Reportable Disease Follow-up for STIs and BBIs

Policy

Category: Clinical Services 
Subject:  Reportable Disease Follow-up for STIs and BBIs
Division:  Community Health and Wellness
Policy Number:  CA.72.01.401
Effective Date:  October 26, 2017

POLICY STATEMENT

Confidential testing, treatment and follow-up of sexually transmitted infections (STIs) and blood-borne infections (BBIs) is offered to individuals at designated offices, community and school clinics.

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to investigate all reports of sporadic cases (clinic or community) of STIs and BBIs which are designated as reportable as set out by Regulation 559/91 (as amended) under the Health Protection and Promotion Act.

A copy of the lab report for reportable STIs or BBIs is received at WDGPH for those testing positive that live in Wellington, Dufferin and Guelph or have attended one of our clinics.

Treatment:

Antibiotics are available for the treatment of Chlamydia, Gonorrhea and Syphilis free of charge from the Public    Health Pharmacy and distributed through WDGPH. Supplies of antibiotics are distributed to clinic clients and larger health care facilities (e.g. hospital emergency rooms, health centres) who track individual client distribution.

Vaccination with Hepatitis A or B vaccine will be provided as per the Publically Funded Ontario Immunization schedule.

Flagyl will be provided at a reduced price to clients for whom the purchase at a pharmacy would be a financial burden.

Follow-up:

Case management follow-up is provided to all clients either directly by WDGPH or through the primary health provider who ordered the testing. Case management includes identifying risk factors leading to the acquisition of the infection, counseling for safe sex practices, treatment, test for cure, referral as necessary, contact tracing, and vaccination as applicable for positive cases and/or contacts.

Individual incidences of reportable infections and follow-up case management are documented in the Integrated Public Health Information Systems (iPHIS) database as per iPHIS Guidelines and Procedures Manual, 2005 (or most recent publication).

SCOPE

This policy applies to all WDGPH nurses assigned to Clinical Services and student nurses working in these programs.

DEFINITIONS

Sexually Transmitted Infections (STIs) – the term STI is now commonly used in the place of STD (sexually transmitted disease). STI is more encompassing, including infections that may be asymptomatic. STI is an illness that has a significant probability of transmission between humans by means of human sexual behaviour.

Blood-borne Infections (BBIs) – A virus that circulates in the blood and can be transmitted from one person to another during blood-to-blood contact.

Reportable Infections – infections considered to be of great public health importance. Local, provincial, and national agencies require that these diseases be reported when they are diagnosed by physicians and laboratories. Reporting allows for the collection of statistics that show how often the disease occurs. This helps researchers identify disease trends and track disease outbreaks. This information can help control future outbreaks.

Case Management – is a general term referring to the facilitation of access, assessment and treatment to assure the appropriate medical care is provided to individuals who may have come into contact with individuals with a reportable infection. 

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure: CA.72.02.401 Sexually Transmitted Infections and Blood-borne Infections

CA.72.01.402   Reportable Disease Follow-up

Iphis Guidelines and Procedures Manual, 2005

Ontario Publically Funded Immunization Schedule

CONTACT FOR INQUIRIES

Manager, Clinical Services

APPROVED BY

Director, Community Health Services


Procedure

Category:  Clinical Services
Subject:  Reportable Disease Follow-up for STIs and BBIs
Division:  Community Health and Wellness
Procedure Number:  CA.72.02.401
Effective Date:  October 26, 2017

PROCEDURE

  1. When notification of a community or clinic case of a sexually transmitted infection (STI) or blood-borne infection (BBI) is received, Clinical Services nurses will begin the case by contacting the ordering provider or source of the report to obtain additional details either by a phone call, mailed letter or faxed form.  Follow-up will be based upon best practice guidelines, client risk and ministry direction such as accountability indicators (i.e. gonorrhea must be initiated within 48 hours).
  2. Clinical Services nurses will refer to the current disease specific guidance documents for disease-specific information, case definitions, and case management guidelines:
  • Infectious Diseases Protocol (Appendix A and B);
  • Sexual Health and Sexually Transmitted Infections Prevention and Protocol, 2013;
  • Canadian Guidelines on Sexually Transmitted Infections;
  • WDGPH Guidance Documents;
  • Provincial Infectious Disease Advisory Committee Best Practice Manuals;
  • Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report, Ontario Agency for Health Protection and Promotion, Public Health Ontario, iPHIS bulletins/weekly notices, and Ministry of Health and Long-Term Care (MOHLTC) memos); and
  • Specimen Collection Guide and Labstracts.
  1. Once information has been collected/returned from the ordering provider, Clinical Services nurses will attempt to interview clients, in order to obtain any missing case information, as required under Ontario Regulation 569 – Reports, and additional information as per MOHLTC Disease Specific User Guides, Infectious Disease Protocols, as applicable. 
  2. Where disease-specific work sheets are used to guide the client interview, Clinical Services nurses may add additional charting, which includes any information learned from the client that is not covered by the disease-specific work sheet. Charting can be completed on progress notes or on notes pages appended to disease- specific work sheets.
  3. Clinical Services nurses or the Integrated Public Health Information System (iPHIS) data entry clerk will enter relevant case details on the iPHIS within five business days of the investigation start date.
  4. If contact tracing is required, the Clinical Services nurses will follow-up as outlined in the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2013, Infectious Disease Protocols and WDGPH guidance documents. If contact tracing involves an organized group, tattoo/piercing parlor, or medical clinic, Clinical Services nurses will identify this trend with the manager who will discuss agency follow-up with the Medical Officer of Health.
  5. Clinical Services nurses or the iPHIS data entry clerk will complete iPHIS entry as soon as possible after the investigating clinical services nurse has completed the case investigation. Once the case has been closed on iPHIS, the chart will be filed in the appropriate office.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy: CA.72.01.401 Sexually Transmitted Infections and Blood-Borne Infections

CA.50.01.100 Documentation Practices

Applicable disease-specific work sheets (Chlamydia, Gonorrhea, Hepatitis B, Hepatitis C, HIV, Syphilis)

Canadian Guidelines on Sexually Transmitted Infections

Control of Communicable Diseases Manual, David. L. Heymann, MD, Editor

Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report Public Health Ontario, IPHIS bulletins/memos, Ontario Agency for Health Protection and Promotion, and Ministry of Health and Long-Term Care)

Health Protection and Promotion Act, 1990, Available online at: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e…

Infectious Diseases Protocol, 2009, Available online at: http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_stan…

Provincial Infectious Disease Advisory Committee Best Practice Manuals

Public Health Ontario – Enhanced Surveillance Directives

Specimen Collection Guide and Labstracts

WDGPH Guidance Documents for STIs and BBIs

CONTACT FOR INQUIRIES

Manager, Clinical Services

APPROVED BY

Director, Community Health and Wellness