Health Quality Ontario; 2012.
    Available from: http://www.hqontario.ca/public-reporting/patient-safety