ipac in the clinical office settings/2016-09-13_ipac_… · description: the ipac checklists were...

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IPAC in the Clinical Office Setting Primary Care Community of Practice September 2016

Mandy Public Health Ontario North Simcoe Muskoka Infection Control Network

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Today’s Objectives

1. Introduce the Infection Prevention and Control (IPAC) For Clinical Office Practice

2. Discuss possible challenges and solutions in implementing these Best Practices

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What’s in the Document?

• Legislation relating to IPAC Practices in the Clinical Office

• Staff education and training

• Transmission of microorganisms in clinical office settings

• Routine Practices

• Additional Precautions

• Medications, Vaccines and Skin Antisepsis

• Control of the Environment

• Reprocessing Medical Equipment

• Surgical/Invasive Procedures

• Administrative Controls

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Legislation relating to IPAC Practices in the Clinical Office

The Occupational Health and Safety Act

The Workplace Hazardous Materials Information System (WHMIS)

Legislated items include duties, WHMIS and states:

Employers shall ensure that the setting is a safe work environment that protects patients, staff and themselves and is in accordance with federal and provincial legislation.

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OH&S Responsibilities

What responsibilities do administrators have under the OH&S Act?

• Administrators running an office practice have significant occupational health and safety responsibilities as an employer under occupational health and safety legislation.

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Public Health Ontario, 2013

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Staff education and training

Regular education and support shall be provided in clinical office practices to help staff consistently implement appropriate IPAC practices.

• Risk

• Immunization

• Hand hygiene

• RPAP

• PPE

• Reprocessing

• Cleaning/disinfection

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Staff Education

How is staff education provided in your clinical setting?

• Who does the training? • How often is training provided? • To whom is training provided? • How do you support education in your office?

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Routine Practices

Important point:

All health care providers should follow Routine Practices for all patients during all care in all clinical office settings.

• Elements include: • Risk Assessment and Screening

• Hand Hygiene

• Control of the Environment

• Administrative Controls

• Personal Protective Equipment

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Routine Practices

Important points:

Hand hygiene should be practiced according to the ‘4 Moments for Hand Hygiene’, as described in Ontario’s ‘Just Clean Your Hands’ program.

Alcohol-based hand rub should be used as the preferred agent for cleaning when hands are not visibly soiled.

Soap and water must be used for cleaning when hands are visibly soiled. If running water is not available, moistened towelettes should be used to remove visible soil, followed by alcohol-based hand rub.

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Routine Practices

Important points:

Hand washing sinks should be dedicated to that purpose and not used for any other purpose, such as equipment cleaning or disposal of waste fluids.

Rings should not be worn. If worn, the ring must be a smooth band with no projections.

Health care providers must not wear artificial nails, nail enhancements, hand or arm jewellery.

Alcohol-free, waterless antiseptic agents should not be used as hand hygiene agents in any health care setting.

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Routine Practices

What processes do you have in place to support routine practices?

• Hand wash sinks? • ABHR and hand soap? • Expiry dates? • P&Ps on hand hygiene and hand care?

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Routine Practices

Important points:

Gloves should be worn if it is anticipated that hands will be in contact with blood, body fluids, secretions or excretions.

A gown should be worn if it is anticipated that arms and/or clothing will be in contact with blood, body fluids, secretions or excretions.

Facial protection should be worn if it is anticipated that the mucous membranes of the eyes, nose and/or mouth will be in contact with blood, body fluids, secretions or excretions.

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Do staff have easy access to personal protective equipment during the course of their care?

Where are supplies of PPE stored?

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Routine Practices


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Additional Precautions

• Contact transmission and precautions

• Droplet transmission and precautions

• Airborne transmission and precautions

• Combinations of Additional precautions

• Antibiotic-Resistant Organisms

Important point:

Additional Precautions should be applied in addition to Routine Practices for patients with infectious syndromes or identified transmissible infections.

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How would you identify people who may need to be on additional precautions?

• Charts?

• Screening? Passive? Active?

Can you provide a separate waiting area for patients on precautions?

• Other options? (respiratory etiquette, ABHR, masks, signs with screening questions)

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Additional Precautions

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PPE

Does your clinic do regular fit-testing for N95 Respirators?

• If it is indicated from the risk assessment that an N95 respirator is required, a respiratory protection program shall be in place.

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Medications, Vaccines and Skin Antisepsis

• General principles • Safe administration of

injectables • Refrigerators • Vaccines • Sterile irrigation solutions • Ophthalmology ointments and

drops • Antiseptic agents for skin

antisepsis • Point-of-care testing

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Vaccine Storage

Who is responsible for refrigerator use in your clinic?

• In the clinical office, at least three refrigerators might be required: • one for specimens

• one for vaccines and medications

• one for food (e.g., staff lunches, beverages)

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Medications, Vaccine and Skin Antisepsis

Important points:

A medication vial must never be re-entered nor medication removed from a vial with a syringe or needle that has been used for a patient.

Syringes must not be reused.

Single dose vials must not be reused and leftover contents of single dose vials must not be pooled.

Syringes must not be pre-filled for later use.

Opened multidose medication vials should be discarded according to the manufacturer’s instructions or 28 days after opening, whichever is shorter.

The vaccine manufacturer and the Ministry of Health and Long-term Care instructions for vaccine storage and handling must be followed.

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Multiuse Vials

Do you generally order multidose vials for medications and vaccines?

• Multidose vials are a common

source for outbreaks and bloodborne pathogen transmission

• use should be minimized/avoided

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Control of the Environment

• Cleaning the environment

• Clinical office design/renovations

Important points:

The clinical office setting should have cleaning practices in place appropriate to the clinical setting.

There shall be a waste management program that is compliant with current legislation and national standards

Sharps shall be managed according to current legislation and national standards.

When developing new clinical space, CSA requirements shall be met.

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In your practice…

Reuse of single-use devices?

Are Lancet hubs, vacutainer holders/hubs reused?

• Ensure lancet hubs are single-patient use.

• Ensure lancet holders/hubs are single-patient use or disinfected between uses.


Cleaning Responsibility

Who is responsible for cleaning in your office setting?

• When hiring a company to clean clinical offices, be sure that they will be able to meet the standards required for health care

• High-touch surfaces should be cleaned at least daily and more frequently if the risk of environmental contamination is higher (e.g., endoscopy suites).

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Cleaning between Patients

Are surfaces and equipment cleaned between patients?

• Cleaning of surfaces and equipment with a low level disinfectant (e.g. alcohol or activated hydrogen peroxide) is required between each patient visit

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Reprocessing Medical Equipment

• General principles for reprocessing

• Reprocessing methods

• Single use medical devices

• Requirements for staff training

• Requirements for reprocessing space

• Transport of contaminated equipment within premises

• Instrument cleaning

• Packaging instruments

• Sterilization

• High and Low level disinfection

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Important points:

Critical and semi-critical medical equipment/devices labelled as single-use must not be reprocessed and re-used unless the reprocessing is done by a licensed reprocessor.

Single-use items should not be reprocessed except by FDA-approved 3rd party reprocessors.

Medical equipment is reprocessed by a method that is appropriate for the intended use of the equipment.

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Important points:

CSA standards shall be followed when reprocessing medical equipment.

The sterilization process shall be monitored and there must be a process in place for dealing with sterilization failures.

Use of chemical disinfectants shall comply with regulations under the Occupational Health and Safety Act.

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Separate Reprocessing Area

Do you have a separate reprocessing area in your clinic?

• If reprocessing is undertaken in a clinic setting, a separate area is required and detailed logs of chemicals (dates, concentration testing, etc.) are required to be kept.

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Reprocessing Responsibility

Who is responsible for reprocessing in your clinic?

• Develop written policies and procedures for sterilization of medical equipment/ devices

• Ensure that the manufacturer’s instructions are followed

• Only trained staff should operate sterilizers

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Sterilization

What quality testing do you do on your sterilizer and instruments?

• Sterilization logs, including indicators documenting successful sterilization, are required for office/desktop autoclaves and should be available for review by public health.

• Similar documentation is required for scope washers in settings where endoscopy is undertaken.

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Reprocessing

Do you have a procedures in place that deal with reprocessing failures?

• A written procedure must be established for the recall and reprocessing of improperly reprocessed medical equipment/ devices.

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Administrative Controls

• Healthy workplace policies

• Staff immunization

• Tuberculin skin test

• Infections in health care providers

• Employee exposure protocol

Important point:

Clinical office settings should have in place mechanisms for ensuring a healthy workplace, appropriate staff immunizations and protocols for exposure to infectious diseases, including a bloodborne pathogen exposure protocol.

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Reporting to Public Health

Are you familiar with the reportable disease list?

Is there a procedure in place to ensure the diseases are reported to public health as required?

• Frontline health care providers are key to timely and effective public health interventions

• see O. Reg. 559/41 Specification of Reportable Diseases

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Other sections

• Abbreviations

• Glossary

• Appendices include:

• Hand Hygiene,

• Risk Assessment and Tools for PPE Education and Use

• Sample Signage for Reception Areas,

• Cleaning, Disinfection and Reprocessing Resources

• Reportable Diseases in Ontario List

• Checklists and Schedules http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/PIDAC/Pages/Infection-Prevention-and-Control-for-Clinical-Office-Practice.aspx

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http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/PIDAC/Pages/Infection-Prevention-and-Control-for-Clinical-Office-Practice.aspx

















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37 PublicHealthOntario.ca

IPAC Checklists

Description: The IPAC checklists were developed to promote consistency when conducting IPAC inspections of out-of-hospital premises (OHP),

independent health facilities (IHF) and other clinical office settings. They will assist you in IPAC assessment activities and are not mandatory.

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Online Learning: Reprocessing in Community Health Care Settings

Description: Reprocessing in the Community is a series of online modules for health care providers who are required to perform tasks related to

the reprocessing process of reusable medical devices in the community setting. This newly developed resources feature self-paced learning,

engaging activities, interactive content, step-by-step demonstration, work related scenarios, and an intuitive user interface.


Online Learning: Additional Precautions

Description: Additional Precautions are the IPAC safety measures that are necessary in addition to Routine Practices to interrupt the

transmission of suspected or identified pathogens. The module provides education on the modes of transmission, the categories of Additional

Precautions and the application of the elements of Additional Precautions. It includes sector-specific (acute care, long-term care and

community) content and practice.



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