October 2020 Version 2.0

Infection Prevention and Control (IPAC) Toolkit

Purpose

The purpose of the toolkit is to support a consistent Infection Prevention and Control (IPAC)

approach across the Ontario West region, with a focus on COVID-19 response by providing

validated and credible resources, based on science, evidence and best practice to build capacity

at the local, organization and individual level.

The toolkit consists of 3 parts: resources, IPAC COVID-19 response process, and a frequently

asked questions (FAQ) page including “what is the difference between Public health units and

public health Ontario.

Note: Information is changing rapidly and we encourage everyone to refer back to Public Health

Ontario for the latest scientific information relating to IPAC. The following information is

intended to provide health system providers with a summary of available resources and tools for

reference. It is not intended to replace guidance or direction from the Ministry of Health, Public

Health Ontario, and/or IPAC/Occupational Health and Safety accountabilities within your

organization.

Who can use this toolkit?

This toolkit was developed for the use of care sectors, organizations and providers; however,

there is information that is also valuable to individuals and volunteers.

IPAC Organizations:

National standards and guidance: IPAC Canada,

Provincial standards and guidance: Public Health Ontario (PHO) and Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC)

Regional: PHO regional IPAC support teams.

Municipal: Public Health Units (PHU)

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Table of Contents Part A ............................................................................................................................................................ 3

ALL SECTORS – INCLUDES CORE COMPETENCIES ................................................................................ 3

LONG TERM CARE HOME ..................................................................................................................... 8

RETIREMENT HOME ............................................................................................................................. 9

COMMUNITY CARE ............................................................................................................................. 10

ACUTE CARE ........................................................................................................................................ 10

PRIMARY CARE ................................................................................................................................... 12

CONGREGATE SETTINGS ..................................................................................................................... 13

EMS ..................................................................................................................................................... 14

INDEPENDENT HEALTH CARE FACILITIES ........................................................................................... 15

PART B ......................................................................................................................................................... 16

PUBLIC HEALTH UNITS AND PUBLIC HEALTH ONTARIO .................................................................... 16

PART C ......................................................................................................................................................... 18

FAQ ..................................................................................................................................................... 18

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Part A Information is categorized by subject types such as: EDUCATION, CORE COMPTENCIES, COVID-

19, STANDARDS & BEST PRACTICE GUIDELINES, AUDIT TOOLS, and CHECKLISTS.

The subject types are available for ALL SECTORS followed by sector specific. If you do not see

your sector listed your resources are in ALL SECTORS section.

ALL SECTORS – INCLUDES CORE COMPETENCIES Topic Subject Type Link Agency Notes

CO

VID

- 1

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DIRECTIVES & ORDERS

COVID-19 Orders, Directives, Memorandums and Other Resources

Ministry of Health, Ministry of Long-Term Care

COVID-19 Guidance for the Health Sector

Contains current provincial guidance applicable across different health care sectors including hospice, IHF, Consumption and treatment services pharmacies, community labs

Coronavirus disease: For health professionals

Government of Canada

Contains information on product advisories, guidance

IPA

C C

anad

a

EDUCATION

IPAC Canada

IPAC Canada

Opportunities to participate in webinars with some being available to non-members as well. Also has a COVID-19 Web page with links to provincial resources. Non-acute care resources page includes resources for home health, prehospital/EMS, LTCH, Community care, Clinic/ambulatory care,

STANDARDS &

GUIDELINES

IPAC Standards and Guidelines

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AU

DIT

TO

OLS

IPAC Canada Audit Toolkits: Doctor’s office, home care, hospice, occupational health and safety, pharmacy, prehospital, hand hygiene, PPE, Routine practices, Outbreak management, Self-audit tool for ICPs, environmental cleaning, reprocessing, construction/renovation and maintenance

IPAC Canada

Physician/dental offices, mental health, Paediatric and child care, lab IPAC Canada Infection Control Audit toolkit-available for members and for purchase by non-members.

ED

UC

ATI

ON

FU

ND

AM

ENTA

LS

Infection Prevention and Control Fundamentals

Public Health Ontario

Fundamentals training in four streams based on role.

CO

RE

CO

MP

ETEN

CIE

S

EDUCATION

ONLINE LEARNING

IPAC Core Competencies 1. Courses are: 2. Chain of Transmission 3. Administrative

Controls 4. Control of the

Environment 5. Additional Precautions 6. Health Care Provider

Controls 7. Occupational Health

and Safety 8. Personal Risk

Assessment in:

Acute Care

Community Care Clinic

Community Care Home

Long Term Care

Public Health Ontario

Core Competencies are included in the Fundamentals course; we recommend people complete The Fundamentals. Improve staff IPAC knowledge. 10 modules. 10-15 minutes per module. Free. Set up of PHO account required to access courses. 8 core competency courses

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PP

E &

HA

ND

HY

GIE

NE

EDUCATION

Training videos

Public Health Ontario

Videos on YouTube platform

Recommendations for the Prevention, Detection and Management of Occupational Contact Dermatitis in Health Care Settings

Public Health Ontario – PIDAC – IPC

A guide for selection of appropriate hand hygiene products and gloves based on the skin condition

Hand Hygiene E-Learning Tool

IPAC Canada and Discovery Campus

Online education for HCW and volunteers. 15 minutes to complete and certificate issued upon completion

STANDARDS & BEST PRACTICE

GUIDELINES

Hand Hygiene Webpage Best Practices for Hand Hygiene in all Health care settings

Public Health Ontario – PIDAC – IPC

Contains Best Practice for Hand Hygiene document, information on occupational contact dermatitis in health care settings, instructional signs

RO

UTI

NE

PR

AC

TIC

ES &

AD

DIT

ION

AL

PR

ECA

UTI

ON

S

TOOLS & RESOURCES

Routine Practices and Additional Precautions webpage

Public Health Ontario

Information to assist in understanding and applying routine practices and additional precautions in a setting. Here you will find signs and pocket cards for down load, fact sheets, guidance and best practices

EN

VIR

ON

MEN

TAL

CLE

AN

ING

EDUCATION

Environmental Cleaning webpage

Public Health Ontario

Provides information on Environmental cleaning applicable to all health care sectors

Environmental Cleaning Toolkit

Public Health Ontario – PIDAC - IPC

Current toolkit reflects best practices contained within PIDAC’s Environmental Cleaning (EC) document published in 2012. PIDAC’s EC document was updated in 2018 and changes are not reflected in the current EC toolkit

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ENV

IRO

NM

ENTA

L C

LEA

NIN

G &

REP

RO

CES

SIN

G

STANDARDS & GUIDELINES

Best Practice Guidelines for Routine Practices and Additional Precautions

Public Health Ontario – PIDAC – IPC

Resources related to routine practices and additional precautions in health care settings across the continuum of care including, but not limited to, pre-hospital care, acute care, complex continuing care, rehabilitation facilities, long-term care, chronic care, ambulatory care and home health care

Best Practice Guidelines for Environmental Cleaning

Public Health Ontario – PIDAC – IPC

This best practice document deals with cleaning and disinfection of the physical environment in health care as they relate to the prevention and control of infections. It is targeted to those who have a role in the management of cleaning/housekeeping services for the health care setting

EDUCATION

Reprocessing webpage

Public Health Ontario

Contains resources to support settings conducting reprocessing of equipment

SUR

VEI

LLA

NC

E

Best Practices for Surveillance of Health Care Associated Infections

Public Health Ontario – PIDAC – IPC

This best practice document is intended as a guide for infection control professionals in acute and long-term care, to ensure that the critical elements and methods of surveillance for health care-associated infections (HAIs) are incorporated into their practice

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TRA

NSM

ISSI

ON

AC

UTE

RES

PIR

ATO

RY

INFE

CTI

ON

S

STANDARDS &

GUIDELINES

Best Practices for Prevention of Transmission of Acute Respiratory Infections in All Health Care Settings

Public Health Ontario – PIDAC – IPC

PIDAC-IPC document that deals with the surveillance, reporting and specific interventions for prevention and control of droplet-spread

OR

GA

NIS

MS

Clostridium difficile

Best Practices for Surveillance and Management of Clostridioides difficile in Health Care Settings

Public Health Ontario – PIDAC – IPC

PIDAC-IPC document that deals with the prevention and control of transmission of C. difficile

Annex A: Screening, Testing and Surveillance for Antibiotic-Resistant Organisms (AROs) in All Health Care Settings Antibiotic-Resistant Organisms (MRSA, VRE, CPE, ESBL) for all health-care settings

Public Health Ontario – PIDAC – IPC

PIDAC-IPC document that provides guidance on screening, testing and surveillance of AROs

LAP

SES

IPAC LAPSES

Resources for Preventing Infection and Control Lapses

Public Health Ontario

Resources and advice to support public health units in preventing and investigating lapses in community settings such as clinics, clinical office practices, family health teams, community health and personal services settings

PR

OTO

CO

LS

PROTOCOLS & GUIDELINES

Protocols and Guidelines

Ministry of Health, Ministry of Long-Term Care

Protocols and Guidelines that accompany the Standards are program and topic-specific documents incorporated into the Standards which provide direction on how boards of health shall operationalize specific requirement(s) identified in the Standards

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LONG TERM CARE HOME Topic Subject

Type Link Agency Notes

Personal Risk Assessment

ASSESSMENT

IPAC Core Competencies: Personal Risk Assessment in Long-Term Care

Public Health Ontario

Part of IPAC Core Competencies. Create PHO account to view course description

IPAC Comprehensive

CHECKLIST IPAC Checklist for LTCH and RH

Public Health Ontario

HAND HYGIENE EDUCATION

Just Clean your hands Long-Term Care

Public Health Ontario

Documents and resources for hospitals to implement the Just Clean your hands program

COVID-19 GENERAL

RESOURCES COVID-19 LTC Resources Webpage

Public Health Ontario

Resources for LTC complementary to the current public, public health, and health care guidance available on the Ministry of Health’s website

COVID-19 SECTOR

RESOURCES

COVID-19 for Health Sector webpage: LTCH resources

Ministry of Health, Ministry of Long-Term Care

Number of resources to support LTCH contained in this webpage

IPAC ASSESSMENT

TOOL

COIVD-19 IPAC Assessment tool for LTCH

Public Health Ontario

CONSIDERATIONS EDUCATION

WEBINAR

COVID-19 Considerations for Long-Term Care and Retirement Homes Recorded Webinar

Public Health Ontario

Recorded Webinar

PREVENTION EDUCATION

WEBINAR

How to prevent or respond to a COVID-19 outbreak

Public Health Ontario

Recorded Webinar

DE-ESCALATION OF CONTROL MEASURES

GUIDANCE

De-escalation of COVID-19 outbreak control measures

Public Health Ontario

Reference Guide

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PREVENTION & MANAGEMENT OF COVID-19

GENERAL RESOURCES

Prevention and Management of COVID-19 in Long-Term Care and Retirement Homes

Public Health Ontario

Compilation of important resources and information to assist in the preventing COVID-19 from entering the home, early identification, preventing spread of COVID-19 and de-escalation of outbreaks

PPE USE IN COHORTING

EDUCATION WEBINAR

COVID-19 Healthcare Worker Personal Protective Equipment (PPE) Use and Cohorting in Long-Term Care and Retirement Homes

Public Health Ontario

Recorded Webinar

COHORTING IN OUTBREAK

FACT SHEET

How to Cohort During an Outbreak of COVID-19 in a Long-Term Care Home COMING SOON

Public Health Ontario

RESPIRATORY OUTBREAKS

OUTBREACK GUIDANCE

Control of Respiratory Infection Outbreaks in Long-Term Care Homes, 2018

Ministry of Health Ministry of Long-Term Care

Guide to assist LTCHs and Public health units with prevention, detection and management of respiratory infection outbreaks which arise from the transmission of common viral pathogens through droplet exposure

RETIREMENT HOME Topic Subject

Type

Link Agency Notes

IPAC CHECKLIST IPAC Checklist for LTCH and RH

Public Health Ontario

Comprehensive checklist for all aspects of IPAC

RESIDENT & FAMILY INFO COVID - 19

UDATES & RESOURCES

RHRA Updates and resources

Retirement Homes Regulatory

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Authority (RHRA)

COVID – 19 DAILY

UPDATES COVID-19 Updates

Ontario Retirement Communities Association (ORCA)

COMMUNITY CARE Topic Subject

Type Link Agency Notes

PERSONAL RISK ASSESSMENT

CORE COMPETENCY

ONLINE LEARNING

IPAC Core Competencies: Personal Risk Assessment in Community Care-Home

Public Health Ontario

Part of IPAC Core Competencies. Create PHO account to view course description

COVID-19 GUIDANCE

Guidance for Home and Community Care Partners

Ministry of Health, Ministry of Long-Term Care

COVID-19 PUBLIC RESOURCES

FACT SHEETS

Resources for the public

Public Health Ontario

Fact Sheets

ACUTE CARE Topic Subject

Type Link Agency Notes

ORGANISM Clostridium difficile

EDUCATION ONLINE

LEARNING

Clostridium difficile infection (CDI) Case Scenarios

Public Health Ontario

Online learning module targeted to who identify and manage C.diff outbreaks in Ontario Hospitals. Create PHO account to view course

Carbapenemase-Producing Enterobacteriaceae (CPE)

FAQ

FAQs Carbapenemase-Producing Enterobacteriaceae (CPE)

Public Health Ontario

Vancomycin-Resistant Enterococcus

RECOMMEND-ATIONS

Evidence Review and revised Recommendations

Public Health Ontario

The goal of the VRE program of research is to synthesize the available data on the

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Program of Research

for the control of VRE in All Ontario Health Care Facilities Status of VRE Screening and isolation Practices in Ontario Hospitals

impacts of VRE control strategies to help inform the best practice guidance for the prevention of VRE

Hand Hygiene EDUCATION &

RESOURCES Just Clean Your Hands Hospitals

Public Health Ontario

Documents and resources for hospitals to implement the Just Clean your hands program

Patient Safety DATA Patient Safety Indicator results

Health Quality Ontario

A Public Hospitals Act (PHA) regulatory amendment, effective July 28, 2008, requires hospitals to publicly report on patient safety indicators related to hospital-acquired infections, actions undertaken to reduce such infections, and mortality. Under Regulation 965 of the PHA, hospitals are required to disclose the results of each indicator through their website

Antimicrobial Stewardship

RESOURCES ASP in Acute Care Public Health Ontario

Since 2013, Accreditation Canada mandates that all acute care facilities have an antimicrobial stewardship program (ASP)

Additional Precautions

SIGNAGE & LANYARD

CARDS

Signage and Lanyard cards

Public Health Ontario

COVID-19 GUIDANCE Guidance for Acute Care

Ministry of Health, Ministry of Long-Term Care

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PRIMARY CARE Topic Subject

Type Link Agency Notes

Personal Risk Assessment

CORE COMPETENCY

IPAC Core Competencies: Personal Risk Assessment in Community Care- Clinic

Public Health Ontario

Part of IPAC Core Competencies. Create PHO account to view course description

Reprocessing EDUCATION

ONLINE LEARNING

Reprocessing in Community Health Care settings

Public Health Ontario

9 modules. 2-4 hours to complete. Certificate issued upon completion. Create PHO account to view course description

IPAC CORE ELEMENTS

CHECKLIST

IPAC Checklist for Clinical Office Practice- Core Elements

Public Health Ontario

Supports clinical office practice to examine, evaluate and compare current IPAC practices using provincial recommendations

REPROCESSING

IPAC Checklist for Clinical Office Practice- Reprocessing

Public Health Ontario

Supports clinical office practice to examine, evaluate and compare current IPAC practices using provincial recommendations

ENDOSCOPY

IPAC Checklist for Clinical Office Practice- Endoscopy

Public Health Ontario

Supports clinical office practice to examine, evaluate and compare current IPAC practices using provincial recommendations

OFFICE PRACTICE IPAC Checklist for Office Practice CPSO

CPSO

Supports clinical office practice to examine, evaluate and compare current IPAC practices using

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provincial guidance and best practices

IPAC OFFICE PRACTICE

BEST PRACTICE

GUIDELINE

Best Practice for Infection Prevention and Control for Clinical Office Practice

Public Health Ontario

Assists physicians with their clinical office-based practice. Contains elements derived from legislation and evidence based best practices. Foundational document for IPAC Checklists

REPROCESSING EDUCATION

Recommendations for Education, Training and Certification for Reprocessing in Clinical Office Settings

Public Health Ontario

Provides recommendations on the level of reprocessing education staff who are conducting reprocessing should complete

INFECTION CONTROL RESOURCES

GENERAL RESOURCES

Infection Control Resources and Tools website

Association of Family Health Teams of Ontario

Links to Ontario Health Documents, information on PPE, educational tools (videos), provincial guidance, webinars, PHO resources etc.

COVID-19 GUIDANCE

Guidance for Primary Care Providers in a Community Setting

Ministry of Health, Ministry of Long-Term care

CONGREGATE SETTINGS Topic Subject

Type Link Agency Notes

COVID-19 GENERAL

RESOURCES

COVID-19 Resources for Congregate Living Settings web page

Public Health Ontario

Resources to help staff and administrators address COVID-19 prevention and

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VULNERABLE POPULATIONS

GUIDANCE

Guidance: Congregate Living for Vulnerable Populations

Ministry of Health, Ministry of Long-Term Care

control. Includes information on Cohorting, PPE, recorded webinar on Foundations of COVID-19 prevention and control for congregate living settings plus a lot more

PREPAREDNESS

RESOURCE TOOLKIT

COVID-19 Resource Toolkit for Congregate Living settings COVID-19 Preparedness and Prevention in Congregate Living Settings

MANAGING OUTBREAKS

RECORDED WEBINARS

Managing outbreaks, PPE, Cohorting Managing COVID-19 Outbreaks in Congregate Living Settings

EMS Topic Subject

Type Link Agency Notes

COVID-19 GUIDANCE Guidance for Paramedic Services

Ministry of Health, Ministry of Long-Term Care

COVID-19 CARE PROVISION

EVIDENCE

Evidence Brief: IPAC for First Responders Providing Direct care for suspected or Confirmed COVID-19 Patients

Public Health Ontario

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INDEPENDENT HEALTH CARE FACILITIES Topic Subject Type Link Agency Notes

IPAC CHECKLISTS

Checklist for Infection Prevention and Control During the Pandemic Independent Health Facilities Provincial webpage

Ministry of Health, Ministry of Long-Term Care, CPSO

Checklist to assist IHF’s to assess IPAC practices

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PART B PUBLIC HEALTH UNITS AND PUBLIC HEALTH ONTARIO

PUBLIC HEALTH UNITS PUBLIC HEALTH ONTARIO

Description Official health agencies established by a group of urban and rural municipalities to provide a more efficient community health program Each health unit is governed by a board of health, which is an autonomous corporation under the Health Protection and Promotion Act, and is administered by the medical officer of health who reports to the local board of health.

The Ontario Agency for Health Protection and Promotion (OAHPP - operated under the name Public Health Ontario since 2011), established in 2008 by the OAHPP Act of 2007, is an agent of the Crown and an arm's-length government agency

Number 34 - Shared funding and governance between province and municipalities

Head office in Toronto, 11 lab sites, 5 regional offices

Functions include

• Implementation of Health Protection and Promotion Act (HPPA)

• administer health promotion and disease prevention programs (healthy lifestyles, healthy growth and development programs)

• Sexual health services • Immunization • Inspections/compliance • Outbreak management and reporting • Communicable disease follow-up

• Provide scientific evidence and expert guidance to shape policies and practices for a healthier Ontario.

• Partner with government, public health and health care, to prevent illness and improve health

• Laboratory testing • Research and Analysis

Consultation May be available via telephone or on-site to any organization within the boundaries of the PHU. Varies by PHU.

Focus is on sector level consultation and support. Available to support PHUs, other ministries for IPAC issues Some individual consultation by phone/email available

Regulation/ Enforcement

All PHUs are required to do annual IPAC inspections in Personal Service Settings, childcare.

No regulatory role A PHU may consult with PHO for scientific direction while conducting enforcement

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All PHUs are required to investigate outbreaks in healthcare and institutional settings and investigation may include IPAC assessment. PHUs are required to respond to reports or complaints of IPAC lapses in any type of health care setting as well as community settings

Education • IPAC education provided during inspections and investigations

• Local workshops – outbreaks and IPAC • Targeted IPAC campaigns • Varies by PHU and year. Based on assessment of

local needs.

• Production of evidence –based, sector-specific IPAC educational and training materials

• Focus on knowledge translation and capacity building including “train-the-trainer” approach

• Education and training available online • Various assessment and audit tools for determining IPAC

needs

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PART C FAQ Public Health Ontario Long Term Care Homes FAQ https://www.publichealthontario.ca/-

/media/documents/ncov/ltcrh/2020/08/covid-19-faq-ltch.pdf?la=en

Public Health Ontario Congregate Living Settings FAQ https://www.publichealthontario.ca/-

/media/documents/ncov/cong/2020/06/covid-19-congregate-living-settings-faq.pdf?la=en