Healthcare Quarterly Vol.12 Special Issue 2009 161 Creating Safety Learning Systems H ealthcare-associated infections (HAIs), previously called nosocomial infections, constitute a serious problem for patient safety. Traditionally, HAIs have been defined as infections that are acquired during hospitali- zation. Today, however it has been recognized that infections can be contracted in all settings where healthcare is delivered (Archibald and Hierholzer 2004). HAIs have always existed, particularly in the hospital environment, but the highly publi- cized outbreaks of severe acute respiratory syndrome (SARS) and Clostridium difficile in recent years in Canada and the growth of antibiotic-resistant bacteria have raised concern about the problem and underlined the need for healthcare authorities to react vigorously. Some studies have shown that HAIs rank second among avoidable adverse events, right after adverse drug events (Kohn et al. 1999; Leape et al. 1991). Infections that occur most frequently are urinary infections, nosocomial pneumonia, surgical site infections and primary nosocomial bacteremia. HAIs affect about 5–10% of hospitalized patients, depending on the level of care and characteristics of the clientele, and this rate appears to be growing (Gourdeau et al. 2005). The death rate attributable to these infections is estimated to be between 1 and 10%, depending on the type of infection; furthermore, these infections extend hospital stay by about four days (Centers Abstract Healthcare-associated infections (HAIs) constitute a major safety problem. Healthcare managers need complete and valid information to fight against these infections. The purpose of this study was to develop a dashboard of indicators to help healthcare managers monitor HAIs. A pilot testing approach was used that was composed of the following steps: literature review, consultation with infection control experts and healthcare managers, operationalization of selected indicators, data collection from six Quebec hospital complexes to test the feasi- bility of the selected indicators and results dissemination. The literature review identified 299 possible indicators. After consulting infection control experts and health- care managers and having collected data in the hospi- tals, a proposed dashboard was created that includes 97 indicators divided in three categories (structure, process and outcome) and grouped in 22 themes. The proposed indicators are both scientifically valid and administra- tively feasible. However, many healthcare facilities need additional financial resources and expertise to measure these indicators and manage the information they will generate. TOCSIN: A Proposed Dashboard of Indicators to Control Healthcare- Associated Infections Régis Blais, François Champagne and Louise Rousseau