Routine Practices for Client/Facility Contacts

Policy

Category: Control of Infectious Diseases
Subject: Routine Practices for Client/Facility Contacts
Division: Health Protection
Policy Number: CA.82.01.123
Effective Date: October 1, 2015

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) that all employees will be protected from communicable diseases while conducting the daily activities associated with the requirements of their employment. Employees required by WDGPH to wear or use any personal protective equipment (PPE) shall be instructed and trained in its care, use, and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction and training. To determine the need or type of PPE to be worn for each interaction, employees must assess clients either over the phone prior to meeting, or during the first moments of a face-to-face interview.  Employees should don appropriate PPE before continuing with the interview. When visiting facilities, staff should perform their own assessment following, at a minimum, posted signage.

To guide PPE choices, Control of Infectious Diseases (CID) employees will refer to the Provincial Infectious Diseases Advisory Committee Best Practice Documents on Routine Practices and Additional Precautions in all health care settings (as current).

To ensure CID employees are protected from vaccine preventable diseases, employees will be immunized according to organizations policies and procedures on immunization.

SCOPE

This policy applies to all CID team members who are required to meet with or test cases or contacts of cases of reportable diseases and do site visits to facilities during outbreaks. 

DEFINITIONS

Contact Transmission – is the most common route of transmission of infectious agents. There are two types of contact transmission:

  • Direct contact occurs through touching; for example, an individual may transmit microorganisms to others by touching them; and
  • Indirect contact occurs when microorganisms are transferred via contaminated objects or the hands of a health care provider coming into contact with an individual.

Droplet Transmission – occurs when droplets carrying an infectious agent exit the respiratory tract of a person. Recent work suggests that droplets forcibly expelled from a cough or sneeze travel for up to two metres.  Microorganisms contained in these droplets may remain viable for extended periods of time. Contact transmission can then occur by touching surfaces and objects contaminated with respiratory droplets.

Airborne Transmission – occurs when airborne particles remain suspended in the air, travel on air currents and are then inhaled by others who are nearby or who may be some distance away from the source patient, in a different room or ward (depending on air currents) or in the same room that a patient has left, if there have been insufficient air exchanges. Clients/patients/ residents suspected or confirmed to have an airborne infection are to wear a mask at all times, if tolerated, when they must leave an area that has correct engineering controls (e.g., negative pressure ventilation). There is never an indication for a client/patient/resident to wear an N95 respirator.

Routine Practices – are based on the premise that all clients/patients/residents are potentially infectious, even when asymptomatic, and that the same safe standards of practice should be used routinely with all clients/patients/residents to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin or soiled items and to prevent the spread of microorganisms.

Additional Precautions – include the use of barriers, such as personal protective equipment (PPE), and additional environmental controls that are put in place for encounters with the client/patient/resident or their immediate environment. In some instances, specialized engineering controls may be required (e.g., negative pressure room for a patient with Tuberculosis).

N95 Respirator – A personal protective device that is worn on the face and covers the nose and mouth to reduce the wearer’s risk of inhaling airborne particles. A NIOSH-certified N95 respirator filters particles one micron in size, has 95% filter efficiency and provides a tight facial seal with less than 10% leak.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.123 Routine Practices for Client/Facility Contacts
CA.40.01.108 Specimen Collection – Swabs
CA.40.01.109 Specimen Collection – Blood
CA.52.01/02.111 Immunization
CA.56.01/02.111 Blood-borne Pathogen Exposure Precautions, Safe Work Practices, and Post Exposure
CA.56.01/02.100 Environmental Cleaning of Equipment and Supplies by Employees
Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions in All Health Care Settings. 2010 [cited June 14, 2011] (as current)
Infectious Disease Protocols, Appendix A (as current)
College of Nurses of Ontario Practice Standards: Infection Prevention and Control
College of Nurses of Ontario Practice Guidelines: Influenza Vaccinations

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases 

APPROVED BY

Director, Health Protection  


Procedure

Category: Control of Infectious Diseases
Subject: Routine Practices for Client/Facility Contacts
Division: Health Protection
Procedure Number: CA.82.02.123
Effective Date: October 1, 2015

PROCEDURE

An individual assessment of each client/patient/resident/facility’s potential risk of transmission of microorganisms must be made by all staff who come into contact with them. Based on that risk assessment and a risk assessment of the task, one may determine appropriate intervention and interaction strategies, such as hand hygiene, waste management, use of personal protective equipment (PPE), and client/patient/resident placement, that will reduce the risk of transmission of microorganisms to and from the individual. When a client/patient/ resident has undiagnosed symptoms or signs of an infection, interventions must be based on the PIDAC Best Practices for Routine Practices and Additional Precautions in all Health Care Settings (as current).

  1. Routine Practices refer to infection prevention and control practices to be used with all clients/patients/residents during interactions/interventions to prevent and control transmission of microorganisms.
  2. Perform a risk assessment of the client/patient/resident and the employee’s interaction with the client/patient/resident.
  3. Perform hand hygiene with an alcohol-based hand rub or with soap and water before and after contact with a client/patient/resident or their environment, before invasive procedures and after contact with body fluids.
  4. Assess the need for necessary equipment, including point-of-care sharps containers, hand hygiene product dispensers and adequate dedicated hand wash sinks.
  5. Determine the availability of sufficient, easily accessible, and appropriate PPE to prevent contact with blood, body fluids, secretions, excretions, non-intact skin or mucous membranes.
  6. Assess the risk of transmission of microorganisms, including the possibility of contamination of skin or clothing by microorganisms in the client/patient/resident environment; exposure to blood, body fluids, secretions, excretions, tissues; exposure to non-intact skin; exposure to mucous membranes; and exposure to contaminated equipment or surfaces; and recognition of symptoms of infection (e.g., syndromic surveillance).  See the “Definitions” section in the policy for a list of clinical syndromes requiring the use of PPE and other controls pending diagnosis.
  7. Where there is a risk of transmission of infection based on the risk assessment, appropriate controls must be put into place and appropriate PPE must be used to protect staff and other clients/patients/residents until a definitive diagnosis may be made. For example, use avoidance procedures that minimize contact with droplets (e.g., sitting next to, rather than in front of, a coughing client/patient/resident when taking a history or conducting an examination).
  8. PPE should be put on prior to the interaction with the client/patient/resident. When the interaction for which the PPE was used has ended, PPE should be removed immediately and disposed of in the appropriate receptacle. The process of PPE removal requires strict adherence to a formal protocol to prevent recontamination.
  9. Gloves must be worn when it is anticipated that the hands will be in contact with mucous membranes, non-intact skin, tissue, blood, body fluids, secretions, excretions, or equipment and environmental surfaces contaminated with the above.

Gloves are not required for routine activities in which contact is limited to intact skin of the client/patient/resident.

Gloves must be removed immediately and discarded into a waste receptacle after the activity for which they were used and before exiting a client/patient/resident environment.

  1. A gown is recommended when it is anticipated that an interaction is likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.
  2. A mask is used by a health care provider (in addition to eye protection) to protect the mucous membranes of the nose and mouth when it is anticipated that an interaction is likely to generate splashes or sprays of blood, body fluids, secretions or excretions or within two metres of a coughing client/patient/resident.

Criteria for selecting masks include: secure fit to cover the nose and mouth; substantial enough to prevent droplet penetration; and employee should be able to tolerate the mask for the duration of the activity for which the mask is indicated.

A fit tested N95 mask must be donned for interaction with clients who are suspected or known to have an airborne disease to which the staff person has no documented vaccination or immunity – airborne diseases include measles, chickenpox and tuberculosis. CID staff must keep a small supply of fit tested masks at their desk for ready access.

  1. Eye protection is used by healthcare providers (in addition to a mask) to protect the mucous membranes of the eyes when it is anticipated that an interaction is likely to generate splashes or sprays of blood, body fluids, secretions or excretions, or within two metres of a coughing client/patient/resident.

Eye protection includes: safety glasses; safety goggles; face shields; and visors attached to masks.

Prescription eye glasses are not acceptable by themselves as eye protection; they may be worn underneath face shields and some types of protective eyewear.

  1. Clients/patients/residents who have a cough or other symptoms of an acute respiratory infection: move the client/patient/resident out of the waiting area and into a separate area or room (preferably with negative pressure) as soon as possible. If there is a suspicion that the infection is transmitted via the airborne route, the client/patient/resident must be moved into a room under negative pressure, if this is available. The client/patient/resident must don a procedure mask (not an N95) for the duration of the interview if the client/patient/resident is able to tolerate a mask. Staff should don a surgical/procedure mask when interacting with people with respiratory symptoms. The employee must don an N95 for which they have been fit-tested if TB is suspected (e.g., client is being seen in TB clinic, on medical surveillance for TB, or known to have risk factors for TB).

RESPONSIBILITIES

The Manager will:
  • Ensure employees are fully trained, fit-tested, immunized, comprehends Routine Practices and Additional Precautions, has access to necessary PPE, and is in compliance with all recommendations.
Employees will:
  • Be familiar with the transmission routes of various bacteria, viruses, and fungi that cause infectious diseases;
  • Risk assess each client interaction; and
  • Take the necessary precautions to prevent transmission of disease-causing organisms. Precautions can be grouped into three transmission categories: contact, droplet, and airborne.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.123 Routine Practices for Client/Facility Contacts
Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions in All Health Care Settings. 2010 [cited June 14, 2011] (as current)
Infectious Disease Protocols, Appendix A (as current)
CA.40.01.108 Specimen Collection – Swabs
CA.40.01.109 Specimen Collection – Blood
CA.52.01.111 and CA.52.02.111 Immunization
CA.56.01.111 and CA.56.02.111 Blood-borne Pathogen Exposure Precautions, Safe Work Practices, and Post Exposure
CA.56.01.100 and CA.56.02.111 Environmental Cleaning of Equipment and Supplies by Employees
College of Nurses of Ontario Practice Standards: Infection Prevention and Control
College of Nurses of Ontario Practice Guidelines: Influenza Vaccinations

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis 

APPROVED BY

Director, Health Protection