cic course slides - infectious disease control training feb 2008

Infectious Disease Control A Training Initiative for

Resettlement Staff/Volunteers

Funded by Citizenship & Immigration Canada

Facilitated by Kappel Ramji Consulting Group

March – April 2008

Training for Resettlement Workers/Volunteers - A CIC Funded

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Overall Purpose of Training

Increase the health and well being of refugees with infectious diseases

Demystify privacy & confidentiality issues

Ensure the safety of refugees, staff & community from infectious diseases


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AgendaMorningBuilding on Past Successes Infectious Diseases “101”Pre-Arrival Protocols

LunchAfternoonManaging Privacy & ConfidentialityInfectious Diseases – Symptoms & PreventionWays to Collaborate & Share Skills


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Format & Style for this Training

Experiential

Interactive

Purposefully Positive


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Infectious DiseasesOverview / “101”


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What is an Infectious Disease?Disease that can be passed from one person to another

When a person gets sick because they have become infected with a virus, bacteria, parasite or worm

Usually you have to be susceptible to infections like TB – helps +++ if you’re healthy!


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1. Micro-organism

2. Reservoir

3. Portal of Exit

4. Mode of Transmission

5. Portal of Entry

6. Susceptible Person

The Chain of Transmission


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“Chain” of Infection or Transmission

There are 6 major links in the “chain” of transmission. If one of these links is interrupted, the infection will not occur:o Micro-organism/germ – number & strengtho Reservoir – where germ liveso Portal of Exit – where germ exits from eg. Broken skino Mode of Transmission – eg. Direct contacto Portal of Entry – where germ enters body o Susceptible Person – one with health compromised

**Understanding how the “chain” is broken is the basis of infection prevention and control


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How do People get Infected?TRANSMISSION of infectious agents occurs in

many ways:Contact with blood and bodily fluids - eg. biting, sexual intercourse,oral &anal sex‏Airborne particles - eg. TB in droplets from sneezing, coughingMother to unborn baby during pregnancyInjections of contaminated blood - IV drug useTouching/kissingContaminated Food and Water


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What puts Refugees at Riskbefore entry to Canada?

Increased exposure to diseases endemic toCountry of asylum and/or origin

Refugee camp or transit country- Poor public health infrastructure- Poor nutrition- Poor immunization rates- Crowded housing- Poor or non-existent health care


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Does Every Exposed Person get Sick?

Healthy Person may not get sick or may have a mild response to infection:eg.TB – 90% of infected never get sick

Person may become a carrier of an infection capable of infecting others without ever getting sickeg. Hepatitis B and C – infected person can be without symptoms for 10-20 years


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Recent Statistics – Sample of 68 Karens in Toronto CCDR, Dec 2007

No positive cases of Hepatitis C, HIV, Active TB or Syphilis

28% had Inactive TB

2 had Malaria upon arrival

Main concern:- 13% positive for Hepatitis B- 48% positive for at least one parasite


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Q & A


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How does CIC protect the Public’s Health?

Pre-Arrival

Upon Arrival

Post Arrival


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Refugee Screening Process

Pre- Arrival At Arrival Post Arrival

Immigration Medical ExamIME

Normal No needs Regular primary care

TB or Syphilis

Treatment None unless has IMM5544B

Refuses treatment

Urgent Dr. visit Surveillance per IMM535

Non-admissible

HIV

Counselling None unless has IMM5544B

Voluntary visit to Public Health per IMM535


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Pre-Arrival

Immigration Medical Examination (IME)‏- Enhanced process piloted for Karens

Treatment for TB & Syphilis if Positive

Counselling if HIV+

Notification to SPO/sponsoring group re. Needs identified in IMM5544B


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Upon ArrivalLocal supports/resources are organized - based on info in IMM5544B re types of supports/care requirements the refugee might have immediately upon arrival – this will not include the diagnosis

All refugees should be assisted to see a physician/clinic for a general physical exam as soon as possible

Resettlement Workers/Volunteers need some basic awareness of the worrisome symptoms that could be indicative of infectious diseases


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Post Arrival

Medical Surveillance Post Landing by Public Health for:- inactive TB - treated syphilis

Referral/Follow up Support for HIV positive


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Info Sharing re Refugees who Contract Infectious Disease once in Canada

If a refugee contracts an infectious disease once in Canada, processes for all residents followed i.e.

- HIV : lab informs Public Health - Active TB/Active Syphilis: lab informs Public

Health

Public Health follows up


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Q & A


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Managing Privacy/Confidentiality


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Four Pillars to Privacy Refugees control the type of personal medical information that is released to SPO/SAH or Same privacy rights & protections for refugees as all other residents of Canada

Informed consent at heart of respectful/effective client relationship - SPOs/SAH should have policy guidelines/practices re this aligned with provincial law

Important to use informed consent for need to know not nice to know personal/medical information

Some laws override privacy laws e.g. child safety/welfare.


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Privacy & ConfidentialityKey Points

Refugee controls right to release/not release info

Respect & protect clients’ privacy at all times

SPO/SAH will receive info needed to do their job

SPO/SAH may receive private info if there’s an informed consent -age 14 yrs +, or from parent

Informed consent requires you to be open about who will have access to information


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Privacy & ConfidentialityKey Points Cont’d

Careful/considerate usage of release of info

Client’s Doctor will not provide medical record to SPO/SAH; Doctor may comment on appropriateness of planning/support being provided without informed consent

Privacy Act does not cover some criminal offences e.g. Child abuse has to be reported ASAP

Collaboration planning involves “protection” tools


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Infectious Diseases Symptoms & Prevention


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Infectious Diseases of Concern

Tuberculosis - TBSyphilis

Hepatitis – A, B, CHIV/AIDs

Details available in Manual & Display TableTrue/False Quiz highlights key facts related to transmission & prevention


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Symptoms of Concern- Related to Infectious Diseases*Flu like – headache, nausea/vomiting, muscle pain, malaise, chillsFeverPersistent Coughing ( phlegm)‏Profound fatigue /TirednessEnlarged lymph nodes (eg. In neck, groin)‏Persistent rashesLoss of appetite, nausea, fever, abdominal pain, jaundiceDiarrhea & vomiting

* Other non-specific symptoms eg. Feeling unwell, chest pain, etc – important to get help/see doctor


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Follow up/Support re. SymptomsClose monitoring

Document e.g. temperature

Refer to Clinic/Physician – opportunity to address preventative issues too.

Follow through with diagnostics – e.g. lab tests

Reinforce education re. medications use


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Q & A


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Infectious Disease Prevention


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What Prevents Infections?

Public Health Infrastructure

Medical Interventions & Infection Control

Personal Prevention Strategies


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Public Health Infrastructure

Sewage systems Safe foodSafe waterHousing codesMosquito control


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Medical Interventions & Infection Control

Early detection and treatment

Isolation of sick person e.g. TB

Preventative treatment for people exposed

Medical Surveillance e.g. Direct Observed Therapy (DOT) for TB

– Ensures completion of therapy– Reduces development of resistance to treatment

Infection control in hospitals/facilities


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Personal Prevention StrategiesGood nutrition, adequate rest & exercise

Immunization

Hygiene– hand washing, cover cough/sneeze

Protective coverings/barriers– Condoms

Disinfestation/Disinfection

Avoid exposure


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How do Settlement Workers/Volunteers stay Healthy?

Healthy lifestyle – exercise, nutrition, sleep

Immunizations eg. Flu shots, Hepatitis B

Personal hygiene – handwashing

Medical follow-up if:– Asymptomatic but known exposure; or – Symptomatic for early detection/treatment


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Standard Precautions in Workplace & At Home

- Wash hands thoroughly and often

- Always treat blood as if it were contagious (catching)

- Wear disposable gloves when helping a bleeding person

- Wear disposable gloves when handling or touching anything soiled with blood or body fluids


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Standard Precautions in the Workplace & At Home Cont’d

- Clean & then Disinfect items and surfaces soiled with blood or body fluids

- Wash/bleach clothing and bedding soiled in blood or body fluid

- Do not let anyone share personal items eg. Towels, Razors, Toothbrushes


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Q & A


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Ways to Collaborate & Share Skills


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Various Roles – in Providing Resettlement Assistance to Refugees

EducatorAdvocateInformation/ReferrerSupportCoach/ mentorMedical surveillanceMedical treatment


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Wrap Up/Evaluation


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“To the world you might be one person, but to the one person you might be the world.” – Casey


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Information Sources:

Dr. Cheryl Anderson, Presentation at National CIC RAP Conference, Feb 2007Dr. Ann Duggan, Senior Medical Officer, Health Policy, CIC, OttawaDenburg, A et al. “Initial health screening results for Karen refugees: A

retrospective review”, Canada Communicable Diseases Report, Dec 2007 Vol33 Number 13.

Don McColl, Jennifer Mensink & Debra Goble, Presentation at National CIC RAP Conference, Feb 2007.

Dr. Carolyn Pim, Program Director, Calgary Refugee Health ProgramDr. Meb Rashid, Access Alliance Community Health Centre, TorontoSneezes and Diseases Handbook -

http://www.vch.ca/public/communicable/docs/sneezes_diseases.pdfToronto Pubic Health, Introduction to Infection Prevention & Control – Breaking the

Chain of Transmission. Module 2 CID-IC 2006

Please note: Additional references and resources are included in your manual

cic course slides - infectious disease control training feb 2008

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