Sexually Transmitted Infections and Blood-borne Infections

Policy

Category: Clinical Services
Subject: Sexually Transmitted Infections and Blood-borne Infections
Division: Community Health and Wellness
Policy Number: CA.72.01.401
Effective Date: January 15, 2015

POLICY STATEMENT

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.

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.

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

Case management follow-up is provided to all clients either directly by WDGPH or through the primary health provider who ordered the testing.

SCOPE

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

DEFINITIONS

Sexually Transmitted Infections (STIs) – the term STI (Sexually Transmitted Infection) 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. In the case of sexually transmitted infections case management can include 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 or contacts.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.72.02.401 Sexually Transmitted Infections and Blood-borne Infections
Iphis Guidelines and Procedures Manual, 2005
Ontario Publically Funded Immunization Schedule

CONTACT FOR INQUIRIES

Director, Community Health and Wellness

APPROVED BY

Director, Community Health and Wellness


Procedure

Category: Clinical Services
Subject: Sexually Transmitted Infections and Blood-borne Infections
Division: Community Health and Wellness
Procedure Number: CA.72.02.401
Effective Date: January 15, 2015

PROCEDURE

Follow-Up

1. When notification of a community or clinic case of a STI or 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, treatment 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 (PIDAC) Best Practice Manuals;
  • Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report (CCDR), Ontario Agency for Health Protection and Promotion (OAHPP), Public Health Ontario (PHO), iPHIS bulletins/weekly notices, and Ministry of Health and Long-Term Care (MOHLTC) memos); and
  • Specimen Collection Guide and Labstracts.

3. 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. 

4. 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.

5. Clinical Services nurses or the iPHIS Data Entry Clerk will enter relevant case details on the Integrated Public Health Information System (iPHIS) within five business days of the investigation start date.

6. 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 discuss issuing an Advisory letter with the Program Manager.

7. Clinical Service nurses or the iPHIS Date 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.59.01.100 Documentation Practices
WDGPH Guidance Documents for STIs and BBIs
Applicable disease-specific work sheets (Chlamydia, Gonorrhea, Hepatitis B, Hepatitis C, HIV, Syphilis)
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…
Canadian Guidelines on Sexually Transmitted Infections
Provincial Infectious Disease Advisory Committee (PIDAC) Best Practice Manuals
Control of Communicable Diseases Manual, David. L. Heymann, MD, Editor
Disease-specific best practice and clinical guidance documents (e.g. Canada Communicable Disease Report (CCDR), Public Health Ontario (PHO), IPHIS bulletins/memos, Ontario Agency for Health Protection and Promotion (OAHPP), and Ministry of Health and Long-Term Care (MOHLTC))
Specimen Collection Guide and Labstracts
Public Health Ontario – Enhanced Surveillance Directives

CONTACT FOR INQUIRIES

Director, Community Health and Wellness

APPROVED BY

Director, Community Health and Wellness