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Essential Resources for Effective Infection Prevention and Control Programs: A Matter of Patient Safety - A Discussion Paper (2010)

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Foreward and Acknowledgements

This document, Essential Resources for Effective Infection Prevention and Control Programs: A Matter of Patient Safety, has been developed under the direction of the Public Health Agency of Canada’s Infection Control Guidelines Steering Committee. Its main purpose is to help health care administrators and planners understand what resources infection control professionals require to provide effective Infection Prevention and Control Programs that will improve the quality and safety of health care. The information presented in this document is designed to assist in the development of policies, procedures, and evaluation mechanisms to ensure an optimal level of care as well as patient and staff safety.

The Public Health Agency of Canada invited experts to form the working group for Essential Resources for Effective Infection Prevention and Control Programs. Membership included paediatric and adult infectious diseases physicians, hospital epidemiologists, a medical microbiologist, paediatric and adult acute care infection control practitioners, health educators, long-term care and home care infection control practitioners, and administrators. The working group met in person and by teleconferences to formulate the information and recommendations in this document.

The Public Health Agency of Canada Infection Control Guidelines Steering Committee acknowledges, with sincere appreciation, the many practising health care professionals and others who contributed advice and information to this endeavour. The Public Health Agency of Canada is especially appreciative of the time and expertise contributed by the Working Group and to Dr. Dick Zoutman for chairing it.

The information in this document was current at the time of publication; nonetheless, areas of knowledge and aspects of medical technology advance with time. Health care professionals are encouraged to contact the Public Health Agency of Canada for updated information.

Professionals using this document are encouraged to refer to the Health Canada/Public Health Agency of Canada Infection Control Guidelines series for further information on Infection Prevention and Control.

The Prevention of Health Care Associated Pneumonia (in press)

Classic Creutzfeldt-Jakob Disease in Canada (2002) Revised addendum (2007)

Prevention and Control of Occupational Infections in Health Care (2002)

Routine Practices and Additional Precautions for Preventing Transmission of Infection in Health Care (1999) (under revision)

Infection Prevention and Control Practices for Personal Services: Tattooing, Ear/Body Piercing and Electrolysis (1999)

Hand Washing, Cleaning, Disinfection and Sterilization in Health Care (1998)

Preventing the Spread of Vancomycin-Related Enterococci (VRE) in Canada (1997)

Preventing Infections Associated with Foot Care by Health Care Providers (1997)

Preventing Infections Associated with Indwelling Intravascular Access Devices (1997)

Preventing the Transmission of Blood Borne Pathogens in Health Care and Public Services Settings (1997)

Canadian Contingency Plan for Viral Hemorrhagic Fevers and Other Related Diseases (1997)

Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings (1996)

Long Term Care Facilities (1994)     

Antimicrobial Utilization in Health Care Facilities (1990)

Prevention of Surgical Wound Infections (1990)

Prevention of Urinary Tract Infections (1990)

Organization of Infection Control Programs in Health Care Facilities (1990)

Perinatal Care (1988)

Another publication of the Nosocomial and Occupational Infections Section that complements the Infection Control Guidelines series is Construction-related Nosocomial Infections in Patients in Health Care Facilities; Decreasing the Risk of Aspergillus, Legionella and Other Infections CCDR 2001 27S2.

For information regarding these Public Health Agency of Canada publications, contact:

Nosocomial and Occupational Infections Section
Blood Safety Surveillance and Health Care Acquired Infections Division
Centre for Communicable Diseases and Infection Control
The Public Health Agency of Canada
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9
Telephone: 613-952-9875
Fax: 613-946-0678

Infection Control Guidelines Steering Committee Members

John Conly, MD FRCPC
Professor and Head, Dept. of Medicine Foothills Medical Centre
9th floor, North Tower
1403 29th St. NW
Calgary, AB T2N 2T9

Colleen Hawes, RN BScN MAOM
Infection Control Manager
Royal Columbian Hospital/Fraser Health Authority
330 E Columbia St.
New Westminster, BC V3L 3W7

Dorothy Moore, MD PhD
Division of Infectious Diseases
Montreal Children’s Hospital
2300 Tupper Rd., Rm. C-1242
Montréal, QC H3H 1P3

Deborah Norton, RN BEd MSc CIC
Infection Prevention and Control Consultant
c/o CRI Program
1440 - 14th Ave.
4E Room 25, CRI Clinic
Regina, SK S4P 0W5

Filomena Pietrangelo, BScN
Occupational Health and Safety Manager
McGill University Health Centre
2155 Guy Street, Suite 313
Montréal QC, H3H 2R9

Charles Frenette, MD FRCPC
Hospital Epidemiologist
Medical Director Infection Control
McGill University Health Centre
McGill University
Montreal, QC

Lynn Johnston, MD FRCPC
Hospital Epidemiologist and Professor of Medicine
QEII Health Science Centre
Room 5-014 ACC, 1278 Tower Road
Halifax, NS  B3H 2Y9

Lindsay Nicolle, MD FRCPC  (Chairperson)
Professor of Medicine
Department of Internal Medicine
University of Manitoba Health Sciences Centre
GG443-820 Sherbrooke St.
Winnipeg, MB R3A 1R9

Laurie O’Neil, RN BN CIC
Infection Control Advisor
1819 Cayuga Cres. NW
Calgary, AB T2L 0N9

Geoff Taylor, MD FRCPC
Department of Medicine Division of Infectious Disease
Division of Infectious Diseases
2E4.11 Walter McKenzie Centre
Edmonton, AB  T6G 2B7

Dick Zoutman, MD FRCPC
Professor of Pathology and Molecular Medicine
Chief, Department of Medical Microbiology KGH
Medical Director, Infection Control Services
Kingston General Hospital
76 Stuart St.
Kingston ON, K7L 2V7

Infection Control Guidelines Steering Committee Liaison Members

Sandra Boivin, RN BScN CIC
Association des infirmières en prévention des infections (AIPI)
520 boul. Arthur-Sauve

Saint-Eustache, QC J7R 5B1

John Embil, BSc, Hon, MD FRCPC
Canadian Healthcare Association (CHA)
Director, Infection Control Unit
Health Sciences Centre
820 Sherbrooke St., MS673
Winnipeg, MB R3A 1R9

Jessica Peters,
Senior Research & Product Development Specialist
Accreditation Canada
1730 St Laurent Blvd, Suite 100
Ottawa, ON K1G 5L1

JoAnne Seglie, RN COHN-S
Occupational Health Manager
Office of Environmental Health and Safety
University of Alberta
Rm 107, 11390- 87 Ave.
Edmonton, AB T6G 2R5

Mary Vearncombe, MD FRCPC
Canadian Association for Clinical Microbiology and Infectious Diseases (CACMID)
Sunnybrook & Women’s College
Health Sciences Centre
Hospital Epidemiologist
2075 Bayview Ave. Suite B130
Toronto, ON M4N 3M5

Nan Cleator RN (BNc)
Victorian Order of Nurses Canada (VON)
National Client Services Practice Consultant
2-110 Main Street East
Huntsville, Ontario P1H 1K6

Anne Matlow, MD FRCPC
Community and Hospital Infection Control Association (CHICA)
Director of Infection Control
Physician Liaison, Patient Safety
The Hospital for Sick Children
555 University Ave.
Toronto, ON M5G 1X8 

Hélène Sabourin, RN BScN MHA
Canadian Nurses Association (CNA)
Nursing Policy Consultant
50 Driveway
Ottawa, ON K2P 1E2

Pierre St-Antoine, MD FRCPC
Association des médecins microbiologistes infectiologues du Québec (AMMIQ)
Centre Hospitalier de l’Université de Montréal
Hôpital Notre-Dame
1560, rue Sherbrooke Est

Montréal, QC H2L 4M1

Ex Officio Members

Judith Morrison, RN BScN MN
Nurse Consultant
Nosocomial and Occupational Infections
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9

Shirley Paton, RN BScN MN
Manager, Nosocomial and Occupational Infections
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9

Jennifer Kruse, RN BScN
Nurse Consultant, Infection Control Guidelines
Nosocomial and Occupational Infection Section
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9

Working Group: Essential Resources for Infection Prevention and Control Programs

Cathy Anderson
Epidemiologist
Saskatoon District Health
Public Health Services
#203 – 310 Idylwyld Dr. N.
Saskatoon, SK S7L 0Z2

Judith Morrison, RN BScN MN
Nurse Consultant, Patient Safety
Nosocomial and Occupational Infections
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9

Linda Kingsbury, RN BScN CIC
Nurse Consultant, Infection Control Guidelines      
Nosocomial and Occupational Infections
Public Health Agency of Canada      
100 Eglantine Driveway, AL: 0601E2
Ottawa, ON K1A 0K9 

Heather Lee, RN BN
Atlantic Health Science Corporation
Box 2100
Saint John, NB E2L 4L2

Lindsay Nicolle, MD FRCPC 
Professor of Medicine
Department of Internal Medicine
University of Manitoba Health Sciences Centre
GG443-820 Sherbrooke St.
Winnipeg, MB R3A 1R9

Pat Piaskowski, RN HBScN CIC
Regional Coordinator,
Northwestern Ontario Infection
Control Network
289 Munro Street,
Thunder Bay, ON P7A 2N3

Geoff Taylor, MD FRCPC
Department of Medicine Division of Infectious Disease
Division of Infectious Diseases
2E4.11 Walter McKenzie Centre
Edmonton, AB  T6G 2B7

Clare Barry, BN MSc CIC
Strategic Planning and Implementation Branch
Public Health Division
Ministry of Health and Long-term Care
1075 Bay Street, 8th Floor
Toronto, ON M5S 2B1

Colleen Hawes, RN BScN MAOM
Infection Control Manager
Royal Columbian Hospital/Fraser Health Authority
330 E Columbia St.
New Westminster, BC V3L 3W7

Mary Leblanc, RN BN CIC
Co-ordinator
Infection Prevention and Control
Carewest
3504 29th St. SW
Calgary, AB T3E 2LE

Janis Leiterman, RN BScN MPA CCHN(C)
Director of Clinical Services
Victoria Order of Nurses for Canada
110 Argyle Avenue
Ottawa, ON K2P 1B4

Deborah Norton, RN BEd MSc CIC
Infection Prevention and Control Consultant
c/o CRI Program
1440 - 14th Ave.
4E Room 25, CRI Clinic
Regina, SK S4P 0W5

Ramona Rodrigues, MSc(A) CIC
Manager, Infection Prevention and Control McGill University Health Centre,
Montreal General Hospital
1650 Cedar Ave
Montreal, QC H3G 1A4

Dick Zoutman, MD FRCPC (Chair of Working Group)
Professor of Pathology and Molecular Medicine
Chief, Department of Medical Microbiology KGH
Medical Director, Infection Control Services
Kingston General Hospital
76 Stuart St.
Kingston ON K7L 2V7

Glossary of Terms, Abbreviations, and Acronyms

Ambulatory Care

Any medical services provided to patients/clients who are not admitted to inpatient units. For the purposes of this document, ambulatory care settings include emergency departments, hospital-based clinics, and outpatient diagnostic and treatment facilities (e.g., endoscopy suites, pulmonary function laboratories, ambulatory surgery centres).
Adverse Events

Adverse events are unintended injuries or complications that result from health care management rather than from the patient’s underlying diseaseFootnote 1.
AROs

Antibiotic/antimicrobial resistant organisms are organisms that have developed resistance to common antimicrobials. Infections with antimicrobial resistant organisms are likely to be more difficult to treatFootnote 2.
Continuum of care

The term reflects the variety of environments within which health care is provided, ranging from acute to ambulatory, home, and long-term care settings.
HAIs

Health care associated infections are infections acquired while receiving health care irrespective of site: hospital; long-term care facility; ambulatory care; or home. This term reflects the shift away from hospitals as the predominant provider of health care services and has largely replaced the term nosocomial.
Home Care

Home care is care provided in the home to patients/clients of all ages with both acute and chronic conditions. The scope of services ranges from assistance with activities of daily living and physical/occupational therapy to the care of postoperative wounds, intravenous therapy, and chronic ambulatory peritoneal dialysis.
Hospital epidemiologist

An individual, usually a physician, with expertise in epidemiological principles and Infection Prevention and Control Program delivery and evaluation.
Infection control (IC)

The original term used to describe the hospital program responsible for monitoring and preventing nosocomial infections.
ICP

Infection Control Professional: A health care professional (e.g., nurse, medical laboratory technologist) with responsibility for functions of the Infection Prevention and Control Program. This individual, who must have specific Infection Prevention and Control training, is referred to as an infection control practitioner/professional or ICP.
IPCP

Infection Prevention and Control Program:  The program consisting of the hospital epidemiologist, practitioners, and support staff charged with the responsibility to minimize the occurrence of infections in patients, health care workers, and visitors.
LTC

Long-term Care: This refers to the care delivered in a diverse group of residential settings, ranging from institutions for the developmentally disabled to nursing homes for the elderly to paediatric chronic-care facilities. Nursing homes for the elderly are the most common type of LTC facility. Long-term care facilities are different from other health care settings in that for most “residents” it is their home and an atmosphere of community is fostered through common eating, living and recreational areas.
MRSA

Methicillin-resistant Staphylococcus aureus: Strains of a common bacterium (S. aureus) that are resistant to beta-lactam antibiotics and that have been responsible for many outbreaks of infection over the past two decades.
Nosocomial Infection

The term used for an infection acquired while receiving health care. Since this is a term historically associated with infections acquired while in hospital, there has been a move to the term HAI (defined above) to more clearly reflect the continuum of care.
Restructuring

Refers to changes in the structure of a health care delivery system. For example, regionalization involves joining multiple facilities in an urban centre or joining facilities in a geographic region under a single administration. However, a “region” may include all settings in the continuum of care or it may only include one setting, e.g.,  acute care. Such inconsistency has created difficulty in defining the mandate/area of responsibility of infection prevention and control programs.
VRE

Vancomycin-resistant enterococcus: A strain of a common bacterium (enterococcus) that is resistant to many commonly used antibiotics, including vancomycin.

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