Infection Control in Clinical Office Settings: A Regulated Health Professional Workshop

Report to: Chair and members of the Board of Health

Meeting Date: December 7, 2016

Report No: BH.01.DEC0716.R22

Prepared by: Diane Wallace, Supervisor, Control of Infectious Diseases and
                        Infection Control
                        Janice Walters, Manager, Control of Infectious Diseases and Infection
                        Control

Approved by: Christopher Beveridge, Director, Health Protection Division

Submitted by: Dr. Nicola J. Mercer, MD, MBA, MPH, FRCPC
                           Medical Officer of Health & CEO

 

Recommendations

It is recommended that the Board of Health:

1. Receive this report for information.

Key Points

  • The Regulated Health Professions Act (RHPA), 1991, provides the governing framework for Regulated Health Professionals (RHP) and is intended to protect the public and ensure the provision of quality service.1
  • RHPs do not receive regular or annual inspections by public health. However, public health is mandated to initiate an investigation of all complaints of RHPs within 24 hours of receiving the complaint(s) to assess the risk of transmission of an infectious disease and to determine the appropriate board of health response.2
  • In 2016, through October 31, the Wellington Dufferin Guelph Public Health (WDGPH) Control of Infectious Diseases and Infection Control (CIDIC) team has responded to four RHP premises’ complaints, one of which involved a patient recall. This complaint inspection and investigation was reviewed in a June 2016 BOH report (BH.01.JUN0116.R09).3
  • The RHP premise inspection process has identified an Infection Prevention and Control (IPAC) Best Practices knowledge gap among some RHP practices.
  • WDGPH proactively planned and developed an interactive workshop for RHP and clinical office staff, specifically focused on those who are responsible for the cleaning, disinfection and sterilization of medical equipment and devices.
  • The event was well-attended and well-reviewed by RHP practicing within the  WDGPH boundaries.

Discussion

Public health units were designated as responsible for the investigation and public reporting of any IPAC lapses discovered as a result of a complaint inspection of a RHP premise as of October 2015. Since being designated, WDGPH has completed four RHP complaint-based inspections. In consultation with Public Health Ontario (PHO), one of these inspection resulted in the recall of over 700 patients for testing of blood and body fluid infections, specifically hepatitis B and C and Human Immunodeficiency Virus (HIV). WDGPH inspections of RHP premises has identified areas of concern regarding IPAC practices, specifically with respect to safe injection practices and Best Practices for the cleaning, disinfection and sterilization of medical devices and equipment.
In an effort to proactively address IPAC deficiencies and knowledge gaps identified during these investigations, WDGPH developed a list of topics to be covered by an expert in the IPAC field. ‘Save the Date’ invites were mailed out to all family physicians, midwives, obstetricians and gynecologists, gastroenterologists and dermatologists in July, and an invite followed on August 30, 2016. Physicians, nurses, office managers and office staff were invited to attend this free event, which included dinner and the presentation. The WDGPH RHP workshop, Infection Control in Clinical Office Settings, was held on the evening of October 19, 2016 at Cutten Fields, Guelph, during National IPAC week (October 17-21). The Keynote Speaker was Dr. Maureen Cividino, IPAC Physician, Infection Prevention and Control Program, PHO, accompanied by presenter Donna Moore, Subject Matter Expert in Reprocessing, PHO. The Provincial Infectious Diseases Advisory Committee (PIDAC) Best Practices guidance documents were the basis for the presentations.
The presentation was interactive in nature and

BACKGROUND

The presentation was interactive in nature and attendees were encouraged to ask questions during the event. Additionally, tote bags were distributed which contained a number of resources intended for the clinical office practice and WDGPH staff were on hand to answer any questions practitioners had with respect to IPAC issues and vaccination schedules.
The goal of the evening event was to discuss common and serious IPAC breaches and high risk activities that may be occurring in clinical practices in order to allow the attendees to implement risk strategies to prevent serious, preventable outcomes for patients and staff.
The venue was chosen due to its central location within the health unit boundaries and its cost-effectiveness. Prior to 2014, the Ministry of Health and Long-Term Care provided funds dedicated to IPAC initiatives; however this funding is no longer available. The cost of the presentation was covered jointly by the IDIC budget and an unrestricted educational event received from Pfizer ® Canada.

Attendees

A total of 136 persons attended the event, representing 47 different offices throughout the WDGPH area. The City of Guelph was well represented, with 58% of attendees practicing there, followed by 29% practicing in Wellington County, 8% practicing in Dufferin and 5% practicing elsewhere. Fifty-three percent of attendees identified as either registered nurses (RN) or registered practical nurses (RPN), 21% identified as physicians, followed by 11% that identified as office or clinic managers. Resources provided to the attendees included those developed by WDGPH as well as PIDAC documents:

  • Reprocessing in Community Health Care Settings fact sheet
  • Physical Space Requirements for Reprocessing Rooms fact sheet
  • High Level Disinfectant Solution Log
  • High Level Disinfectant Log
  • Sterilization Log
  • Specimen Fridge Temperature Log
  • Reprocessing Tips for Cleaning, Disinfections and Sterilization of Reusable Medical Items fact sheet
  • PIDAC Infection Prevention and Control for Clinical Office Practice (multiple copies)
  • PIDAC Best Practices for Infection Prevention and Control in Perinatology (midwives and obstetricians, only)

Evaluations

Evaluation forms and slide presentation handouts were distributed on the attendees’ tables; there was a 60% completion rate for the evaluations. The majority of attendees stated they registered for the event to ‘increase their knowledge’, ‘learn best practices’ and to ‘gather information’. These general topics were followed by those who were interested in learning more about specific topics, including reprocessing and infection control. The majority of attendees stated their practice knowledge was increased in the following areas: reprocessing, appropriate use of multi-dose vials, PIDAC documents and Core Competencies and office setting management.

Conclusion

A need for education around cleaning, disinfection and sterilization of medical devices and equipment and Best Practices for infection prevention and control in clinical office practice had been identified through several WDGPH RHP inspections. Through proactively providing an educational event and resources to clinical practices within the WDGPH boundaries, practitioners may implement risk strategies and recognize common infection control breaches, thereby decreasing the risk of transmission of infectious diseases to staff and patients.

Ontario Public Health Standards

Infectious Diseases Prevention and Control
Goal: To prevent or reduce the burden of infectious diseases of public health importance.

Health Promotion and Policy Development
Requirement #4

The board of health shall work with community partners to improve public knowledge of infectious diseases of public health importance and infection prevention and control practices in the following areas:
• Epidemiology of infectious diseases of public health importance that are locally relevant;
• Respiratory etiquette;
• Hand hygiene;
• Vaccinations and medications to prevent or treat infectious diseases of public health importance;
• Infection prevention and control core competencies, incorporating both Routine Practices (including personal protective equipment) and Additional Precautions (transmission-based precautions); and
• Other measures, as new interventions and/or diseases arise.

These efforts shall include:
• Adapting and/or supplementing national and provincial health communications strategies;  and/or
• Developing and implementing regional/local communications strategies.

Requirement #6

The board of health shall work with appropriate partners to increase awareness among relevant community partners, including correctional facilities, health care and other service providers of:
• The local epidemiology of infectious diseases of public health importance;
• Infection prevention and control practices; and
• Reporting requirements for reportable diseases, as specified in the Health Protection and   Promotion Act.

Disease Prevention
Requirement # 10

The board of health shall ensure that the medical officer of health or designate receives reports of and responds to complaints regarding infection prevention and control practices in settings for which no regulatory bodies, including regulatory colleges, exist, particularly personal services settings. This shall be done in accordance with the Infection Prevention and Control in Personal Services Settings Protocol, 2008 (or as current) and the Infection Prevention and Control Practices Complaint Protocol, 2008 (or as current). In addition, if an infection prevention and control lapse is identified, the board of health shall post an Initial and a Final Report online on the board of health’s website, in accordance with the Infection Prevention and Control Practices Complaint Protocol, 2008 (or as current) and the Infection Prevention and Control in Personal Services Settings Protocol, 2008 (or as current). For the purposes of sections 9 and 10, a “regulatory college” means the college of a health profession or group of health professions established or continued under a health professions Act named in Schedule 1 to the RHPA.

WDGPH Strategic Direction(s)

Strategic Directions
DIRECTION APPLIES? (YES/NO)
Health Equity: We will provide programs and services that integrate health equity principles to reduce or eliminate health differences between population groups.      YES
Organizational Capacity: We will improve our capacity to effectively deliver public health programs and services.        NO
Service Centred Approach: We are committed to providing excellent service to anyone interacting with Public Health.      YES
Building Healthy Communities: We will work with communities to support the health and well-being of everyone.      YES

 

Health Equity

The evening workshop was open to all regulated and non-regulated health care providers who expressed an interest in attending. Invitations were sent on two separate occasions to a wide variety of practitioners and no limits were placed on attendance numbers from any one office/clinic. There was no fee associated with attending the event, to remove any financial barriers.

Appendices

None.

References

1. Regulated Health Professions Act. [Internet] 1991, S.O. [cited 2016 Nov 14] Available from: https://www.ontario.ca/laws/statute/91r18
2. Infection Prevention and Control Practices Complaint Protocol. [Internet] 2015 [cited 2016 Nov 14] Available from: www.health.gov.on.ca/en/pro/programs/…/infection_prevention_complaint.pd
3. Wellington-Dufferin-Guelph Board of Health. BOH report - BH.01.JUN0116.R09 Riverview Medical Group Overview [Internet]. 2016 June 1. [cited 2016 Nov 14] Available from: http://www.wdgpublichealth.ca/?q=bohreports