Best Practices for Infection

Prevention & Control (IPAC) in

Clinical Offices – A Review of the

Guidance Documents Barley Chironda RPN CIC

Manager of Infection, Prevention & Control and Medical Device Reprocessing Department, SJHC

AGENDA

• Importance of Adhering to Best Practice Recommendations

• Best Practices for IPAC in Clinical Office Practice

• Staff Education and Safety

• Risk Assessments

• Resources and Supports

Physician Offices around the world

Physician Offices around the world

Physician Offices around the world

Reasons to follow Practice

• Legal and Best Practice Guidelines

• Increasing provision of care in the Physicians office

• Vulnerable patient populations visiting offices

• Ongoing outbreaks and patient notification events.

Best Practice Guideline

Key Document Highlights

• Administrative Measures

• Facility Recommendations

• Reception Area

• Environmental Cleaning

• Examination Room

• Staff

• Medication Administration

Administrative Measures for Clinical Office

• Dedicate Resources to Infection Prevention

• Develop and maintain IPAC and occupational health programs

• Assure sufficient and appropriate supplies necessary for adherence to Routine Precautions

Facility Recommendations

• There are waste receptacles available in each room

• There is a waiting area for patients that need to be segregated for acute infection

• Gloves are available and used appropriately

• Masks are available and used appropriately

• There is a functional separation of clean storage and dirty utility areas

Reception Area

• Reception staff are protected from patients by a barrier • There is infection control signage at the entrance of the

office/clinic • A telephone screening tool has been provided and is

being used appropriately • There is infection control signage at the reception desk • There are alcohol-based hand rub and masks available at

reception, with signage for appropriate use • There are tissue boxes available • Toys are properly cleaned

Signage

Environmental Cleaning

• There are procedures for cleaning the office setting. If cleaning is contracted out, the cleaning contractor has procedures for cleaning the office setting

• Approved and appropriate disinfectant products are available for patient surfaces, equipment and instruments

• Clinic/examination areas and high touch surfaces are cleaned and disinfected daily. Areas in direct contact with the patient are cleaned between patients.

Environmental Cleaning cont..

• Other office areas are cleaned at least weekly

• Medical equipment used on multiple patients is cleaned between patients

• There is a procedure for cleaning up spills of body fluids

• Waste is segregated and managed according to provincial regulations and local bylaws

What's wrong with this waiting room?

Examination Rooms

• There are hand washing sinks with liquid soap available in each clinic area

• Alcohol-based hand rub is available in each examination room

• Puncture-resistant sharps containers are provided in each exam room or clinic area

• Sharps are discarded directly into sharps containers

• Sharps containers are not overfilled past the fill line

Examination Rooms continued

• PPE is available and is worn when necessary and appropriately

• Supplies are not stored under, or on counters adjacent to, hand washing sinks

• If patients with active pulmonary tuberculosis are routinely seen, an appropriately ventilated examination room is available

Staff

• There are written IPAC policies and procedures • Staff are aware of the location of IPAC policies

and procedures • Staff follow IPAC policies and procedures • Staff are immunized appropriately • If patients with active pulmonary tuberculosis

are routinely seen, N95 respirators are available and used appropriately and staff receive annual TB skin testing

• Staff who wear N95 respirators are fit-tested

Medications and Vials

• Single dose vials are not reused. Leftover contents are not combined or pooled.

• A sterile syringe and needle/cannula is used when entering a vial.

• All needles and syringes are single patient use only.

• Multidose vials are not used wherever possible

Vaccines

• There are policies and procedures for handling and storage of vaccines.

• There is a thermometer in the refrigerator. • Temperatures of refrigerators used to store vaccines

are checked twice daily and recorded. • Vaccines are: kept refrigerated at a temperature

between 2°C and 8°C kept frozen at a temperature of -15 °C protected from light if required

• If refrigerator temperatures are less than 2°C or greater than 8°C, report immediately to the public health unit for assessment of vaccine potency.

Resources

• Public Health Ontario Checklists

• Toronto Public Health

• Hospital Infection Control Team

• Regional Infection Control Networks (RICN)

References

• Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Infection Prevention and Control for Clinical Office Practice. 1 st Revision. Toronto, ON: Queen’s Printer for Ontario; April 2015. https://www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_2013.pdf

Questions