Infection Prevention and Control Key Principles for Clinical Office Practice
Advisory Alert
September 14, 2021
*Cette information est seulement disponible en anglais.
To: Primary Care Providers
FOR IMMEDIATE ATTENTION
Integrating infection control best practices into clinical practice settings
Preventing the spread of acute respiratory illnesses (ARI) (e.g., influenza, COVID-19) and other communicable infections (e.g., chicken pox, norovirus) during the provision of care in the clinical office setting is critical for the health of patients/clients, health care workers (HCW) and other staff.1
Providers of care in clinical office settings have a responsibility to have systems in place with established policies and procedures that protect the health and safety of workers in their workplace. Preventing transmission of microorganisms to other patients is a patient safety issue and preventing transmission to staff is an occupational health and safety issue.1 The consistent and appropriate use of Routine Practices by all HCWs will lessen microbial transmission in the clinical office setting.1
Public Health Ontario has recently released its Summary of Infection Prevention and Control Key Principles for Clinical Office Practice. This document is complimentary to and supported by a variety of other infection prevention and control (IPAC) best practice resources available from the Provincial Infectious Diseases Advisory Committee. It is intended to support IPAC best practice implementation in health care settings as in-person patient care activities increase/resume.
Key components of IPAC best practice include:
Planning and preparedness
Perform an annual IPAC organizational risk assessment (ORA) to identify potential internal and external infection risks to staff or patients and implement controls to mitigate identified hazards. This includes application of the hierarchy of hazard controls (elimination, substitution, engineering controls, administrative controls, and the use of PPE) when risks are identified. Preparedness also includes education and training of staff, communication, patient education, universal masking and physical distancing as well as providing opportunities and supplies for hand hygiene and environmental cleaning.
Office Space
Office spaces (public, clinical and staff areas) are critical to safety and must be conducive to the provision of care while mitigating the risk of transmission of infection. Ensure passive and active screening measures are utilized at points of entry to identify persons with ARI or symptoms of other infectious diseases and manage them appropriately. For symptomatic persons, management may include activities such as rescheduling of non-urgent appointments where possible, seeing symptomatic clients at the end of the day or offering virtual appointments. This also includes having flexible sick policies for staff with symptoms of ARI or other communicable illness so that they don’t come to work while ill. Patient flow practices should ensure that patients spend the least amount of time in waiting areas as possible. Limit the number of persons attending an appointment to essential persons only. Arrange rooms (waiting areas, offices, and clinical spaces) to ensure that physical distancing is maintained and to allow for as much physical space between individuals as possible. Have infection control supplies (alcohol-based hand rub, tissues, waste receptacles, masks and PPE) available for use. HVAC systems should be regularly reviewed to ensure they are in compliance with applicable legislative requirements. Take every opportunity to optimize fresh air and ventilation in your practice setting.
Patient Care Management
Maximize opportunities to actively screen patients and others prior to arrival at your office setting, such as at the time of booking, or by telephone just prior to their scheduled appointment time. Screening should include questions beyond ARI/COVID-19 and include conditions relevant to the populations you are servicing (i.e., chickenpox or gastroenteritis among pediatric patients, conjunctivitis among ophthalmic patients, etc.).
Prior to any patient interaction, a point of care risk assessment (PCRA) should be conducted to identify potential risks for staff and strategies for mitigation. This would include the use of additional precautions and the selection of PPE appropriate to the precaution level (i.e., use of a fit-tested N95 respirator for clients with suspected tuberculosis infection, or where an AGMP is being performed).
Offer patients vaccination opportunities for all vaccines for which they are eligible, based on their age, personal health history, occupation, and lifestyle. Ensure IPAC best practices for vaccinations are followed by all staff who administer, handle and store vaccines.
Occupational Health and Safety
Ensure appropriate supplies of PPE are available for staff to use based on PCRA and that staff have education and training to choose and use PPE appropriately.
Policies should be implemented on acute illness in the workplace requiring staff to monitor for signs of illness at work, or at home and not report to work when ill with an infection that may be communicable to others. Staff vaccinations should be up-to-date based on their eligibility, personal health history/risk factors and occupational risks.
Public Health Ontario has a variety of IPAC resources available on their website to assist you in evaluating your clinical office practice. This includes an audit checklist to identify areas of potential gaps and strategies to mitigate same. You can access their website and resources here.
Thank you in advance for your ongoing commitment to IPAC in your practice setting. Should you have questions about IPAC and how to apply best practice strategies in your office setting please contact the Control of Infectious Diseases Program at: 705.522.9200, ext. 772 or toll-free at 1.866.522.9200.
Sincerely,
Original Signed By
Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer
NOTE: All Advisory Alerts are found on our website.
Source:
- Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Infection prevention and control for clinical office practice [Internet]. 1st revision. Toronto, ON: Queen’s Printer for Ontario; 2015 [cited 2021 Aug 12]. Available from: https://www.publichealthontario.ca/-/media/documents/b/2013/bp-clinical-officepractice.pdf?sc_lang=en
This item was last modified on September 14, 2021