Infection Prevention and Control for Clinical Office …

1 Infection Prevention and Control for Clinical Office Practice Published: June 2013 1st revision: April 2015 Infection Prevention and Control for Clinical Office Practice | April 2015 i Public health Ontario Public health Ontario is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health . Public health Ontario links public health practitioners, frontline health workers and researchers to the best scientific intelligence and knowledge from around the world. Public health Ontario provides expert scientific and technical support to government, local public health units and health care providers relating to the following: communicable and infectious diseases Infection Prevention and Control environmental and occupational health emergency preparedness health promotion, chronic disease and injury Prevention public health laboratory services Public health Ontario's work also includes surveillance, epidemiology, research, professional development and knowledge services.

2 For more information, visit The Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC) is a multidisciplinary committee of health care professionals with expertise and experience in Infection Prevention and Control . The committee advises Public health Ontario on the Prevention and Control of health care-associated infections, considering the entire health care system for protection of both clients/patients/residents and health care produces best practice knowledge products that are evidence-based, to the largest extent possible, to assist health care organizations in improving quality of care and client/patient/resident safety. Disclaimer for Best Practice Documents This document was developed by the Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC). PIDAC IPC is a multidisciplinary scientific advisory body that provides evidence-based advice to Public health Ontario (PHO) regarding multiple aspects of infectious disease identification, Prevention and Control .

3 PIDAC IPC s work is guided by the best available evidence and updated as required. Best Practice documents and tools produced by PIDAC-IPC reflect consensus positions on what the committee deems prudent practice and are made available as a resource to public health and health care providers. PHO assumes no responsibility for the results of the use of this document by anyone. This document may be reproduced without permission for non-commercial purposes only and provided that appropriate credit is given to Public health Ontario. No changes and/or modifications can be made to this document without explicit written permission from Public health Ontario. How to cite this document: Ontario Agency for health Protection and Promotion (Public health Ontario), Provincial Infectious Diseases Advisory Committee. Infection Prevention and Control for Clinical Office Practice.

4 1st Revision. Toronto, ON: Queen s Printer for Ontario; April 2015. Public health Ontario acknowledges the financial support of the Ontario Government. NOTES: This document is intended to provide best practices only. health care settings are encouraged to work towards these best practices in an effort to improve quality of care. Provincial Infectious Diseases Advisory Committee (PIDAC) Public health Ontario Tel: 647-260-7100 Email: Queen s Printer for Ontario, 2015 Infection Prevention and Control for Clinical Office Practice | April 2015 ii Infection Prevention and Control for Clinical Office Practice This document is current to June 2013 with the following listed revisions. Revised material is highlighted in mauve in the text (or grey for black-and-white printers). Summary of Major Revisions: Page Revision 36 Updated recommendations for the use of multidose vials 86 Updated list of reportable diseases in Ontario (Appendix F) 90 Updated checklist for safe medication practices (Appendix H) Infection Prevention and Control for Clinical Office Practice | April 2015 iii PIDAC-IPC would like to acknowledge the contribution and expertise of the following individuals who participated in the development of this document: PIDAC - IPC Members: Dr.

5 Matthew Muller, Chair Medical Director, IPC St. Michael s Hospital Toronto Judy Dennis Manager, IPAC Children s Hospital of Eastern Ontario, Ottawa Dr. Irene Armstrong Associate Medical Officer of health Toronto Public health , Toronto Dr. Susy Hota IPAC Medical Specialist, University health Network Toronto General Hospital, Toronto Anne Bialachowski Manager, IPAC St. Joseph s health Centre, Hamilton Dr. Allison McGeer Director, Infection Control Mount Sinai Hospital, Toronto Sandra Callery Director of IPAC Sunnybrook health Sciences Centre, Toronto Vydia Nankoosingh Manager, IPAC The Scarborough Hospital, Toronto Dr. William Ciccotelli Infectious Disease and Medical Microbiology Grand River Hospital, Kitchener Catherine Richard Manager, Occupational health & Safety Program Champlain Community Care Access Centre, Ottawa Ex-officio Members: Erika Bontovics Manager, Infectious Diseases Policy and Programs Ministry of health and Long-Term Care, Toronto Dr.

6 Gary Garber Chief, IPAC, Public health Ontario, Ottawa Dr. Leon Genesove Chief Physician, health Care Unit Occupational health and Safety Branch Ministry of Labour, Toronto Public health Ontario Staff: Dr. Maureen Cividino IPAC Physician Tim Cronsberry Manager, Regional Infection Control Network Cathy Egan Director, IPAC Dr. Jennie Johnstone IPAC Physician Dr. Kevin Katz IPAC Physician Mabel Lim IPAC Specialist/Writer Liz McCreight Manager, IPAC Resources Dr. Samir Patel Clinical Microbiologist Public health Ontario Laboratory Dr. Jennifer Robertson Manager Knowledge Synthesis and Evalulation Dr. Mary Vearncombe IPAC Physician Infection Prevention and Control for Clinical Office Practice | April 2015 iv In addition, PIDAC-IPC is grateful to the following individuals who contributed to the development and production of the first edition of this document: Contributors to the 2013 edition: IPAC in Physicians Offices Working Group: Dr.

7 Mary Vearncombe (Chair) Medical Director of Infection Prevention and Control Sunnybrook health Sciences Centre, Toronto Wade Hiller Associate Director, Practice Assessment and Enhancement Department Quality Management Division, College of Physicians and Surgeons, Toronto Dr. Wadid Abadir Dermatologist Odette Cancer Center Lecturer University of Toronto, Peer Assessor, CPSO Dr. John Jordan Family Physician Department of Family Medicine, Western University, London, Ontario College of Family Physicians Naideen Bailey Manager, Regional Infection Control Network Public health Ontario, Toronto. Shirley McDonald IPAC Specialist/Technical Writer Public health Ontario, Toronto Anne Bialachowski Manager, IPAC St. Joseph s Healthcare, Hamilton Dr. Toomas Sauks Family Physician Grey Bruce Regional health , Owen Sound Dr. Maureen Cividino Occupational health Physician Public health Ontario, Toronto Liz Van Horne Manager, IPAC Resources (retired) Public health Ontario, Toronto Mandy Deeves Network Coordinator, North Simcoe Muskoka Infection Control Network, Orillia PIDAC-IPC Members: Dr.

8 Mary Vearncombe (Chair) Medical Director of Infection Prevention and Control Sunnybrook health Sciences Centre, Toronto Dr. Irene Armstrong Associate Medical Officer of health Toronto Public health , Toronto Donna Baker Manager, IPAC Bruy re Continuing Care, Ottawa Anne Bialachowski Manager, IPAC St. Joseph s health Centre, Hamilton Dr. Kevin Katz Infectious Diseases Specialist and Medical Microbiologist, Medical Director, IPAC North York General Hospital, Toronto Dr. Allison McGeer Director, Infection Control Mount Sinai Hospital, Toronto Shirley McLaren Director of Client Services CanCare health Services, Kingston Dr. Kathryn Suh Associate Director, IPAC The Ottawa Hospital, Ottawa Infection Prevention and Control for Clinical Office Practice | April 2015 v Rena Burkholder IPAC Professional Guelph General Hospital, Guelph Judy Dennis Manager, IPAC Children s Hospital of Eastern Ontario, Ottawa Dr.

9 Dick Zoutman Professor, Divisions of Medical Microbiology and Infectious Diseases, Queen s University, Kingston Chief of Staff, Quinte health Care, Belleville Ex-offocio Members: Erika Bontovics Manager, Infectious Diseases Policy and Programs Ministry of health and Long-Term Care, Toronto Dr. Leon Genesove Chief Physician, health Care Unit, Occupational health and Safety Branch Ministry of Labour, Toronto Liz Van Horne Operational Lead, Manager, IPAC Resources, Public health Ontario, Toronto. Dr. Gary Garber Chief, IPAC, Public health Ontario, Ottawa Public health Ontario Staff: Camille Achonu Epidemiologist, Hospital Infections Surveillance and Epidemiology, Toronto Dr. Maureen Cividino IPAC Physician Public health Ontario, Toronto Shirley McDonald IPAC Specialist/Technical Writer Public health Ontario, Toronto Dr. Samir Patel Clinical Microbiologist Public health Ontario Laboratory, Toronto Pat Piaskowski Network Coordinator (retired), Northwestern Ontario Infection Control Network, Thunder Bay Infection Prevention and Control for Clinical Office Practice | April 2015 1 Table of Contents TABLE OF CONTENTS.

10 1 PREAMBLE .. 4 About This Document .. 4 Illustrations and Symbols .. 5 Evidence for Recommendations .. 5 Who Should Use This Document .. 6 I. BEST PRACTICES FOR Infection Prevention AND Control FOR Clinical Office PRACTICE .. 7 1. LEGISLATION RELATING TO Infection Prevention AND Control PRACTICES IN THE Clinical Office .. 7 A. The Occupational health and Safety Act (OHSA) .. 7 B. The Workplace Hazardous Materials Information System (WHMIS) .. 9 2. STAFF EDUCATION AND TRAINING .. 11 3. TRANSMISSION OF MICROORGANISMS IN Clinical Office SETTINGS .. 12 4. ROUTINE PRACTICES .. 13 A. Risk Assessment and Screening .. 13 B. Hand Hygiene .. 15 C. Personal Protective Equipment (PPE) .. 21 D. Booking, Reception and Placement .. 25 5. ADDITIONAL PRECAUTIONS .. 29 A. Contact Transmission and Precautions .. 30 B. Droplet Transmission and Precautions .. 31 C. Airborne Transmission and Precautions.