Dr. Michael Gardam - University Health Network. Toronto, ON, CA

Dr. Michael Gardam Dr. Michael Gardam

Director of Infection Prevention and Control | University Health Network

Toronto, ON, CA

Fiercely committed to ensuring patient safety and preventing the spread of infectious disease






Fighting the Flu Auditing Hand Hygiene Performance Michael Gardam Finale.mpg Treadmill desk, healthy habits keep you moving (LC reports)




As Director of Infection Prevention and Control at the University Health Network since 2001, and former Director of Infectious Disease Prevention and Control at Public Health Ontario (2008 – 2010), Dr. Gardam has devoted his career to discovering and uncovering new ways to prevent the spread of infectious diseases in healthcare settings and the community. He continues to champion patient safety as Physician Director of the Community and Hospital Infection Control Association Canada (CHICA); as the National Lead of infection control collaboratives for Safer Healthcare Now! and through his pioneering efforts in the use of the behavioural change approaches, including ‘Positive Deviance’ and ‘Front Line Ownership’ to prevent healthcare associated infections. Dr. Gardam continues to lead safety improvement work using Front Line Ownership in Canada and the United States and has expanded its focus to include other patient safety challenges such as preventing patient falls, pressure ulcers, and medication reconciliation.

In addition to general infectious diseases practice, Dr. Gardam’s clinical work focuses on the prevention and treatment of tuberculosis and he is the founding Medical Director of the tuberculosis clinic at Toronto Western Hospital.

Industry Expertise (6)

Health Care - Facilities Health Care - Providers Education/Learning Research Health and Wellness Public Safety

Areas of Expertise (12)

Infectious Diseases Infection Prevention and Control Tuberculosis Organizational Change Healthcare Management Patient Safety Epidemology Ebola Hospital Infections Noscocomial Infections Change Management Positive Deviance

Education (4)

University of Toronto: M.Sc., Health Administration 2003

McGill University: MDCM, Medicine 1992

McGill University: M.Sc., Biochemistry 1989

McGill University: B.Sc., Biochemistry 1987

Affiliations (2)

  • University of Toronto : Associate Professor
  • Royal College of Physicians and Surgeons of Canada : Fellow (infectious diseases)

Media Appearances (6)

Why Health Officials say the Ebola Epidemic Won't Spread to Canada

Global News  online


“There are certainly diseases that are easier to catch than Ebola, but there are very few that are as scary,” according to Dr. Michael Gardam, director of infection prevention and control at Toronto’s University Health Network. “It’s scary. It’s had movies made about it and it’s the ultimate scary viral infectious disease that people have heard about for decades,” Gardam told Global News...

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Dr. Michael Gardam on the Risks of Avian Flu

CityNews Toronto  tv


Federal public health officials say a fatal human case of H5N1 bird flu has been reported in Canada, the first such case in North America. Dr. Michael Gardam spoke to Francis D’Souza about the viral infection.

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Full Interview: Michael Gardam on Hospital Surveillance

CBCRadio  radio


There's a new tool for tracking the spread of infections and diseases in hospitals. Developed by the Canadian company Infonaut in collaboration with George Brown College, this tool tracks the movements of health care workers in hospitals, including if they've washed their hands or not! Toronto General will be the first hospital in the world to use this technology. Dr. Michael Gardam is Director of Infection Prevention and Control at the University Health Network in Toronto, and he explains why the data collected will be invaluable, and how they're ensuring this won't be a "big brother" type surveillance situation.

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Ebola virus: 4 new things you need to know

CBC News  online


With the first case of Ebola now diagnosed in Texas, scientists and physicians in North America are trying to put the threat in perspective. What are we learning now about Ebola and how to deal with it? Here, from the members of The National's Ebola Checkup Panel, are the responses: It doesn't transmit before symptoms.
Dr. Michael Gardam, director of infection prevention and control at the University Health Network in Toronto, was asked on CBC News Network on Wednesday how worried people on a plane or at an airport should be, given the new diagnosis of a traveller from Liberia to Dallas. He replied: "If there is any good news about the Ebola virus, it's actually quite hard to catch. … For people in casual contact with this individual [in Texas], when they actually had symptoms, [the U.S. Centers for Disease Control] is going to be telling them to check their temperatures, etc."

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Reassuring Canadians - First Ebola case in the U.S.

CTV News Channel  tv


In the wake of the Ebola crisis in West Africa and a confirmed case in the United States, it isn’t enough to rely on screening at airports and borders, says Dr. Michael Gardam, director of infection prevention and control at the University Health Network. People travelling from infected areas need to be clear about their travel history when seeking medical care and health workers need to be asking patients questions about their travel histories.

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Why this expert is against making flu shots mandatory for health-care workers

Globe and Mail  print


Dr. Michael Gardam is the director of infection prevention and control at the University Health Network in Toronto. He has established a reputation as one of Canada’s leading voices in the field of infection control and matters of public health. Which is why some might be surprised to learn he thinks the growing trend toward mandating flu shots to health-care workers is a bad idea. “A few years ago, I was also for mandatory flu shots [for health-care workers],” Gardam says. “Then what happened is I started reading and I started going back to the original studies. I don’t feel that I can sugar-coat those any more.” It turns out that the evidence in favour of mandatory vaccination policies is far from conclusive. For instance, a review of the medical literature published in the Cochrane Database of Systematic Reviews in July, 2013, found vaccinated health-care workers had no measurable benefit on flu rates or the number of related complications of long-term-care residents. The physician argues that given the limited effectiveness of the annual flu shot and the lack of evidence showing that mandatory campaigns can reduce transmission rates, health-care workers should retain the ability to choose.

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Event Appearances (2)

If You Don't Succeed the First 20 Times, Please Try Something Different

Qmentum Quarterly : Quality in Healthcare  Lac-Leamy Gatineau, QB.


Using Front Line Ownership to Improve Patient Safety

Infection Prevention Society : February Speaker Highlight  Toronto, ON.


Articles (12)

Measuring the effect of sousveillance in increasing socially desirable behaviour 2013 IEEE International Symposium on Technology and Society (ISTAS): Social Implications of Wearable Computing and Augmediated Reality in Everyday Life


Hospital acquired infections (HAIs) occur frequently in hospitalized patients. Staff compliance with hand hygiene (HH) policy during patient care has been shown to reduce HAIs. Currently, hospitals evaluate adherence to HH policies through direct observation by human auditors. The auditors do not have authority over staff members; thus, this process is more akin to sousveillance (watching from below) than surveillance (watching from above). When behaviour change occurs due to awareness of being observed, it is referred to as the “Hawthorne effect”. We quantified the effect of sousveillance by comparing the frequency of HH events with an auditor present to when no auditor was present. The data analysed in the present work is from an ongoing study on hand hygiene compliance monitoring. A monitoring network recorded 290,000 hand hygiene events over 6 months; auditors were present on five occasions for about an hour each visit. When using an exponential underlying distribution we found that the change in the HH event rate was significant (p

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Is Surveillance for Multidrug-Resistant Enterobacteriaceae an Effective Infection Control Strategy in the Absence of an Outbreak? Journal of Infectious Diseases


Multidrug-resistant enterobacteriaceae (MDRE) are an important cause of nosocomial infections. The effectiveness of screening for MDRE in the nonoutbreak setting in an attempt to prevent transmission is unknown. Patients admitted for new organ transplantation were screened for MDRE colonization. Prospective clinical data were collected, and pulsed-field gel electrophoresis and plasmid and integron analysis of isolates were performed. Colonized patients were not isolated except when required by standard precautions. Of the 287 patients, 69 (24%) were colonized, and 6 (9%) of the 69 developed clinical infections. Most colonizing isolates (66/69) were unique. No clinical infections resulted from patient-to-patient transmission. Analysis of clinical isolates from nonstudy patients demonstrated no evidence of transmission leading to clinical disease. The annual cost of a surveillance program was calculated at Canadian $1,130,184.44. Thus, the routine and costly use of MDRE surveillance and isolation precautions are not warranted in the absence of a clonal outbreak in this population.

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Impact of the patient-provider relationship on the survival of foreign born outpatients with tuberculosis Journal of Immigrant and Minority Health


Managing tuberculosis in foreign born patients entails a complex interaction between patient and provider.
Using a retrospective cohort study and survival analysis, this study evaluates the impact of patient and provider factors on the survival of foreign born outpatients with active tuberculosis. The primary outcome of the study is 1 year all-cause mortality.
Patient-provider communication and health systems factors played a large role in the survival of our cohort of foreign born tuberculosis outpatients. These findings suggest that language barriers and the provision of care by experienced providers in specialized clinic settings may have important effects on health outcomes.

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Tuberculosis infection in the United States: national trends over three decades American Journal of Respiratory and Critical Care Medicine


This study examined the changes in latent tuberculosis burden between two cohorts representing the US population in the 1970s and and 1990s using data from the National Health and Nutrition Examination surveys. We identified that the burden of tuberculosis infection significantly decreased in both US- and foreign-born populations although the burden of disease in the foreign born was 8 fold higher than the US-born. As our study looked at two large cohorts over three decades, it considerably added to the tuberculosis literature as prior studies tended to look at non-representative or convenience samples. As senior author I was involved in all aspects of this study.

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Transmission of influenza A in human beings The Lancet - Infectious Diseases


This systematic review of the literature was a landmark study in that it identified that many of the assumptions regarding influenza transmission in humans are unfounded in science. This work resulted in my being involved in pandemic influenza planning activities in Europe, the United States and the World Health Organization (WHO). Furthermore, this paper has been cited as strong support for the current WHO infection control guidelines for pandemic influenza and resulted in my being an advisor to the WHO during the recent H1N1 pandemic.

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Detecting latent tuberculosis infection in hemodialysis patients: a head-to-head comparison of the T-SPOT.TB test, tuberculin skin test, and an expert physician panel Clinical Journal of the American Society of Nephrology


Patients with chronic renal failure at well known to be at high risk for progressing from latent tuberculosis infection to active disease. In this study we compared two step tuberculin skin testing to an elispot interferon gamma release assay and the deliberations of an expert clinician panel who had access to epidemiologic information, radiography, and tuberculin skin testing results. We clearly showed that the current recommendations for tuberculin skin testing of dialysis patients need to be reconsidered, as the sensitivity of the tuberculin skin test in this population is extremely poor. This paper was identified as significant in the annual review of nephrology literature in 2006.

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Measurement of patient hand hygiene in multiorgan transplant units using a novel technology: an observational study Infection Control and Hospital Epidemiology


Healthcare worker hand hygiene is known to prevent healthcare-associated infections, but there are few data on patient hand hygiene despite the fact that nosocomial pathogens may be acquired by patients via their own unclean hands. The purpose of this study was to measure patient hand hygiene behavior in the hospital after visiting a bathroom, before eating, and on entering and leaving their rooms.

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Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study BMJ Quality and Safety


The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this.
To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS).
The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital. The RTLS also tracked the movement of hospital hand hygiene auditors. Rates of hand hygiene events per dispenser per hour as measured by the RTLS were compared for dispensers within sight of auditors and those not exposed to auditors.

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Integration and proliferation of Pseudomonas aeruginosa PA01 in multispecies biofilms Microbial Ecology


Despite an increased awareness of biofilm formation by pathogens and the role of biofilms in human infections, the potential role of environmental biofilms as an intermediate stage in the host-to-host cycle is poorly described. To initiate infection, pathogens in biofilms on inanimate environmental surfaces must detach from the biofilm and be transmitted to a susceptible individual in numbers large enough to constitute an infectious dose. Additionally, while detachment has been recognized as a discrete event in the biofilm lifestyle, it has not been studied to the same extent as biofilm development or biofilm physiology. Successful integration of Pseudomonas aeruginosa strain PA01 expressing green fluorescent protein (PA01GFP), employed here as a surrogate pathogen, into multispecies biofilm communities isolated and enriched from sink drains in public washrooms and a hospital intensive care unit is described.

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Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting American Journal of Infection Control


A survey pilot asked patients to observe the hand hygiene compliance of their health care providers. Patients returned 75.1% of the survey cards distributed, and the overall hand hygiene compliance was 96.8%. Survey results and patient commentary were used to motivate hand hygiene compliance. The patient-as-observer approach appeared to be a viable alternative for hand hygiene auditing in an ambulatory care setting because it educated, engaged, and empowered patients to play a more active role in their own health care.

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A pragmatic approach to infection prevention and control guidelines in an ambulatory care setting American Journal of Infection Control


The vast majority of infection prevention and control (IPAC) experience and practice guidance relates to the inpatient setting. We have taken a pragmatic approach to applying IPAC guidance in our ambulatory setting, and here we identify and describe the 4 key areas where we modified our IPAC program and adapted current guidelines to fit with our setting.

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Prophylaxis for latent tuberculosis infection prior to anti–tumor necrosis factor therapy in low-risk elderly patients with rheumatoid arthritis: a decision analysis Arthritis Care and Research


To determine if low-risk elderly patients with rheumatoid arthritis (RA) who screen positive for latent tuberculosis (TB) infection prior to anti–tumor necrosis factor (anti-TNF) therapy should be given isoniazid (INH).
A Markov model was developed. The base case was a patient age 65 years with RA starting anti-TNF therapy with a positive tuberculin skin test (TST) finding of 5–9 mm, who was born in a country with low TB prevalence and had no other TB risk factors. The decision was 9 months of INH or not. The primary outcome was quality-adjusted life expectancy. Multiple sensitivity analyses were performed.

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