Clostridium Difficile Infection
Infection Prevention and Control Guidance for Management in Long-term Care Facilities
Public Health Agency of Canada has developed this document to provide
infection prevention and control guidance to long-term care facilities and healthcare workers for the management of residents with Clostridium difficile (C. difficile) infection. The content of this guidance document has been
informed by technical advice provided by members of the Public Health Agency of Canada’s Steering Committee
on Infection Prevention and Control Guidelines.
This guidance is
meant to be used in conjunction with relevant provincial/territorial and local legislation,
regulations, and organizational policies. The recommendations are based on
current, scientific evidence and best practices, and are subject to review and
change as new information becomes available.
Clostridium difficile (C. difficile) is a Gram
positive, spore-forming, anaerobic bacillus that causes infectious diarrhea by
producing two toxins - toxin A (an enterotoxin) and toxin B (a cytotoxin). C. difficile is the most frequent cause of healthcare-associated
infectious diarrhea in Canadian hospitals, and is the most common
cause of acute infectious diarrheal illness in long-term care facilities.,
The reported incidence of healthcare-associated C. difficile infection
in Canada has risen over the last decade and is associated with increased
morbidity and mortality. C. difficile infection can have a variety of
manifestations from uncomplicated diarrhea to life-threatening pseudomembranous
colitis, bowel perforation and sepsis. Residents
in long-term care facilities are at greater risk because of advanced age, the frequent need for
hospitalization,, the presence of underlying diseases/comorbidities,
recurrent exposures to antimicrobial agents, and receipt of
chemotherapy and immunosuppressive agents. Incident rates of C. difficile infection
for those aged 65 and older may be 10 times higher than in younger adults.
C. difficile is easily transmitted within
healthcare settings, commonly causing outbreaks in hospitals and long-term care facilities, and is associated with an increase in C. difficile infection-related morbidity and mortality in
Canada. There has been an almost four-fold increase in the C. difficile infection
attributable mortality rate in Canadian hospitals from 1997 to 2005 (1.5% of
cases to 5.7%, respectively, p<.001). There are multiple
reasons behind the increase in C. difficile infection and C. difficile infection-related mortality rates in Canada
but an important contributor has been the spread of a more virulent strain,
often referred to as North American pulsed field (NAP) type 1.
The primary mode of transmission
for C. difficile within healthcare settings, including long-term care facilities, is by
person-to-person spread through the fecal-oral route. The hands of
healthcare workers, transiently contaminated with C. difficile spores, along with environmental
contamination play an important role in the transmission of C. difficile in healthcare settings.- Compared to other healthcare-associated
bacterial pathogens, environmental contamination around a C. difficile infection resident is
thought to be a relatively more significant factor in cross-transmission to
others. This is because C. difficile, being a spore-forming
microorganism, persists in the environment longer and resists routine
disinfection processes more than non-spore forming bacteria.
The incidence of C. difficile infection within a long-term care facility is
variable. Those responsible for infection prevention and control within a facility
should be aware of C. difficile infection epidemiology within their organization and gauge their
response accordingly. Consistent and correct application of
infection prevention and control measures has proven effective in reducing the
incidence of healthcare-associated C. difficile infection.,
As C. difficile infection is strongly associated with previous
antibiotic use, antimicrobial stewardship is believed to have a role in
preventing and terminating C. difficile infection outbreaks., While this guidance
document is focused on infection prevention and control measures to prevent C. difficile infection
in long-term care facilities, it should be acknowledged that the prevention of C. difficile infection also requires
appropriate use of antimicrobial therapy (i.e., antimicrobial stewardship).
Infection control professionals or delegates should advocate for both effective
infection prevention and control and antimicrobial stewardship programs as important
strategies to prevent C. difficile infection within their organizations.
Recommended Infection Prevention and Control Measures
following guidance is based primarily on recommendations in the Public Health Agency of Canada’s Routine Practices and Additional Precautions for Preventing
the Transmission of Infection in Health Care Settings guideline, except where indicated.
In addition to routine practices, residents suspected
or confirmed to have C. difficile infection in long-term care facilities should be placed on Contact Precautions.
risk assessment approach (Appendix A) should be used to guide decisions
regarding when to apply contact precautions.
The following topics are addressed in more detail below:
- Organizational Controls
- Engineering Measures
- Administrative Measures
- Laboratory Testing/Reporting
- Contact Precautions
- Personnel Restrictions
- Hand Hygiene
- Resident Placement and Accommodation
- Resident Flow/Activities
- Personal Protective Equipment
- Management of Fecal Matter
- Cleaning and Disinfection of Non-critical
Resident Care Equipment
- Environmental Cleaning
- Handling Linen, Dishes, Cutlery
- Duration of Precautions
- Handling Deceased Bodies
- Education of Healthcare Workers, Residents,
- Visitor Management
- Outbreak Management
A major role of all healthcare
organizations, including long-term care facilities, is to minimize the risk of exposure to and
transmission of infections within healthcare settings. This can be achieved by
having policies, procedures and programs specifically for the prevention of C. difficile infection
based on the following engineering and administrative measures.
a) Engineering Measures
- Facility design should include
single rooms for the routine care of residents (with in-room private toilets,
designated resident sinks, appropriately placed alcohol-based hand rub dispensers
and designated staff hand washing sinks).
- Facility design should include
surfaces that are constructed of materials that can be easily and effectively cleaned
at the point of use.
- Appropriate number of bedpans and commodes
should be available.
- To avoid contamination of the environment
with C. difficile spores, systems should be in place to manage the
disposal of fecal matter when bedpans or commodes are required. Some options
for consideration are:
- Installation of
bedpan washers/disinfector systems on resident units;
- Utilization of
disposable bedpans for residents with acute diarrhea and the installation of
macerator systems for the disposable bedpans.
- Appropriate supply of and
accessibility to personal protective equipment should be available.
- Appropriate number of accessible
no-touch waste receptacles for disposal of paper towels, tissues, gloves, etc.
should be available.
- Appropriately functioning, accessible dispensers for
hand hygiene products (soap, lotion, paper towels and alcohol-based hand rubs) should be
- Appropriate number of designated staff hand washing
sinks should be available.
- Appropriate number of point-of-care
alcohol-based hand rub dispensers should be installed.
- If laundry chutes are used, they
should be properly designed, maintained and used in a manner to minimize
dispersion of aerosols from contaminated laundry.
b) Administrative Measures
- Policies and procedures should be
developed and implemented for the prevention and control of C. difficile infection, including the
application of routine practices, contact precautions, and outbreak recognition, reporting and management.
expert human capital (e.g., infection control professionals) and financial allocation
to ensure an effective infection
prevention and control program appropriate to the organization’s mandate
should be provided.
control professionals or delegates should be actively involved in the selection
of new resident care equipment and devices that require cleaning, disinfection
- Policies and procedures should be
developed and implemented for environmental cleaning to ensure sufficient
staffing, routine scheduled environmental cleaning, procedures for assigning
responsibility and accountability for cleaning as indicated by the level of resident
contact and degree of soiling, and to include event-related cleaning of environmental
surfaces and increased cleaning, as per additional precautions.
- Education and training programs
should be developed and implemented for those responsible for environmental
cleaning. Evaluation of policies, procedures and practices, including audits,
should be performed to determine effectiveness of environmental cleaning and
- Policies and procedures, including
assigning responsibility, should be developed and implemented for cleaning and
disinfecting all non-critical resident care items (e.g., mobile devices,
multi-use electronics and electronic games, etc.) that are and are not moved in
and out of resident areas.
- A facility-wide, adequately resourced antimicrobial stewardship
program should be established.
- Monitoring, auditing and reporting of hand hygiene
compliance and environmental cleaning procedures should be established.
- A surveillance system should be
established that includes systematic collection, analysis, interpretation and
dissemination of C. difficile infection rates by unit in the facility (refer to item 3,
- Residents with diarrhea or other
symptoms (e.g., nausea ± vomiting, fever, abdominal
pain/tenderness) that may be due to C. difficile infection should be assessed in a timely manner.
A stool specimen should be taken for laboratory testing for C. difficile,
(Refer to item 4, Laboratory Testing/Reporting), and the resident placed on contact
precautions (refer to item 5, Contact Precautions).
- Clinical assessment of symptomatic residents
and where necessary, initiation of antimicrobial therapy according to clinical
practice guidelines, should occur promptly.
- Asymptomatic residents should not
be tested for C. difficile.
- Routine environmental testing for C.
difficile is not useful and should not be done.
- Testing of asymptomatic
staff is not advisable. Symptomatic staff should be referred to the
organization’s occupational health and safety personnel, or their personal
physician for evaluation.
- A system should
be established for the early reporting of symptomatic residents to the
organization’s infection control professional or delegate.
- A system should
be established for early notification of residents testing positive for C.
difficile to the infection control professional or delegate.
surveillance using accepted C. difficile infection case definitions and denominators should be established to determine the organization’s baseline rate and to
monitor changes in the C. difficile infection rate. By adopting a recognized national case
definition (i.e., the Canadian Nosocomial Infection Surveillance Program, Case Definitions for
Communicable Diseases under National Surveillance, Case Definition and Minimum Data Set for the Surveillance
of Clostridium difficile Infection in Acute Care Hospitals across Canada) organizations will be able to benchmark
their C. difficile infection and C. difficile infection-related mortality rate against other Canadian facilities.
4. Laboratory Testing/Reporting
- Long-term care facilities should have accessible
laboratory support to facilitate prompt identification of C. difficile infection.
- A variety of tests are available to
identify C. difficile or its toxins in the stools of residents with diarrhea.
These tests vary significantly in sensitivity. Infection control professionals
or delegates should review local testing methods and algorithms with laboratory
personnel. If increases in C. difficile infection rates are observed, it is important to ensure
that they are not an artifact of increased case detection resulting from
adoption of new test methods or algorithms.
- A protocol and provisions for
testing for C. difficile infection should be established.
- Stool specimen collection for testing
for C. difficile or its toxins should be done as soon as possible after
onset of acute diarrhea.
- A process should be established for
prompt notification of all positive tests to the resident’s physician and the
infection control professional or delegate, as well as regional,
provincial/territorial public health authorities as required.
- When test
methods of lower sensitivity are performed (e.g., enzyme-linked immunoassays) a
single negative test for residents with acute diarrhea should not be relied on
to rule out C. difficile. If the first test is negative,
a second test may be indicated.
- Testing for C. difficile or
its toxins should only be performed on unformed, diarrheal stool (i.e. loose,
- Repeat testing during the same
episode of diarrhea or follow-up for “test of cure” should not be done.
5. Contact Precautions
- Contact precautions should be
implemented empirically, at the onset of diarrhea, for residents with acute diarrheal
illness, suspected or confirmed to be C. difficile infection, and not otherwise explained.
- Residents suspected or confirmed to
have C. difficile infection should be placed on contact precautions, until the diarrhea is
resolved or its cause is determined not to be infectious. (refer to item 8, Resident
Placement and Accommodation).
- Signage should be placed at the
entrance to the room or designated bedspace or
other visible location of the resident suspected or confirmed to have C. difficile infection to
identify contact precautions.
- Refer to items below for further
details relating to contact precautions.
6. Personnel Restrictions
- Healthcare workers should
stay away from work when infectious with a communicable disease, including, but
not limited to, gastroenteritis with vomiting and/or diarrhea.
immediate supervisor/occupational health personnel should be informed if the healthcare worker
worked when symptomatic/infectious.
- Hand hygiene should be performed frequently
using effective techniques (as recommended in Public Health Agency of Canada’s Hand Hygiene Practices
in HealthCare Settings guideline) and include:
- After resident care;
- After contact with the resident’s
- After removing gloves at point-of-care
and just prior to leaving the resident’s room or designated bedspace;
- After handling fecal matter; and
- After handling bedpans and
- Soap and water in preference to Alcohol-based hand rub
should be used in settings with C. difficile infection transmission and during C. difficile infection outbreaks, for
the physical and mechanical removal of spores. (Refer to item 19, Outbreak
- Hand washing with soap and water
should be performed at the point-of-care and at a designated staff hand washing
sink. If a designated staff hand washing sink is not available at the point-of-care,
alcohol-based hand rub (with an alcohol concentration between 60% and 90%) should be used and
hand hygiene with soap and water should be performed as soon as a staff hand
washing sink is available.
- Hand wipes (impregnated with
antimicrobials, plain soap or alcohol) may be used as an alternative to soap
and water when a hand washing sink is not immediately available or when the
hand washing sink is unsuitable (e.g., contaminated sink, no running water, no
soap) for the following conditions.
- When hands are not visibly soiled;
- When hands are visibly soiled. Alcohol-based hand rub
should be used after the use of hand wipes, and hands should be washed with
soap and water once a suitable staff hand washing sink is available.
Placement and Accommodation
- A point-of-care risk assessment
(Appendix A) should be done to determine resident placement and removal from a
shared room, the potential of infection risks to other residents in the room,
the presence of risk factors that increase the likelihood of transmission and
the potential psychological impact on the symptomatic resident. The infection control
professional or delegate should be consulted.
- In a shared room, a resident suspected
or confirmed to have C. difficile infection should not share a toilet or commode with another resident.
A dedicated toilet or commode should be assigned to each individual resident
- In a shared room, privacy curtains
should be drawn between beds at all times, if feasible.
- The room door may
- Infection control signage should be
placed at the entrance to the resident’s room or designated bedspace indicating
contact precautions are required upon entry.
chart/record of the resident suspected or confirmed to have C. difficile infection should not be
taken into the resident’s room or designated bedspace.
- The symptomatic resident suspected
or confirmed to have C. difficile infection should be allowed out of the room as indicated in the
care plan, providing diarrhea can be contained and hand hygiene compliance with
soap and water is adequate.
- The resident suspected or confirmed
to have C. difficile infection should be provided with clean clothes and should perform hand
hygiene with soap and water, with supervision/assistance as necessary, before
leaving the room.
- Instructions/assistance with hand
hygiene should be provided to residents suspected or confirmed to have C. difficile infection
after using the toilet facilities and prior to leaving their room.
- If diarrhea cannot be contained
and/or if hand hygiene compliance is inadequate, residents suspected or
confirmed to have C. difficile infection should be restricted to their room until:
- Diarrhea has resolved; or
- Diarrhea can be contained; or
- Hand hygiene compliance is adequate.
- Participation in group activities should be restricted when diarrhea cannot be contained and adherence to hand hygiene is not possible
- Transfer of residents
suspected or confirmed to have C. difficile infection within and between facilities should be avoided
unless medically indicated (e.g., for essential diagnostic and therapeutic
tests/treatment). If a medically indicated transfer is necessary:
transferring service, receiving unit, or facility should be advised of the
necessary precautions for the resident being transported;
- A request to
have the resident promptly seen to minimize time in waiting areas should be
- The resident
should be provided with clean clothes and bedding as necessary; diarrhea should
be contained (i.e., with incontinent products) as necessary, and instruction/assistance
with performing hand hygiene should be provided;
- The transport
personnel should remove and dispose of their personal protective equipment (refer to item 10, Personal
Protective Equipment) and perform hand hygiene prior to transporting residents;
- The transport personnel
should put on clean personal protective equipment, if necessary (refer to item 10, Personal Protective
Equipment), to handle the resident during transport and at the transport
10. Personal Protective Equipment
Personal protective equipment
for contact precautions should be provided outside the room or designated
bedspace of the resident suspected or confirmed to have C. difficile infection. Healthcare workers, families
and visitors should use the following personal protective equipment for residents suspected or confirmed
to have C. difficile infection and include the following:
- Gloves should be worn if direct
personal care contact with the resident is necessary, if direct contact with
frequently touched environmental surfaces is anticipated, if handling
contaminated objects/equipment, or if handling soiled linen;
- Gloves should be removed and
discarded into a no-touch waste receptacle and hand hygiene (refer to item 7,
Hand Hygiene) should be performed upon exiting the resident’s room or
- A long-sleeved gown should be worn
if it is anticipated that clothing or forearms will be in direct contact with
the resident or with environmental surfaces or objects in the resident’s
- If a gown is to be worn it should
be put on before entering the room or designated bedspace. The gown should be
removed and discarded into a no-touch receptacle immediately after the
indication for use and hand hygiene should be performed before leaving the resident’s
- The same personal protective equipment should not be worn for
more than one resident. If caring for more than one resident in a shared room,
personal protective equipment should be changed and hand hygiene performed between contacts with each resident
in the same room.
of Fecal Matter
- When bedpans
and commodes are required:
- Bedpans and
commodes should be handled in such a way as to avoid contamination of the
environment with C. difficile spores;
bedpans should be considered; and
- Spray wands for
cleaning bedpans and commode pans/buckets should not be used.
- Toilet bowl
brushes should be dedicated to one specific toilet and not be reused. Disposable
toilet bowl brushes should be considered.
12. Cleaning and Disinfection of
Non-critical Resident Equipment
- All equipment/supplies should be
identified and stored in a manner that prevents use by or for other residents.
- Reusable non-critical resident-care
equipment (e.g., blood pressure cuff, stethoscope, commode chair, walker, wheelchair,
recreational equipment, etc.) should be dedicated to the use of the resident
suspected or confirmed to have C. difficile infection, and should be cleaned and disinfected with
chlorine-containing cleaning agent (at least 1,000 parts per million [ppm]) or
other sporicidal agent before reuse with another resident.
- Electronic rectal thermometers
should not be used.
- Single-use devices should be discarded
in a no-touch waste receptacle after use.
- Electronic games, personal effects,
etc., should be dedicated to the use of the resident suspected or confirmed to
have C. difficile infection and not be shared between residents, and should be cleaned and
disinfected before reuse by another resident.
- All horizontal and
frequently touched surfaces in the room or designated bedspace of the resident suspected or confirmed to
have C. difficile infection should be cleaned at least twice daily and when soiled, paying particular attention to
“high touch” areas/items (e.g., resident’s bathroom, bathing facilities, toilet/commode/bedpan,
light switches, light cords, bed/hand rails, bedside tables and other furniture,
wheelchair, walker, etc.).
- Measures should be taken
to limit contamination of cleaning and disinfecting solutions by changing cleaning cloths and mop
- During continued transmission of C. difficile infection, the
rooms or bedspace of residents suspected or confirmed to have C. difficile infection should be
decontaminated and cleaned with chlorine-containing cleaning agent (at least
1,000 parts per million [ppm]) or other sporicidal agent.
cleaning measures or frequency may be warranted in outbreak situations (refer
to item 19, Outbreak Management), or when there is continued transmission of C. difficile infection.
- When the resident
suspected or confirmed to have C. difficile infection is moved to a single room at the onset of
acute diarrhea, or transferred out of the room for other reasons, or when contact
precautions are discontinued, terminal cleaning of the room or designated bedspace and
bathroom, changing the privacy curtains, discarding the toilet bowl brush, and
cleaning and disinfecting or changing the string/cloth call bells or light
cords should be done (refer to Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings guideline, Appendix VII, for
details on terminal cleaning).
- Contact precautions
should be maintained until terminal cleaning of the room or designated bedspace
Linen, Dishes, Cutlery
- No special
precautions are required for linen; routine practices are sufficient and
include the following:
- Soiled linen
should be handled in the same way for all residents without regard to their
- Soiled linen
should be placed in a no-touch receptacle at the point of use;
- Soiled linen
should be handled with a minimum of agitation to avoid contamination of air, surfaces
- Soiled linen
should be sorted and rinsed outside of the resident’s care area; and
- Heavily soiled
linen should be rolled or folded to contain the heaviest soil in the centre of
the bundle. Solid fecal matter that can be removed using a gloved hand and
toilet tissue should be place into a bedpan or toilet for flushing.
- No special
precautions are required for dishes, cutlery; routine practices are sufficient.
15. Duration of
- Maintain contact
- C. difficile infection is ruled out, and/or diarrhea
is determined as not infectious; or
- If C. difficile infection is confirmed, until
diarrhea has resolved;
- According to provincial/territorial
guidelines or organization’s policy.
of contact precautions should be made in conjunction with the infection control
professional or delegate.
- Routine practices, properly and consistently applied, should be used in
addition to contact precautions, for handling deceased bodies, preparing them
for autopsy, or transferring them to mortuary services.
specified communicable disease regulations should be followed.
17. Education of
Healthcare Workers, Residents, Families, Visitors
- Healthcare Workers
- All healthcare workers should receive education
on C. difficile, including measures to control its spread and on their role
in identifying and acting on new onset diarrhea;
- Education should reinforce that routine
practices, contact precautions, and safe work practices, (e.g., no eating or
drinking in resident care areas) protect healthcare workers from acquiring C. difficile infection.
- Residents, Families,
- Residents, families and
visitors should be educated about the precautions being used; the duration of
precautions, as well as the prevention of transmission of infection to others,
with a particular focus on hand hygiene;
- Families and visitors
who are participating in direct resident care should be instructed about the
indications for and appropriate use of personal protective equipment;
- Families and visitors
who assist with resident care should use the same personal protective equipment as healthcare workers.
should be instructed to speak with nursing staff before entering the room or
designated bedspace of a resident on contact precautions to evaluate the risk
to the health of the visitor and the ability of the visitor to comply with
- The number
of visitors for residents on contact precautions should be minimized to
essential visitors (e.g., immediate family member/parent, guardian or primary
should be restricted to visiting only one resident who is on contact precautions.
If the visitor must visit more than one resident, the visitor should be
instructed to use personal protective equipment as healthcare workers and perform hand hygiene before going to the next
resident’s room or bedspace.
- When there is evidence
of continued transmission of C. difficile within a facility or when the incidence
rate for C. difficile is higher than the facility’s baseline rate, the
following heightened measures should be considered:
- Placing signage at
entrances to the affected unit(s) to direct families and visitors;
- Placing all residents with
acute diarrhea illness on contact precautions;
- Reporting the outbreak to
local public health officials as per regional, provincial/territorial reporting
- Decontaminating and
cleaning rooms or designated bedspace of residents suspected or confirmed to
have C. difficile infection with a chlorine-containing cleaning agent (at least 1,000 parts per million [ppm]) or
other sporicidal agent;
- Increasing the frequency of
cleaning, including bathing and toileting facilities, recreational equipment, all
horizontal surfaces in the resident’s room or designated bedspace and, in
particular, areas/items that are frequently touched (e.g., hand and bedrails, light
cords, light switches, door handles, furniture, etc.), common areas, nursing
stations, staff washrooms, etc., on the affected unit(s);
- Cohorting of staff to
residents (i.e., assigning staff to work exclusively with C. difficile infection-positive
- With associated high burden of illness, particularly
with higher than expected attributable mortality, there may be a role, in
consultation with a microbiologist and public health, to characterize the
strain type and clonality of C. difficile isolates;
- Auditing adherence to hand hygiene practices (refer
to item 7, Hand Hygiene), personal protective equipment use by staff (refer to item 10, Personal
Protective Equipment), cleaning/disinfecting shared non-critical equipment
(refer to item 12, Cleaning and Disinfection of Non-critical Resident Equipment),
and environmental cleaning (refer to item 13, Environmental Cleaning);
- Reviewing the process
for disposal of fecal matter (refer to item 11, Management of Fecal Matter);
- Closing affected unit(s)
to admissions if initial control measures are ineffective in controlling the
spread of C. difficile;
- Reviewing antimicrobial
prescribing practices including indications for prescribing and specific agents
used. In some settings, it may be helpful to restrict the use of specific
antimicrobial agents; and
- Consulting provincial/territorial and/or
national public health expertise in outbreak management for ongoing outbreak
- An outbreak should be declared
over when there is no further transmission and there has been a return to the facility’s
baseline C. difficile infection rate.
- Long-term care facility - A facility or unit that
includes a variety of activities, types and levels of skilled nursing care for
individuals requiring 24-hour surveillance, assistance, rehabilitation,
restorative and/or medical care in a group setting that does not fall under the
definition of acute care. These facilities/units are called by a variety of
names including chronic, continuing, complex, residential, rehabilitation, or
convalescence care and nursing homes.
- Healthcare workers - Individuals who provide
health care or support services, such as nurses, physicians, dentists, nurse
practitioners, paramedics and sometimes emergency first responders, allied
health professionals, unregulated healthcare providers, clinical instructors
and students, volunteers and housekeeping staff. Healthcare workers have
varying degrees of responsibility related to the health care they provide,
depending on their level of education and their specific job/responsibilities.
- A thorough evaluation on the efficacy of bedpan
disinfector systems for use on patient units should be done prior to
procurement with a continuous quality improvement process in place for
monitoring and evaluating performance.,
- An operational definition is suggested by some
experts to continue contact precautions for at least 48 hours after diarrhea
has resolved as relapse of diarrhea is common. However, there is currently no
data to support isolation of asymptomatic patients.
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Point-of-care Risk Assessment
Prior to any patient/resident/client
interaction, all healthcare workers have a responsibility to always
assess the infectious risk posed to themselves and to other patients/residents/clients,
families, visitors, and healthcare workers. This risk assessment is based on
professional judgment about the clinical situation and up-to-date information
on how the specific healthcare organization has designed and implemented
engineering and administrative controls, along with the availability and use of
personal protective equipment.
The point-of-care risk
assessment is an activity performed by the healthcare worker before every patient/resident/client interaction,
- Evaluate the likelihood of
exposure to the infectious agent,
- from a specific interaction (e.g., performing/assisting
with aerosol-generating medical procedures, other clinical
procedures/interaction, non-clinical interaction [i.e., admitting, teaching
patients/residents/clients and families], transporting patients/residents/clients,
direct face-to-face interaction with patients/residents/clients, etc.);
- with a specific patient/resident/client (e.g., infants/young
children, patients/residents/clients not capable of self-care/hand hygiene,
have poor compliance with respiratory hygiene, copious respiratory secretions,
frequent coughing/sneezing, diarrhea, etc.);
- in a specific environment (e.g., single rooms,
shared rooms/washrooms, hallway, assessment areas, emergency departments,
public areas, therapeutic departments, diagnostic imaging departments,
- under available conditions (e.g., air exchanges
in a large waiting area or in an airborne infection isolation room, patient/resident/client
waiting areas, etc.);
- Choose the appropriate actions/personal protective equipment needed
to minimize the risk of the patient/resident/client, healthcare workers, other staff, family,
visitor, contractor, etc. of exposure to the infectious agent.
The point-of-care risk assessment is not a new
concept, but one that is already performed regularly by healthcare workers many times a day
for their safety and the safety of patients/residents/clients and others in the
healthcare environment. For example, when a healthcare worker assesses a patient/resident/client
and the situation to determine the possibility of blood or body fluid exposure
or chooses appropriate personal protective equipment to care for a patient/resident/client with an
infectious disease, these actions are both activities of a point-of-care risk assessment.
- Public Health Agency of Canada. Prevention and Control of
Influenza during a Pandemic for All Healthcare Settings. Annex F of The
Canadian Pandemic Influenza Plan for the Health Sector. Available at: www.phac-aspc.gc.ca/cpip-pclcpi/index-eng.php.
To obtain an electronic copy of the report, send your request to:
Centre for Communicable Diseases and Infection Control
Public Health Agency of Canada
100 Eglantine Driveway
Ottawa, ON K1A 0K9