Designated Officer Reporting an Exposure of an Emergency Service Worker to Infectious Disease

Policy

Category: Control of Infectious Diseases
Subject: Designated Officer Reporting an Exposure of an Emergency Service Worker to Infectious Disease
Division: Health Protection
Policy Number: CA.82.01.126
Effective Date: October 1, 2015

POLICY STATEMENT

The purpose of this policy is to clarify responsibilities and actions for Wellington-Dufferin-Guelph Public Health (WDGPH) in response to a Designated Officer’s (DO) report of an Emergency Service Worker’s (ESW) exposure to an infectious disease of public health importance. The policy ensures that WDGPH will provide appropriate evaluation, counseling, and recommendations to the DO to mitigate the risk of the ESW acquiring a bloodborne or other infectious disease due to an exposure while on duty.

As required by the Exposure of Emergency Service Workers to Infectious Diseases Protocol (as current), when the phone call comes to the 4752 reporting line, Control of Infectious Diseases (CID) employees will initiate the assessment and make evidence-based recommendations to DOs reporting an infectious disease exposure of an ESW while on duty. The DO report may be received through the Reportable Disease fax line, a call to the Reportable Disease Outbreak and Reporting Line (x4752), a call directed to an employee on the team, or through the after-hours answering service.

This policy does not address the requirements under the Mandatory Blood Testing Act (MBTA), 2006. If/when a Designated Officer or the affected ESW expresses intent to submit an application under the MBTA (2006), the DO or ESW will be directed to the Ministry of Community Safety and corrections website http://www.mcscs.jus.gov.on.ca/english/LinksResources/MandatoryBloodTest… to review criteria and obtain an application. At this time, CID employee will provide the DO/ESW with the name and extension of the WDGPH Clinical Services employee designated to oversee an MBTA application and have it reviewed by the Medical Officer of Health.

SCOPE

This policy applies to all employees on the CID team, including Managers, Supervisors, Public Health Nurses, Public Health Inspectors and students.

DEFINITIONS

Designated Officer – An individual assigned by each emergency service organization (ambulance, fire, police) to work with WDGPH for recommendations (e.g., testing, treatment) when an occupational exposure to a reportable disease has occurred with an ESW.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.126  Designated Officer Reporting an Exposure of an Emergency Services Worker to Infectious Disease
CA.50.01.101 and CA.80.02.101  Documentation Practices
Mandatory Blood Testing Act (MBTA), 2006 (as per www.wdgpublichealth.ca)
Infectious Diseases Protocol (as current), Appendices A and B
Exposure of Emergency Service Workers to Infectious Diseases Protocol (as current)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis

APPROVED BY

Director, Health Protection


Procedure

Category: Control of Infectious Diseases
Subject: Designated Officer Reporting an Exposure of an Emergency Services Worker to Infectious Disease
Division: Health Protection
Procedure Number: CA.82.02.126
Effective Date: August 31, 2015

PROCEDURE

Under the Health Protection and Promotion Act (HPPA), Wellington-Dufferin-Guelph Public Health (WDGPH) routinely follows up on reports of infectious diseases of public health importance and is responsible for case and contact management.  These reports may be received through the Reportable Disease Fax line, a call to the Reportable Disease Outbreak & Reporting Line (ext.4752), a call directed to an individual member of the team, or through the after-hours answering service. 

When a report of infectious disease is received where an Emergency Service Worker (ESW) has been identified as a contact, WDGPH will notify the Designated Officer (DO) and/or the ESW of the potential risk and recommendations for follow-up.

When an ESW has potentially been exposed to an infectious disease of public health importance during his/her work, the DO and/or ESW may contact the Medical Officer of Health (MOH) or designate to review the potential risks associated with the exposure and receive recommendations for follow-up.                                     

NOTE: All blood exposures must be sent to local emergency for immediate assessment.  Refer to the Infectious Disease Reporting Protocol for Emergency Services Workers algorithm (HPDCD(S)2) for an overview of this process.

In the event that the DO or the affected ESW expresses intent to submit an application under the Mandatory Blood Testing Act (MBTA), 2006, the DO or ESW will be directed to the Ministry of Community Safety and Corrections website to review criteria and obtain an application.  The CID employee will contact the Clinical Services employee who is responsible for assistance with MBTA applications to provide the name and contact information for the DO and the exposed ESW.  The CID employee will provide the name and direct extension of the Clinical Services employee responsible for follow-up to the DO/ESW and advise that they will be contacted within 24 hours. 

In the event that this report occurs during on-call hours, the CID employee will refer to the WDGPH policy CA.73.01.101 and procedure CA.73.02.101 Mandatory Blood Testing Act, 2006.

RESPONSIBILITIES

Emergency Services agencies will:
  • Have a designated and trained officer; and
  • Have procedures for their ESW personnel and DO to follow to notify WDGPH in the event of an infectious disease exposure.
Public Health will:
  • Provide an on-call system for receiving and responding to reports of infectious diseases of public health importance on a 24 hours per day, 7 days a week basis.
The MOH or designate will:
  • Review and assess the details of the potential exposure with the DO and/or ESW. The DO and/or ESW may report/document the details of the exposure using the ESW Infectious Disease Risk Assessment form;
  • Document the details of the exposure incident and any follow-up recommended on ESW Incident Report in Excelicare;
  • Report details of exposure to CID Manager and/or Supervisor or on-call Manager if after hours for review with MOH and direction regarding contact follow-up and post-exposure management;
  • If deemed necessary, the CID employee will contact healthcare facilities and other persons (e.g., infection control practitioners and/or attending physicians) for information on the source case;
  • Refer to the applicable disease-specific guidance documents and resources for information on contact follow-up and post-exposure management;
    • Infectious Diseases Protocol,  2013
    • WDGPH guidance documents
    • Control of Communicable Diseases Manual, David L. Heymann, MD, Editor
    • Red Book, Committee on Infectious Diseases, American Academy of Pediatrics
    • Canadian Immunization Guide, Public Health Agency of Canada
  • For all disease exposures, other than blood borne, inform the DO and/or ESW as soon as possible, but no later than 48 hours after receiving the request, of any specific action that should be taken, including accessing medical care by the ESW. All blood exposures must be sent to local emergency for immediate assessment;
  • Follow-up with the DO and/or ESW to ascertain what actions have been taken; and
  • Document all details in Excelicare as per WDGPH documentation standards.
Manager will:
  • Ensure CID employes, a Program Manager, or the Medical Officer of Health are available to receive reports of exposures and that reports are received, assessed, and responded to as soon as possible and not later than 48 hours after receiving notification.
CID employees will:
  • Review and assess the exposure information provided, contact healthcare facilities or healthcare professionals to obtain additional information when needed, and inform the DO as soon as possible and no later than 48 hours after receiving notification of the advised actions to be taken to mitigate risk of acquiring an infection;
  • Follow-up with the DO to establish what action has been taken;
  • Document all interactions, communications, recommendations, and actions taken in regards to the DO or ESW report; and
  • Direct DO/ESW applying under the MBTA (2006) to the Ministry of Community Safety and Corrections website for MBTA information and required forms. DOs and ESWs will be provided with contact information for the designated WDGPH Clinical Services staff overseeing MBTA applications to the MOH.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.126   Designated Officer Reporting an Exposure of an Emergency Services Worker to Infectious Disease
Health Promotion and Protection Act
Infectious Diseases Protocol, 2009
Mandatory Blood Testing Act, 2006
Exposure of Emergency Service Workers to Infectious Disease Protocol, 2008
WDGPH Guidance Documents
Control of Communicable Diseases Manual, David L. Heymann, MD, Editor
Red Book, Committee on Infectious Diseases, American Academy of Pediatrics
Canadian Immunization Guide, Public Health Agency of Canada

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection