Establishing an Occupational Health and Infection Control Program in a Large Ambulatory Care Facility 

April 2011  

Principal Investigator/Applicant Annalee Yassi 

 

                  RS2008‐IG23 

   

INNOVATION AT WORK: FINAL REPORT FILE #: RS2008-IG23 

Establishing an Occupational Health and  Infection  Control  Program  in  a 

ty  Large Ambulatory Care FaciliAnnalee Yassi, Elizabeth Bryce, L

arf, Lyndsay O’Hara. inda Kingsbury,  

Sydney Sch

pril 2011  A  This research  is supported with  funds  from WorkSafeBC (Workers' Compensation Board of British Columbia). 

   

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Table of Contents  

Research/Project Findings and Workplace Health and Safety Implications……………………… 3  Executive Summary……………………………………………………………………………………………………….. 4 

………………………………………………………………... 8  The Research Problem and Context……………… Methodology and Research/Project Findings   

Project Timeline………………………………………………………………………………………………...11 Part 1‐ Workplace Assessments …………………………………………………………………………13 Part 2‐ Glo‐Germ Environmental Audits …..……………………………….....................................18 Part 3‐ Knowledge, Attitudes and Practice Survey ………………………………………………21 

 Part 4‐ Healthcare Worker and Public Education Sessions…………………………………...33 Implications for future research/projects on workplace health and safety……………………..34  Identification of immediate and long‐term benefits of the findings or results………………….35  Identification of relevant user groups for the research/project results…………………………..38  Dissemination/knowledge transfer……………………………………………………………………………….39 

eferences… R …………………………………………………………………………………………………………………40 

ppendix I‐   A Logical Framework Analysis……………………………………………………………………….43

ppendix II‐ A  Workplace Assessment Tool ………………...…………………………………………………44 

ppendix III A 

‐ Glo‐Germ Environmental Audit Template ………………………………………..……..63 

Appendix IV‐ Knowledge, Attitudes and Practice Worker Questionnaire…………………….…64 

ppendix V‐ A 

 FAQ Sheet…………………………………………………………………………………………….….75 

Appendix VI‐ Infection Control Basics for Medical Students…………………………………………80

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Research/Project Findings and Workplace Health and Safety Implications  

• Ambulatory  care  poses  similar  hazards  to  healthcare  workers  as  acute  care  but  this  is  not 

necessarily  appreciated when  the  infrastructure  requirements  are  established.   Building  in an 

Occupational Health  and  Infection  Prevention  and  Control  program  into  the management 

structure for all ambulatory care partners (private, public and teaching staff) is important and 

can be done retrospectively. 

• Workplace  assessments  using  a  comprehensive  checklist  can  catalyze  improvements  in 

workplace  conditions.  Several  themes  regarding  concerns  and  immediate  concerns  emerged 

from the assessments;  

a) Lack of signage, manuals and directives; b) physical plant issues c) equipment and procedures; 

d) ergonomics and e) workplace practice.  

• Glo ‐Germ environmental audits conducted in 15 clinical areas revealed significant deficiencies in 

cleaning technique and  frequency.   Cleaning protocols were geared more  towards office/hotel 

requirements than the level of cleaning needed for an active healthcare treatment centre. 

• Little is known regarding healthcare worker knowledge and practice related to infection control 

and  occupational  health  in  this  setting  .A  survey  of  ambulatory  care  staff  revealed  inadequate 

ct, workers tended to overestimate their knowledge knowledge in these areas; in fa

• The survey also revealed that application of knowledge in practice was problematic; there was 

an association between knowledge deficits and poor practice.  There were significant differences 

in knowledge and practice between clinical and administrative staff. 

• Education sessions focusing on infection prevention and control basics are well received by both 

staff and the community. Frequent and targeted educational  initiatives to promote healthier 

ambulatory care environments are essential in this increasingly complex care environment. 

 

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Executive Summary  

Little  has  been  documented  regarding  changing  risks,  worker  safety,  knowledge,  and 

models  to  deliver  effective  Infection  Prevention  and  Control  and  Occupational  Health 

programs in outpatient settings.   And yet ambulatory care  is becoming increasingly more 

complex  both  from  a  patient  management  perspective  and  in  regards  to  the  demands 

placed on staff. 

This  Innovation‐at‐work  project  focused  on  the  development  and  implementation  of  a 

collaborative occupational health and  infection control program  that  recognized and met 

the needs of the three partners (Vancouver Coastal Health, University of British Columbia 

and private ventures (housekeeping,  food services and physicians’ offices])  in the Gordon 

and  Leslie  Diamond  Ambulatory  Care  Centre.  Many  aspects  of  internationally 

recommended  occupational  health  programs  were  not  included  in  this  assessment.  

Specifically,  the  full  scope  of  primary,  secondary,  and  tertiary  prevention  activities  of 

occupational  health  programs  needed  to  address  the  physical,  chemical,  biological, 

ergonomic, psychosocial and safety hazards in the workplace, were not fully addressed in 

this  assessment,  nor  was  the  role  of  joint  labour‐management  health  and  safety 

committees.  Rather,  the  model  developed  was  based  on  locally‐accepted  roles  for 

occupational health practitioners focusing on preventing healthcare acquired infections in 

patients and health workers. This more narrow scope was adopted in order to increase the 

likelihood  that  the  model  developed  could  be  readily  applied  to  other  partnership 

healthcare settings with similar more narrow conceptions of the role of occupational health 

programs.    

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The first task was to complete a pre‐established review that focused on identifying the gaps 

in  occupational  health  and  infection  control  knowledge  and  practices  as  well  as  the 

operational  requirements  for  a  functional  program.    This  was  followed  by  extensive 

education session, the refinement of existing assessment/audit tools to suit an ambulatory 

care environment and the integration of occupational health and infection control expertise 

into  the  existing  operational  structure  of  the  facility.  Existing  cleaning  protocols  were 

reviewed and  recommendations were made  to  better  reflect  the needs  of  the  healthcare 

environment.    All  of  the  findings  and  recommendations  were  circulated  to  the  Centre 

partners  and  staff  (where  appropriate).    Policies  and  procedures  were  revised  or 

developed to address the identified needs as the final phase of the project. 

The  workplace  assessment  findings  (Phase  1)  highlighted  several  themes;  a)  lack  of 

signage,  manuals  and  directives  (e.g.  hand  hygiene  and  personal  protective  equipment 

[PPE] posters); b) physical plant issues (e.g. lack of waste disposal systems such as bedpan 

decontaminators in areas with an identified need); c) equipment design, placement and/or 

procedural deficiencies (e.g. availability and  location of  first aid kits); d) ergonomics (e.g. 

poor shelving and file storage); and e) workplace practice (e.g. routine cleaning of patient 

equipment and chemical  storage).   One of  the key  lessons  learned was  the desirability of  

carefully    anticipating  future needs during  the design phase  ‐ particularly with  regard  to 

the documented increasing level of acuity in ambulatory patients.  

The  survey  of  ambulatory  care  staff  revealed  inadequate  knowledge  with  regard  to 

infection control and occupational health practices; in fact workers seemed  not to possess 

the  knowledge  that  they  believed  they  had      Application  of  knowledge  in  practice  was 

problematic, and there was an association between knowledge deficits and poor practice.  

There were significant differences between clinical and administrative staff  in knowledge 

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and practice, likely reflecting the lack of educational sessions for administrative personnel 

who often direct policy that impacts  worker safety and infection prevention. Targeted and 

sustained educational  initiatives  to promote healthier ambulatory care environments are 

essential to ensuring a healthy and safe workplace.  These need to be tailored to meet the 

needs of ambulatory care, carefully documented when they occur and results reported to 

the centre’s operational team. 

Glo‐Germ  Environmental  audits  highlighted  significant  gaps  in  cleaning  processes  in 

addition to a disconnect between what contracted cleaners felt they were responsible  for 

cleaning  and what nursing  staff  felt was  their  responsibility.    The  review of  the  cleaning 

protocol revealed that the type and level of cleaning was what one would expect in an office 

rather than a healthcare facility.  This required considerable changes in practice and more 

clearly defined roles as to cleaning responsibilities in the building. 

Rec mom endations and Lessons Learned: 

1. Needs assessments using tools such as a workplace assessment checklist, Glo‐Germ 

environmental audits and worker knowledge, attitudes and practice questionnaires 

inform  the  development  and  implementation  of  new  programs,  services  and 

educational initiatives. 

2. Staff must have access  to regular, documented  in‐services  targeted at both clinical 

and non‐clinical staff.   

3. To be  successful,  occupational  health  and  infection  control  should  become part  of 

the  administrative  structure  and  be  represented  on  relevant  committees.  This 

 process should engage all the partners in the Centre.

4. Cleaning  contracts  should  be  reviewed  (ideally  before  the  tender  process  is 

complete)  to  ensure  that  the  cleaning  requirements  reflect  the  acuity  of  the 

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population  and  are  not  biased  towards  office  style  cleaning.    Responsibilities  for 

cleaning  equipment  and  examining  room  items  should  be  clearly  designated  to 

nursing and housekeeping staff to ensure all items are regularly cleaned.  Audits of 

cleaning serve as both an educational tool for staff and a quality control measure. 

5. Infrastructure, operational and physical plant design should plan for an increasingly 

complex care as ambulatory care services continue to increase in acuity and volume.  

6. Deliberately  building  in  redundancies  in  the  design  of  the  physical  plant  would 

address  changes  due  to  re‐allocation  of  space  and  the  development  of  new 

technologies. 

7. Algorithms  to  identify  and  manage  patients  at  high  risk  for  transmission  of 

communicable  diseases  would  be  helpful  in  preventing  clusters  of  healthcare 

associated  infections.    These  algorithms  should  be  tailored  to  suit  the  needs  of  

ambulatory  care  and  not  simply  extrapolated  from  acute  care  policies  and 

procedures. 

8. Infection  Control  and  Occupational  Health  resources  that  are  required  should 

consider  the  range  of  services  i.e.  consultation,  education,  training,  workplace 

assessments and policy/procedure development. 

  

The Research Problem and Context  There  is  increasing  focus  on  the  importance  of  maintaining  the  health  of  healthcare 

workers  (HCWs)1‐4  but  given  the  varied  environments  in  which  healthcare  is  now 

administered5‐7,  the challenges to reach all workers are greater  than ever before8.    In  the 

United States, from 1975 to 1995, the number of hospitals decreased from 7,126 to 6,291, 

hospital beds declined from 1.47 million to 1.08 million, patient admissions decreased by 

5%,  the  average  length  of  patient  stay  was  reduced  by  33%,  and  inpatient  surgical 

procedures decreased by 27%8.  In Canada, admissions declined in 1993, stabilizing at 3.1 

million per year between 1998 and 20039. The number of patient visits to ambulatory units 

in acute care hospitals,  including day surgery visits, exceeded 50 million in 2002‐2003 in 

Canada9.  

While  a  considerable  amount  of  hospital  care  and  financial  resources  have  shifted  from 

inpatient  settings  to  ambulatory  clinics,  Infection  Prevention  and  Control  (IPC)  and 

Occupational  Health  (OH)  delivery  has  not  kept  pace  with  the  changing  health  delivery 

model.  Information  on  patient  safety  in  this  new  dynamic  is  just  being  published10‐13, 

however,  little has been documented regarding changing risks, worker safety, knowledge, 

and models  to  deliver  effective  IPC  and  OH  programs  in  outpatient  settings.    Assessing 

HCW knowledge of correct IPC and OH practices is a key first step in determining worker 

needs and in designing programs and their delivery.   

Healthcare  is becoming a more  integrated  service with partnerships  involving  the public 

and private sectors emerging.  This is nicely illustrated in the Gordon and Leslie Diamond 

Centre,  a  new  ambulatory  care  centre  in  Vancouver  that  is  a merger  of  hospital  clinics, 

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private physician offices, food services and the University of British Columbia.  While these 

important  partnerships  have  been  formed,  collaboration  in  key  areas  such  as  Infection 

Control  (IC)  and Occupational Health  (OH) were  lagging behind.    It  is well  known  that  a 

IC/OH successful program improves health and safety within a workplace, decreases injury 

and  disease,  reduces  stress,  and  increases  over‐all  safety  culture.    At  the  onset  of  the 

project,  the  Gordon  and  Leslie  Diamond  Centre  did  not  have  a  single  seamless  formal 

program in place for all healthcare workers and partners.  Our proposal aimed to develop 

and  implement  a  comprehensive  collaborative  occupational  health  and  infection  control 

program  that  recognized and met  the needs of  all partners  in  the Diamond Centre.   This 

model could then be applied to other partnership healthcare settings.   

Setting: The Gordon and Leslie Diamond Health Care Centre  (DHCC)  is  a new 11‐storey, 

365,000 square foot, healthcare facility located on the Vancouver General Hospital campus, 

in Vancouver, British Columbia (BC), Canada.  It  is a private‐public partnership formed by 

Vancouver Coastal Health  (VCH),  the University  of  British  Columbia  (UBC)  and  a  private 

contractor  managing  the  physical  plant.  Tenants  include  private  physicians,  VCH 

ambulatory clinics and services, and UBC offices, classrooms, study areas, and a biomedical 

library. The ambulatory care centre also includes food services, housekeeping services, and 

other support services.  Vancouver Coastal Health recognized the need for a comprehensive 

IPC and OH program and  funding  from WorkSafeBC’s  Innovation at Work  fund provided 

the  opportunity  to  conduct  a  preliminary  needs  assessment  to  determine  gaps  prior  to 

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establishing an OH and IPC program.   

Beginning  in  January of 2007, an  interdisciplinary team of  infection control practitioners, 

and  occupational  health  professionals  conducted  a  preliminary  needs  assessment  for 

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occupational health and infection control within the Diamond Centre.   This Phase 1 work 

was very well‐received and there was strong interest in proceeding to the second phase of 

work. Our  team submitted an  Innovations‐at‐work proposal  for Phase 2,  to  complete  the 

needs assessment (obtaining missing information from worker groups that were not well‐

covered in Phase 1, such as the medical practitioners; complete workplace audits and key 

informant  interviews),  circulate  the  results  to  all  partners,  and  in  collaboration with  the 

staff (both public and private), design, implement and evaluate a functioning program.  

There  were  no  well‐described  models  of  how  to  implement  an  occupational  health 

program  in a multi‐partnered healthcare environment, particularly where  there are both 

public and private sector partners.  Secondly, although SARS, and more recently pandemic 

planning,  had  illustrated  the  desirability  of  a  well‐integrated  occupational  health  and 

infection control approach, there were no models in BC for providing occupational health 

and infection to a large multi‐faceted setting such as this. This innovation‐at‐work proposal 

ocused on these two significant issues. f

 

Project Timeline STATUS  DELIVERABLE  TARGET DATE  NOTES 

Complete  

 Establish an IC/OH Committee  July 29 

Joint  occupation  health  and  safety  committee  with  infection  control representation. 

Remain present at monthly Building Managers' meetings and other administrative functions as: “GLDHCC IC & OH Subcommittee” 

Complete       Pre‐intervention Staff Questionnaires   September 1 

Total collected: 98 questionnaires 

Data  Analysis  Complete:  Summary  tables  compiled,  to  be  integrated  into article/report. 

Room bookings confirmed (8/17) 

 BLJC notified (8/26) 

HCW Education Session Complete (starting August 31) 

Confirmed dates/times: 

8/31 – 1pm, 2pm (DHCC 5213): Attendance= 6 

9/6‐ 2:30pm (SOT unit): Attendance= 9 

9/8 – 9am, 10am, 11am (DHCC 5213: Attendance= 11 

9/15 – 1pm, 2pm, 3pm (DHCC 5213): Attendance= 6 

9/23 – 9am, 10am, 11am (DHCC 5213): Attendance= 55  

10/8 – 9am, 10am, 11am (DHCC 2264):Attendance= 31 

10/15 – 1pm, 2pm, 3pm (DHCC 4223): Attendance=28 

Complete  Public Hand Hygiene Session in Lobby September  3 & October 6 

Sept 3 Staff Attendance: 76 ++ (only staff signed  in, but many others from public participated) 

Oct 6  Attendance: 38 staff and 62 visitors 

Complete  Progress Report to WCB  Mid‐October Sent to Penny Lowe on October 9th  

6 month no‐cost extension granted. 

Complete  Complete Workplace Inspections  November 30  7 complete  

Complete  Complete Environmental Audits  November 30 DONE: Perform Glo‐Germ standards (w/photos) 

DONE: 15 clinical areas complete to date with 14 touch points in each 

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N/A  Complete Hand Hygiene Audits  November 30 The team decided that this is not possible due to the layout of the clinics. 

‐ public hand hygiene education sessions were conducted instead 

Complete  FAQ Sheets  January 29 Distributed 200 FAQ sheets to all floors of the building. 

 

Complete Adaptation  of  Quality  Outcomes  for Cleaning 

April 1 Developed  a matrix  specific  to  ambulatory  care  to  be  used  by  the  contracted cleaners 

Complete Post‐intervention  Staff Questionnaires 

April 1 Distributed on March 4 , 11 and 15 (180 distributed to date) 

Total Collected: 108 questionnaires  

Complete Submit  article  of  results  to‐date  for publication 

August 15 To Journal of Ambulatory Care Management  

 

Complete Creation  of  IC  insert  into  DHCC medical student orientation manual 

May 5 Reviewed by Dr. Bryce and submitted. 

In Progress Post‐intervention  Workplace Inspections 

September 15 7 complete 

Complete* Post‐intervention  process  evaluation for cleaning 

September 15 *this issue remains an ongoing item of discussion amongst GLDHCC managers and the contracted cleaning company. 

Complete  Dissemination of Results to date   October 1 

Abstract accepted‐ March 2010 

Poster presentation at CHICA‐ June 1, 2010 (Vancouver) 

Oral presentation at IFIC‐September, 2010 (Cape Town) 

Complete  Complete Data Analysis  November 1  Data entry of post‐int questionnaires and workplace assessments complete. 

In Progress Dissemination  of  Results  and  Final Report to WCB 

November 15 Oral presentation accepted at IFIC‐ September 2010 

 

Methodology and Research/Project Findings 

The  research  team  employed  complementary  qualitative  and  quantitative  methods  to 

evaluate the determinants of a comprehensive OH and IPC program in the ambulatory care 

facility  and  to  categorize  the gaps between needs and  the  current  level of  service.      (See 

Logical  Framework  Analysis  in  Appendix  I)  In  addition  to  a  literature  review, 

environmental  audits  using  Glo‐Germ  were  conducted;  workplace  assessments  were 

performed, and questionnaires were administered to individuals employed in the building 

to ascertain HCW knowledge and practice.  A quasi‐experimental design was used to assess 

the  effectiveness  of  the  education  and  training  initiatives  by  re‐administering  the 

uestionnaire.  q

 

Part 1­ Workplace Assessments 

METHODOLOGY 

The workplace assessment tool was adapted from a tool previously used by team members 

in  South  Africa,  Ecuador  and  Canada.  (See  Appendix  II)  A  team  consisting  of  a  senior 

infection control practitioner, a research coordinator and the unit manager conducted the 

workplace assessments, covering five domains: physical environment, specific occupational 

health  practices  and  hazards,  specific  infection  control  practices,  equipment  and 

procedures, and ergonomics. Potential risks were reported as satisfactory (S), as a hazard 

requiring  correction  but  not  needing  immediate  correction  (C),  or  as  a  hazard  requiring 

immediate correction (IC). Not applicable (N/A) was also provided as an option.   Figure 1 

documents the areas inspected. 

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Figure 1:  f GLDHCC Clinics where workplace audits we

 funding) 

List o re conducted  

inspectClinics in BLUE were  ed in 2008 (prior to WCBlinics in RED were inspected in 2009 linics highlighted in GREEN were inspected in 2010  CC 

CLINIC Adult Metabolic Clinic Burns Clinic/Hand Injury Clinic/ Trauma Services Clinic/ Ortho‐T

inic rauma Clinic/ 

Plastic Surgery ClCardiac Ultrasound/ Stress Lab Cardiac Rehab/ Pacemaker Clinic Complex Joint Clinic Complex Pain Services Dentistry Clinic Dermatology‐ Wound Healing x2 Diabetes Clinic/ Nutrition Counselling Epilepsy Clinic ENT Clinic Gastroenterology (UBC?) Geriatric Rapid Access Clinic HIV/AIDS  Clinic/  Infectious  Diseases

dicine Clinic   Clinic/  Minor  Surgery/  Home  IV  Clinic/ 

Tropical MeInternal Medicine Rapid Access Clinic Neuro‐otology Podiatry Clinic Radiology and Ultrasound Respiratory Clinic Solid Organ Transplant Clinic/ Kidney Diseases Clinic Stroke Prevention Clinic Urology/Prostate Clinic Women’s Clinic Lab Services 

  

 

 

 

 

 

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RESULTS 

A  total  of  14  workplace  assessments  were  conducted.  Seven  were  conducted  prior  to 

education and training sessions (Adult Metabolic Clinic, Complex Joint Clinic, Dermatology‐ 

Wound  Healing,  Diabetes  Clinic/  Nutrition  Counselling,  Geriatric  Rapid  Access  Clinic, 

HIV/AIDS  Clinic/  Infectious  Diseases  Clinic/  Minor  Surgery/  Home  IV  Clinic/  Tropical 

Medicine Clinic, Podiatry Clinic) and seven after these interventions (Cardiac Ultrasound/ 

Stress Lab Cardiac Rehab/ Pacemaker Clinic, Complex Pain Services, Epilepsy Clinic, ENT 

Clinic,  Internal  Medicine  Rapid  Access  Clinic,  Stroke  Prevention  Clinic,  Urology/Prostate 

Clinic). A total of 73 Concerns and 22 Immediate Concerns were identified in the first round 

of workplace assessments compared to 56 Concerns and 13 Immediate Concerns identified 

in the second round.   An average of 13 employees work each day per clinical area with a 

range  of  patient  visits  from  4  (adult  metabolic  diseases)  to  65  (ortho  trauma/complex 

joint).    The  acuity  of  illness  in  the  patients  who  attended,  varied  significantly  between 

clinics as did the degree of assistance that patients required with ambulation, wound and 

respiratory  care and  the  time  spent on each visit.   Although different  clinical  areas were 

assessed  in  the  first  and  second  rounds,  the  general  themes  of  concerns  and  immediate 

concerns were similar; a) Lack of signage, manuals and directives; b) physical plant issues 

c) equipment and procedures; d) ergonomics an

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d e) workplace practice. 

a)  Lack of signage, manuals and directives.   Several nurse managers expressed desire 

for more multi‐lingual  hand  hygiene  and  signage  depicting  instructions  for  use  of 

personal  protective  equipment.  Signage was  also  lacking  for  blood  and body  fluid 

exposure management, OH and safety reporting procedures as well as WorkSafeBC 

reporting  procedures.  The  greatest  total  number  of  ‘Concerns’  and  ‘Immediate 

Concerns’  reported  were  in  regards  to  the  accessibility  of  occupational  health 

minutes and information.   

b) Physical plant issues.  Most of the concerns and immediate concerns identified in this 

section were the result of a change in the original intent of the physical space.  For 

example,  a  large  room was  divided  into  three  smaller  treatment  rooms  with  the 

addition of floor‐to‐ceiling room dividers. This then resulted in inadequate lighting 

and ventilation in two of the treatment rooms.  Similar constraints were noted with 

sink  numbers  and  placement  in  a  few  clinical  areas  originally  intended  for 

administrative  purposes.    Several  concerns  regarding  the  location  of  electrical 

outlets  were  also  identified.    One  clinic  in  particular  expressed  frustration  with 

having  to  run  long  extension  cords  across  examination  rooms  in  order  to  plug  in 

equipment;  this posed a  safety hazard  for  staff  and patients.    Storage  for  supplies 

was  limited  in  some  clinics  resulting  in  clutter  that  made  thorough  cleaning  of 

surfaces difficult.  Bedpan decontaminators for human waste disposal were required 

in  some  of  the  clinics;  this  had  not  been  considered  in  the  original  design  of  the 

building.   Patients may attend clinics daily and  for  long periods of  time  (e.g. bone 

marrow  and  solid  transplant,  renal  clinics);  waiting  areas  for  patients  and  their 

families was limited in som

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e clinics. 

c) Equipment and procedures:   Better positioning and number of safe sharps disposal 

units were required in some clinical areas. Many clinical areas also reported being 

unsure of where to find a first aid kit.  Few units had their own first aid kit or knew 

where to locate one even though most managers thought that there was a first aid 

kit  available  to  them  somewhere  on  the  floor.    Increasingly  complex  technology 

results  in  more  equipment  and  increasing  acuity  of  care  requires  more  care 

supplies;  unfortunately  there  was  limited  storage  space  in  the  building  to 

accommodate current let alone future needs. 

d) Ergonomics:   Many staff  identified shelving as a concern or an  immediate concern.  

Some clinical areas assessed had large filing cabinets places on the ground making it 

uncomfortable  for  staff  to  file patient  records.    Conversely,  some clinics  identified 

shelves that were to  o high to reach without standing on a chair or stool as a concern. 

e) Workplace practices:    Inconsistent  practices  in  cleaning of  patient  care  equipment 

such  as  examination  tables.  (e.g.  some  examining  tables  had  soiled  sheets)  was 

noted both by housekeeping and clinical staff  (see Glo‐Germ environmental audits 

for  further  details).    Chemicals  were  not  always  stored  appropriately  and  expiry 

dates  were  not  carefully  monitored  in  several  clinical  areas.    However,  several 

clinical  areas  exhibited  model  practices  in  this  regard.  For  example,  the 

podiatry/wound healing, infectious disease and HIV clinics had meticulously labeled 

containers with close attention paid to expiry dates.  On a positive note, many of the 

staff  in  clinical  areas  assessed  had  completed  the  online  infection  control module 

and infection control procedures were prominently displayed on a bulletin board. 

 

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Lessons Learned: While  it  is  impossible  to  identify  all  the  needs  of  an  ambulatory  care 

centre  prior  to  construction,  careful  consideration  must  be  given  to  anticipated  future 

needs particularly with regard to the documented increasing level of acuity in ambulatory 

patients.    The  need  for  waste  disposal  systems,  electrical  outlets  to  meet  increasing 

technological demands, storage space for care supplies, patient and family space for those 

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who attend clinics on multiple days for long periods of time (e.g. bone marrow transplant 

clinics),  ventilation  requirements  for  higher  risk  clinics  (e.g.  respiratory  outpatient 

services)  should  be  considered  and  additional  capacity  or  redundancies  built  into  the 

physical  plant.    The  process  of  conducting  workplace  assessments  at  the  GLDHCC  also 

informed  the  creation  of  a  comprehensive  “Field  Guide  for  Workplace  Assessments  in 

Healthcare” currently being piloted in South African hospitals. 

 

Part 2­ Environmental Audits Using Glo­Germ 

METHODOLOGY 

Environmental marking measured the thoroughness of cleaning using a surrogate marking 

system.  A  colourless  UV  solution  was  applied  to  high‐touch  objects  and  surfaces  in  the 

client/patient/resident  environment  prior  to  cleaning,  followed  by  detection  of  residual 

marker  with  the  use  of  a  UV  light  source  immediately  after  cleaning,  .14‐17  The 

environmental  audits were  conducted  in  15  clinical  areas  using  a  template  developed  at 

Vancouver Coastal Health  (see Appendix  III).   At  the end of  the  clinic day,  surfaces were 

marked  with  Glo‐Germ  before  cleaning  occurred.    The  surfaces  and  objects  were  re‐

examined the following morning (using the UV light source) and results recorded prior to 

the first patient.  This methodology was quantified:  

a)  by  calculating  the  percentage  of  marked  objects/surfaces  that  were  cleaned  in  a 

particular room or area; and/or  

b) by deriving a cleaning score (e.g., 3 = heavy fluorescence, 2 = moderate fluorescence, 1 = 

light fluorescence, 0 = no fluorescence).   For the purposes of this study, a 3 or 2 was coded 

as a “FAIL” and a 1 or 0 was coded as a “PASS.”  Results are shown in Figure 2 below. 

RESULTS  Figure 2: Glo­Germ Environmental Audit: SUMMARY OF RESULTS  Data Collected: August 2009‐November 2009 Collected By: Cole Hilliard and Lyndsay O’Hara Total Observations: 15 clinical areas, 14 items each  

  Location  Pass  Fail 

1  Door Handle  7  8 

2  Light Switch  12  3 

3  Sink   11  4 

4  Taps  9  6 

5  Soap Dispenser  8  7 

6  Paper Towel Dispenser  4  11 

7  Chairs  9  6 

8  Bedside Table  13  2 

9  Bed Rails  10  5 

10  Bed Mattress  13  2 

11  Sharps Container  2  13 

12  Handle Overhead Lamp  4  11 

13  Stool  10  5 

14  Toilet Seat  11  4 

  TOTAL  123 (58.6%)  87 (41.4%) 

      

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     Glo­Germ Environmental Results­ Pass/Fail Results by Item  

    Clinical  areas  audited  include:  Burns  Clinic,  Ortho  Trauma  Clinic  (x2),  Infectious  Disease 

Clinic, Geriatric Rapid Access Clinic, Internal Med Rapid Access Clinic, Diabetes Clinic (x2), Epilepsy Clinic, Dermatology/Wound Healing Clinic, Adult Metabolic Clinic,  Complex  Joint Clinic, Pacemaker Clinic, Stroke Prevention Clinic, Podiatry Clinic 

  

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Lessons Learned: These findings, in addition to an informal qualitative survey of nursing 

staff, highlighted significant gaps in cleaning processes in addition to a disconnect between 

what contracted cleaners felt they were responsible for cleaning and what nursing staff felt 

was  their  responsibility.    The  review of  the  cleaning protocol  revealed  that  the  type and 

level of cleaning was what one would expect in an office rather than a healthcare facility. In 

 

response  to  this  disconnect,  the  project  coordinator  and  a  senior  infection  control 

practitioner worked with the contracted cleaning company and the building management 

to  collaboratively  revise  the  cleaning  processes  (including  frequency)  at  the Gordon  and 

Leslie  Diamond  Health  Care  Centre.    The  research  team  hopes  this  will  inform  the  RFP 

rocess when cleaning contract comes is to be renewed. p

 

Part 3­ Knowledge, Attitudes and Practices Survey 

METHODOLOGY 

A previously validated questionnaire  18  19  consisting of 103  items  (see Appendix  IV) was 

administered  by  two  research  team  members  to  facility  staff.  A  total  of  150  pre‐

intervention  questionnaires  and  180  post‐intervention  questionnaires  were  distributed 

throughout  the  facility  utilizing  convenience  sampling methods,  targeting  VCH,  UBC  and 

private  physician  office  staff  equally.  Respondents  were  offered  a  $5  coffee  card  upon 

completion  of  the  questionnaire  that  was  submitted  anonymously.    The  questionnaire 

consisted of five sections related to OH and IPC issues: 1) baseline demographics; 2) self‐

perception  of  knowledge;  3)  knowledge  assessment;  4)  practices,  and  5)  perception  of 

risks.  Respondents  were  asked  to  rate  their  knowledge  on  a  5‐point  Likert  scale.  The 

questionnaires were coded to ensure confidentiality and took approximately 20 minutes to 

complete.   After statistical analyses were complete, findings were distributed to all clinics 

in the form of an “FAQ S

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heet” (see Appendix V). 

Statistical  Analysis:    Standard  descriptive  statistics  (e.g.,  frequency  and  percent)  were 

calculated  to  analyze  demographic  data  and  characterize  the  distribution  of  variables. 

Fisher’s  exact  test was  used  in  analysis  of  questions  regarding  knowledge,  practice,  risk 

perception  and  training  to  compare  results  between  occupational  groups.  All  tests were 

two‐sided  significance  levels  of  p≤0.05  estimated  from  S‐Plus  8.0  statistical  analysis 

software. Partially missing values were automatically excluded from the analyses. 

 

RESULTS 

A  total  of  98/150  (65%)  questionnaires  were  returned  (Table  1)  with  physicians  and 

surgeons  comprising  3.1%,  nurses  accounting  for  17.3%  administrative  staff  comprising 

36.7%;  9.2%  were  technicians  and  33.7%  of  respondents  identified  themselves  as 

pharmacists, dieticians, psychologists, researchers, and other allied health professions.    It 

should  be  noted  that  housekeeping  staff  are  not  included  in  this  survey  as  they  are 

contracted  employees.  However,  this  subgroup  could  also  be  at  considerable  risk  of 

hysical and biological hazards. exposure to chemical, p

a) Access to expertise: 

Many respondents did not know how to contact OH or IPC services (OH =63 % “yes”’ IPC = 

60% “yes”‐ See Table 2) and were even less confident in their ability to contact their OHS 

representative (41%). Seventy percent of respondents felt confident in how to contact the 

fire/safety steward. Only 44% of staff reported OHS training in the last two years and only 

half  of  health  workers  surveyed  (49%)  recalled  being  screened  for  TB  upon  hiring, 

however,  94%  of  nurses  reported  being  screened  for  TB.  No  physician  had  received OH 

training upon hiring.  

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b) Self perception of knowledge: 

Thirty‐five percent of workers rated their overall OH and IPC knowledge as a 3 (“More or 

less”) and of particular concern, 35% of respondents reported having very little knowledge 

of IPC practices (Table 3). Only 29% felt confident in their knowledge and rated their IPC 

and OH knowledge as a 4 or 5 (“Quite a bit/Very high”).  Nurses did (94%) feel they had a 

good  grasp  of  basic  infection  control  concepts  compared  to  only  14%  of  staff  with 

administrative duties who rated their knowledge of OH and IPC policies as a 4 or 5 (“Quite 

a  bit/Very  high”).    Fifty  percent  in  the  ‘Other’  category  rated  their  infection  control 

 1 or 2 (“Not at all/A bit”). knowledge as a

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c) Knowledge  

The  knowledge  section  of  the  questionnaire  highlighted  deficiencies  in  awareness  of 

correct  IPC  practices  (Table  4  and  5).  As  shown  in  Table  4,  seventy‐six  percent  of 

respondents reported that they know when to use PPE and 71% know how to put on and 

take  off  PPE. Of  note,  21% did  not  know when  to  use  gloves  and  35% and  37% did  not 

know when or how respectively to use a N95 respirator.  There was a significant difference 

in the number of correct responses between clinical staff and non‐clinical staff as to when 

to use an N95  respirator  (p<0.0001) and when  to use a  surgical mask  (p=0.0016).   Only 

32%  of  the  respondents  replied  correctly  to  the  question  on  the  importance  of 

environmental cleaning, highlighting the  lack of understanding the hand hygiene, and not 

cleaning was  the most  important practice  in  infection prevention.  (Table 5).   More direct 

patient  care  staff  (69%)  answered  this  question  correctly  than  did  administrative  staff 

(11%: p<0.0001). A large proportion of respondents (47%) thought that needles should be 

recapped  before  disposal  in  a  sharps  container  and  similarly.    This  question  was  also 

answered correctly by more direct patient care staff (81%) than administrative staff (37%: 

p<0.0001).  More  than  20%  of  respondents  thought  that  they  should  change  their  work 

practice if a patient  is known to have HIV or Hepatitis. Thirty‐three percent believed that 

glove use is always recommended, rather than only when there is anticipated risk of blood 

and body fluid exposure.  On a positive note, 91% of respondents knew that all needle‐stick 

and sharp injuries must be evaluated by occupational health and an impressive 99% were 

sure that patients who are verbally abusive are not permitted to do so as part of their right 

to  care.  Knowledge  regarding  proper  waste  disposal  was  quite  high  with  89%  of 

respondents responding correctly when asked if general waste and medical waste can be 

mixed in the same container if there are no sharps. It should also be noted that 90% knew 

inen must be placed in leak‐proof bags. that blood and body fluid soaked l

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d) Knowledge applied to practice 

The knowledge in practice section of the questionnaire (Table 6) identified several issues 

of concern; some of  these were consistent with reported knowledge gaps  in the previous 

section and other practices were  incongruent with the reported knowledge. For example, 

49% of respondents would deliberately change their IPC approach if a patient was known 

to  have  HIV,  Hepatitis  B  or  C,  a  clear  misunderstanding  of  the  concept  of  Standard 

Precautions.  Thirty‐two  percent  of  respondents  reported  recapping  needles  in  practice 

(Clinical staff: 75%, Non‐clinical staff: 50%: p=0.0004).   Low scores (51% and 48%) were 

identified  in  practices  related  to  health  and  safety  policies  and  procedures  such  as 

reporting of health and safety problems and concerns.   Interestingly, 98% of respondents 

reported  that  they  would  change  their  gloves  between  patients,  but  only  70%  always 

cleaned  their  hands  between  patients.  Practices  pertaining  to  workplace  violence  also 

received  low  scores.  Only  30%  of  respondents  always  assessed  patient’s  potential  for 

aggressive  behavior  upon  admission  and  37%  always  made  suggestions  for  controlling 

workplace  violence.  There  were  several  differences  in  the  number  of  correct  responses 

between  clinical  and  administrative  groups  that  were  significant  regarding  physical 

environment, specific occupational health practices and hazards, specific infection control 

ractices, and ergonomics (Table 6). p

 

Lessons Learned: The workers questionnaire results suggest that in general, respondents 

did not apply  in practice what  they know, and may not possess  the knowledge  that  they 

thought they knew. For example, self‐reported knowledge scores regarding when and how 

to  use  goggles  were  quite  high  (76%  and  77%  respectively),  yet  in  practice,  only  40% 

always  use  eye  protection  (other  than  prescription  glasses)  during  procedures  with 

potential  for  splashes  and  aerosols.    Conversely,  it  was  also  evident  that  a  lack  of 

knowledge  translates  into  practice.  For  example,  knowledge  and  corresponding  practice 

scores related to glove use were both quite high, while both knowledge and practice scores 

related to recapping needles were low and of particular concern.  Only 37% would make a 

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suggestion to control workplace violence. 

The  questionnaire  results  reveal  significant  differences  in  the  level  of  knowledge  and 

correct  practice  between  clinical  staff  and  technical  and  administrative  staff.  All  results 

regarding  when  and  how  to  use  PPE  varied  between  the  different  professions  and  

occupations.   Most of the findings reflect the fact that administrative staff do not don and 

doff  PPE  on  a  regular  basis  and  would  therefore  not  be  expected  to  know  the  correct 

manner of doing so. Differences between occupational groups in the knowledge evaluation 

questions  as  shown  in  Table  5  were  not  significant  with  the  exception  of  knowledge 

regarding  frequent  cleaning  of  the  environment,  footrests,  and  recapping  needles.  In 

contrast,  the percentage of correct responses  in  the section of  the questionnaire  focusing 

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on  knowledge  applied  to  practice  (table  6),  the  majority  of  items  showed  significant 

differences between occupations. It should also be noted that there were high numbers of 

“Not applicable” responses recorded by administrative staff.  Although administrative staff 

is not traditionally expected to possess high levels of clinical knowledge, it is essential that 

they possess basic occupational health and infection control knowledge to understand staff 

needs.  This  is  especially  relevant  in  the  ambulatory  care  setting  where  clerks  and 

receptionists  often  perform  clinical  duties  such  as  intake,  room  cleaning  and  waste 

disposal.  

It was also abundantly clear that healthcare workers did not know how to access IPC and 

OH expertise available to them.  The questionnaire finding that 63% or respondents knew 

how to contact OH, 60% knew how to contact  IPC services and only 41% were aware of 

how  to  contact  their OHS  representative,  clearly  illustrates  a  need  to  communicate  roles 

and  responsibilities  to  ensure  that  all  workers  understand  to  whom  they  should  report 

injuries,  hazards  and  risks  in  their  workplace.    Similar  findings  have  been  reported  in 

traditional healthcare settings (i.e. acute hospital)  in the past, but much has been done in 

recent years to prioritize and protect the health of healthcare workers in acute care18‐20.  It 

is  essential  to  determine  how  to  effectively  break  down  these  barriers  and  create  an 

environment  in  ambulatory  care  settings  that  is  more  conducive  to  communication  and 

support. 

Table 1 – Descriptive statistics of worker questionnaire respondents  

Occupation Group

Physician Nurse Admin Technician Other TOTAL

N (%) 3 (3.1%) 17 (17.3%) 36 (36.7%) 9 (9.2%) 33 (33.7%) 98 (100%)

Median Age Range (Years) 40-49 40-49 40-49 30-39 30-39 40-49

Male 66.6% 0.0% 5.9% 22.2% 3.2% 19.6%Female 33.3% 100.0% 94.1% 77.8% 96.8% 80.4%

Mean Years In Office (SD) 16.7 (11.5) 5.5 (5.8) 5.2 (5.2) 5.4 (6.0) 2.7 (2.3) 4.8 (5.5)

Mean Years In Building (SD) 3.0 (0) 2.2 (0.9) 4.9 (7.9) 2.2 (1.0) 1.9 (1.0) 2.6 (3.5)

Unionized 0.0% 83.3% 94.1% 66.7% 18.2% 59.2%

UBC - 16.7% - 33.3% 3.0% 10.2%

VCH 33.3% 66.7% 94.7% 55.6% 18.2% 53.1%

Private Physician or Group 33.3% 5.5% 5.3% 11.1% 72.7% 29.6%

Private Other 33.3% 11.1% - - 6.1% 7.1%

Private Ambulatory Unit 33.3% 5.7% 5.9% 11.1% 21.2% 12.4%

UBC Ambulatory Unit 66.6% 2.9% - - - 10.3%

VCH Ambulatory Unit - 54.3% 82.4% 33.3% 21.2% 46.4%

Medical Laboratory - - 5.9% - 3.0% 2.1%

Administration - 25.7% - - 27.3% 18.6%

Other - 11.4% 5.9% 55.6% 27.2% 19.6%

Physicians= including SurgeonsAdministrator= Clerks, Receptionists, Managers and AdministratorsTechnician= Technologist, Technicians, TherapistsOther= Pharmacist, Dietician, Psychologist, Researcher, Social Worker, AudiologyUnions include: AAPS, BCNU, CUPE2950, HEU, HSA

Dem

ogra

phic

sEm

ploy

erW

orki

ng A

rea

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Table 2 – Proportion of respondents who know how to contact health professionals, who have had TB screening upon hiring, who have had BBF exposure in the last 2 years, and who have prior OH education. 

  

Occupation Group

Yes No Yes No Yes No Yes No Yes No Yes No

OH Dept. 100.0% 0.0% 100.0% 0.0% 53.3% 46.7% 75.0% 25.0% 44.8% 55.2% 62.8% 37.2%

OH & Safety Represent 66.7% 33.3% 80.0% 20.0% 32.2% 67.8% 55.6% 44.4% 25.0% 75.0% 41.1% 58.9%

Infection Control 100.0% 0.0% 100.0% 0.0% 45.2% 54.8% 75.0% 25.0% 45.2% 54.8% 60.0% 40.0%

Safety/Fire Dept. 66.7% 33.3% 87.5% 12.5% 62.3% 37.1% 75.0% 25.0% 69.0% 31.0% 70.3% 29.7%

33.3% 66.7% 94.0% 6.0% 46.9% 53.1% 55.6% 44.4% 23.3% 76.7% 48.9% 51.1%

0.0% 100.0% 5.9% 94.1% 5.7% 94.3% 0.0% 100.0% 3.2% 96.8% 4.2% 95.8%

0.0% 100.0% 54.5% 45.5% 30.4% 69.6% 50.0% 50.0% 10.7% 89.3% 26.8% 73.2%

66.7% 33.3% 62.5% 37.5% 35.3% 64.7% 62.5% 37.5% 36.7% 63.3% 44.4% 55.6%

TOTALPhysician Nurse Administrator Technician Other

Sharp Injury or BBF In Last 2 Yrs

Screened For TB Upon Hiring

OH Evaluation Upon Hiring

OH Training In Last 2 YrsTB

scr

eeni

ng, B

BF e

xpos

ure,

OH

ed

ucat

ion

Know

how

to c

onta

ct th

e fo

llow

ing:

  

Physician= including Surgeons Administrator= Clerks, Receptionists, Managers and Administrators Technician= Technologist, Technicians, Therapists Other= Pharmacist, Dietician, Psychologist, Researcher, Social Worker, Audiology     

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Table 3 – Proportion of respondents self‐reporting of  Infection Control  (IC) knowledge and Occupational Health (OH) knowledge  

Physician Nurse Administrator Technician Other TOTAL

Infe

ctio

n C

ontro

lK

now

ledg

e

Not at all / A bit 0.0% 0.0% 45.7% 22.2% 50.1% 35.4% More or

less 33.3% 5.9% 40.0% 44.4% 43.8% 35.4% Quite a bit

/ Very high 66.7% 94.1% 14.3% 33.4% 6.1% 29.2%

Rep

ortin

g K

now

ledg

e Yes 66.7% 94.1% 51.4% 66.7% 56.2% 62.5% No 33.3% 5.9% 31.4% 11.1% 21.9% 15.6% Not Sure 0.0% 0.0% 17.2% 22.2% 21.9% 21.9%

 Physician= including Surgeons Administrator= Clerks, Receptionists, Managers and Administrators Technician= Technologist, Technicians,

Therapists Other= Pharmacist, Dietician, Psychologist, Researcher, Social Worker, Audiology            

Table 4 - Proportion of respondents self-reporting knowledge of when to use Personal Protective Equipment (PPE) and how to put on and take off PPE by Clinical and Non-clinical occupation group1.

      

When to Use PPE        

   Surgical Mask 

N95 Respirator 

 Sterile        Gloves 

Non‐sterile Gloves  Goggles  Gowns/Aprons  Total 

 Clinical*                 Satisfactory  91.2%  88.6% 82.9% 88.2% 86.1% 91.4% 88.0%Inadequate  8.8%  11.4% 17.1% 11.8% 13.9% 8.6% 12.0% Non‐Clinical*               

Satisfactory  58.1% 32.6% 68.9% 63.0% 56.1% 55.0% 55.8%Inadequate  41.9% 67.4% 31.1% 37.0% 43.9% 45.0% 44.2% All Staff    77.7%      65.3%        79.4%       78.1%      76.0%            77.9% 

   75.7% 

(Satisfactory) p‐value  0.0016  <0.0001  0.1967  0.0194  0.0057  0.0006                     

     How To Put On and Take Off PPE  

   Surgical Mask 

N95 Respirator 

Sterile Gloves 

Non‐sterile Gloves  Goggles  Gowns/Aprons  Total 

 Clinical*                 Satisfactory  83.3% 83.3% 88.9% 91.7% 88.6% 94.3% 88.3%Inadequate  16.7% 16.7% 11.1% 8.3% 11.4% 5.7% 11.7% Non‐Clinical*               Satisfactory  52.3% 31.0% 60.9% 60.0% 47.6% 48.8% 50.4%Inadequate  47.7% 69.0% 39.1% 40.0% 52.4% 51.2% 49.6% All Staff    71.9      63.2%        71.9%       63.2%      77.3%          78.1% 

  70.9% 

(Satisfactory) p‐value  0.0044      0.001  0.0055      0.0018  0.0002         <0.0001   

 

*Clinical = Physicians, Surgeons, Nurses, Technicians, Other (including Pharmacists, Dieticians, Psychologists, Researchers, Social Workers, Audiologists) Non-clinical = Managers, Administrators, Clerks, Receptionists 1Satisfactory= 1= More Or Less, Quite A Bit, Very High Inadequate= 0= A Bit, Not At All

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Table 5 - Proportion correctly answering Knowledge Evaluation questions by occupation group.1

Clinical* Non-clinical*

All Staff

p-value

PHYSICAL ENVIRONMENT

Frequent cleaning of the environment is not the most important practice to prevent infections 69% 11%

32%

<0.0001

Local exhaust ventilation such as hoods is needed to protect people from breathing in harmful vapours 74% 87%

82%

0.158

SPECIFIC OCCUPATIONAL HEALTH PRACTICES AND HAZARDS All needle-stick and sharp injuries must be evaluated by an occupational health responsible/service 94% 88%

91%

0.4762

First aid kits should be centrally located in one area of the floor/building 74% 78% 77% 0.8014 Patients who are verbally abusive are not permitted to do so as part of their right to care 100% 98%

99%

1

I am capable of recognizing potentially aggressive patients 78% 71% 73% 0.6356 I know how to assess patients potential aggressive behaviour 69% 48% 56% 0.0562 SPECIFIC INFECTION CONTROL PRACTICES Needles should not be recapped before disposing in a sharps container 81% 37% 53% <0.0001 The use of gloves is always recommended, not only when the risk of blood and body fluid exposure is present 69% 60%

63%

0.0799

Patients with suspected TB cannot sit in the waiting room with other patients 78% 87% 83%

1

Having food or drinks in the clean storage places or in the medication room/work station is not permitted 94% 88%

91%

0.4752

If a patient is known to have HIV or Hepatitis you should not change your work practice 89% 72%

78%

0.0729

ERGONOMICS Twisting can be as bad for your back as lifting 97% 89% 92% 0.2513 Foot rests under desks and at work stations are not primarily used to rest your legs 97% 63%

76%

<0.0001

EQUIPMENT AND PROCEDURES It's OK to have mobile X-ray equipment used in a clinic with a number of patients because they usually don't stay long in the clinic enough to have significant exposure 91% 88%

89%

0.7397

BBF soaked linen cannot be put in any plastic bag 94% 87% 90% 0.3166 General waste and medical waste can be mixed in the same container if there are no sharps 92% 87%

89%

0.7414

1 The correct statement has been provided for clarity. The Worker Questionnaire does not explicitly state the correct answer, as written above.

*Clinical= Physicians, Surgeons, Nurses, Technicians, and Other (including Pharmacists, Dieticians, Psychologists, Researchers, Social Workers and Audiologists) Non-Clinical= Office Managers, Administrators, Clerks, Receptionists

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Table 6 - Proportion of respondents correctly practicing IC and OH & Safety Procedures' Evaluation tasks by occupation group. 1

Clinical* Non-clinical* All Staff

p-value

PHYSICAL ENVIRONMENT Always use local exhaust ventilation when working with harmful chemicals 100% 83% 91%

<0.0001

Always report witnessed spills 68% 65% 66% 0.7646 SPECIFIC OCCUPATIONAL HEALTH PRACTICES AND HAZARDS

Always use eye protection (other than prescription glasses) during procedures with potential for splashes 38% 44% 40%

0.4723

Always wear hearing protection in noisy areas 36% 36% 36% 1 Always report health and safety problems to the occupational health service 54% 47% 51%

0.3962

Always report health and safety problems to occupational health & safety committee/representative 48% 47% 48%

1

Always make suggestions for correcting health and safety problems to the occupational health service 31% 24% 27%

0.3421

Always make suggestions for correcting health and safety problems to the occupational health & safety representative 28% 29% 28%

1

Always assess patients potential for aggressive behaviour upon admission 43% 16% 30%

<0.0001

Always communicate to co-workers about potentially aggressive patients 75% 62% 68%

0.0673

Always report workplace violence incidents to managers 96% 67% 78% <0.0001 Always make suggestions for controlling workplace violence 52% 26% 37%

0.0003

SPECIFIC INFECTION CONTROL PRACTICES Always clean hands between the care of patients 79% 58% 70% 0.0022 Never change procedures if a patient is known to have HIV, Hepatitis B, and/or Hepatitis C 72% 23% 51%

<0.0001

Never recap needles 75% 50% 68% 0.0004 Always change gloves (if worn) between patients 97% 100% 98% 0.2462 Always wear N95 respirators when caring for patients with airborne diseases such as TB 85% 67% 81%

0.0046

Always utilize the online Infection Control Manual as an effective workplace tool 18% 16% 17%

0.8509

Always dispose of sharps in a sharps container 100% 94% 98% 0.0289 Never work in situations where patients suspected of having TB are seen at clinic/office 46% 39% 43%

0.3908

ERGONOMICS Always ask for help to reposition or to lift heavy objects or patients 62% 50% 56%

0.1169

Always use lifting devices that are provided 47% 83% 57% <0.0001

EQUIPMENT AND PROCEDURES Always use guards on machinery 71% 67% 70% 0.6467

1 The correct statement has been provided for clarity. The Worker Questionnaire does not explicitly state the correct answer, as written above. *Clinical= Physicians, Surgeons, Nurses, Technicians, and Other (including Pharmacists, Dieticians, Psychologists, Researchers, Social Workers and Audiologists) *Non-Clinical= Office Managers, Administrators, Clerks, Receptionists 

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Part 4­ Healthcare worker and public education sessions 

A  total  of  7  education  sessions were held  for  all  staff  at  the Gordon  and Leslie Diamond 

Health  Care  Centre  with  146  staff  members  in  total  attending.    The  content  of  these 

sessions  included  basic  infection  control  and  occupational  health  principles  as well  as  a 

specific  focus on  the prevention and control of  influenza  like  illness  in  light of  the H1N1 

outbreak.   Two full‐day interactive public hand hygiene demonstrations were also held in 

the  lobby  of  the  facility.  These  sessions  allowed  the  public  to  test  their  hand  washing 

technique using Glo‐Germ to mimic  soap.    Informational brochures and question/answer 

periods  were  also  included  in  the  sessions.    These  events  garnered  interest  from  176 

attendees.   All  sessions  received positive  feedback  from  staff  and members of  the public 

alike. 

 

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Implications for future research/projects on workplace health and safety  

The ambulatory care setting offers distinct advantages to patients, by combining disciplines 

in  one  central  location  and  offering  a  variety  of  diagnostic  tests  on  an  outpatient  basis. 

Outpatients are now more likely to have unstable medical conditions that can pose an IPC 

or  OH  risk  to  healthcare  workers  who  traditionally  have  not  received  comprehensive 

training in these fields compared to their acute care colleagues. Further coordinated efforts 

are  necessary  to  protect  workers  in  ambulatory  care  facilities  from  the  possibilities  of 

infections and occupational risks, while also considering the unique challenges and benefits 

presented by this setting.    

Ambulatory care medical procedures may put patients and staff at risk of infections. While 

this risk is still considered low21 when compared to hospital‐based care, there is a risk to 

workers, and sometimes patients, as more complex and invasive procedures are performed 

in this setting. Surgical procedures that were once carried out in a hospital are now done in 

an ambulatory care setting22,  23 resulting in greater exposure to blood and body fluids for 

workers and patients alike.  Our findings suggest that staff in ambulatory care settings have 

not  been  reached  by  traditional  training methods  in  occupational  health  and  safety  and 

infection  control  based  on  the  intellectual  knowledge  scores.    The  Joint  Commission’s 

Surveillance, Prevention and Control of  Infection Standards  for Ambulatory Care espouse 

principles  which  are  almost  identical  to  the  standards  for  a  hospital  setting24.  This  is 

warranted  as  hospital  settings  and  ambulatory  care  are  moving  in  the  direction  of 

providing the same care. Special attention must be paid to education and communication 

due to the diverse worker population who may not possess the basics in IPC.  

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In  addition,  it  is  noted  that  the  scope  of  occupational  health  services  considered  in  this 

study  was  much  more  narrow  than  the  internationally‐recommended  roles  for 

occupational health practitioners in primary, secondary, and tertiary prevention regarding 

the  full  array  of  physical,  chemical,  biological,  ergonomic  and  psychosocial  hazards  in 

workplace settings, nor did this study explore the adequacy of joint labour‐employer health 

and safety committee functions.  Rather, this study adopted a much more narrow concept 

of the role of occupational health services commonly accepted in this jurisdiction, in order 

to develop recommendations that would be more readily implemented.   Further research 

is therefore still needed in this area.  

  Identification  of  immediate  and  long­term  benefits  of  the  findings  or res ltu s 

1. Ambulatory  care  visits  continue  to  increase.    The  findings  of  this  project  have 

informed  the  following  recommendations  to  improve  occupational  health  and 

 

infection control in ambulatory care settings: 

2. Needs assessment using tools such as a workplace assessment checklist, Glo‐Germ 

environmental audits and worker knowledge, attitudes and practice questionnaires 

inform  the  development  and  implementation  of  new  programs,  services  and 

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educational initiatives. 

3. Staff need to have access to regular, documented in‐services targeted at clinical and 

non‐clinical staff.   The results of  the questionnaire suggest that gaps  in knowledge 

and  practice  exist  in  ambulatory  care  and  that  targeted  training  and  educational 

initiatives  are  necessary.  These  sessions  can  provide  education  and  training  on 

occupational  health  and  infection  control  basics, while  also  providing  a  venue  for 

the delivery of specific messages as in the case of pandemic H1N1. 

4. An  occupational  health  and  infection  control  program  should  be  part  of  the 

administrative  structure  and  represented  on  relevant  committees.  Strong 

managerial  support  and  engagement  by  all  public  and  private  organizations 

represented  in  ambulatory  care  partnerships  is  required  during  all  phases  of 

rprogram design and delivery to ensure both healthcare wo ker and patient safety. 

5. Examine  cleaning  contracts  to  ensure  that  the  cleaning  requirements  reflect  the 

acuity of the population and are not biased towards office style cleaning.  Roles and 

responsibilities of front‐line healthcare workers and cleaning staff need to be clearly 

outlined  to  ensure  that  all  items  and  equipment  are  cleaned  regularly.    Audits  of 

process (i.e. how cleaning occurs) and glo‐germ audits (or similar technology using 

fluorescent markers  that  examine  cleaning  efficacy)  serve  as  both  an  educational 

tool  (for  both  healthcare  workers  and  housekeeping  staff)  and  a  quality 

improvement measure. 

6. Plans  for  ambulatory  care  services  must  consider  the  increasing  volume  and 

complexity.   This  includes consideration of  issues such as waste disposal  facilities, 

storage  space  for  more  acute  care  patient  supplies,  ambulation  aides,  improved 

lighting, and adequate space for procedure rooms. 

7. To  that  end,  thoughtful  consideration  should  be  give  to  deliberately  building  in 

redundancies to address physical plant changes due to re‐allocation of space and the 

development of new technologies (e.g. extra electrical outlets, moveable partitions). 

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8. Algorithms  to  identify  and  manage  patients  at  high  risk  for  transmission  of 

communicable diseases would be beneficial.  These algorithms should not simply be 

extrapolated from acute care settings but developed to reflect the needs and patient 

flow in an outpatient setting. 

9. The Infection Control and Occupational Health resources required should consider 

consultation,  education/training,  workplace  assessments,  investigations  and 

policy/procedure  development.  The  resources  required  will  of  course  depend  on 

the  size  of  the  facility  and  the  population  served.      For  the  Gordon  and  Leslie 

Diamond  Health  Care  Centre,  a  new  11‐storey,  365,000  square  foot  healthcare 

facility,  we  recommend  a  0.5  FTE  Infection  Control  Practitioner  and  a  0.25  FTE 

Occupational Health Professional. 

Identification of relevant user groups for the research/project results  

The  research  team  anticipates  that  the  recommendations made  above will  be  useful  for 

planning  purposes  for  anyone  who  is  involved  in  establishing  an  occupational  health 

and/or  infection  control  program  in  an  ambulatory  care  setting.    The  findings  of  this 

project  are  particularly  relevant  to  the  following  user  groups  in  the  ambulatory  care 

setting: 

• trative personnel Executive/adminis

• Clinical Managers 

• s Building/Administrative Manager

• Contracted Cleaning Company 

•  staff  Front‐line clinical

• Non‐clinical staff 

• ators Medical educ

• Researchers 

• The general public  

 

 

 

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Dissemination/knowledge transfer  The  research  team met  once  per  month  with  the  Diamond  Centre  User’s  Committee  to 

share progress  and  results  and  to  request  feedback and  input.   Activities  that promote a 

two‐way  dialogue,  not  a  one‐way  flow  of  information  (such  as  face‐to‐face  meetings  or 

briefings)  are  a  very  effective  way  to  reach  decision  makers  such  as  managers,  senior 

administrators and health authority executives.   

As mentioned previously,  findings were disseminated  front‐line workers as  “FAQ Sheets” 

as well as during education sessions. The findings of this project informed the development 

of a section  focusing on Infection Prevention and Control  to be  included  in the handbook 

for new medical students (Appendix VI).   

The  research  team also presented  results  at  the Canadian and Hospital  Infection Control 

Association conference in Vancouver. 

The findings from the worker knowledge, attitudes and practice questionnaires have been 

accepted  for  publication  in  the  peer‐reviewed  Journal  of  Ambulatory  Care Management. 

The  article  is  entitled:  “Preventing  infections  in  the  ambulatory  care workforce: What  do 

healthcare workers know and do?” 

This  final  report  will  also  be  distributed  to  the  GLDHCC  user  committee  as  well  as  any 

individuals who are interested. 

 

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15. Alfa MJ,  Dueck  C,  Olson N,  Degagne  P,  Papetti  S, Wald  A,  et  al.  UV‐visible marker 

confirms that environmental persistence of Clostridium difficile spores in toilets of 

patients with C. Difficile  associated diarrhea  is  associated with  lack of  compliance 

with cleaning protocol.  BMC Infect Dis 2008;8:64. 169.  

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16. Carling  PC,  Von  Beheren  S,  Kim  P,  Woods  C.  Intensive  care  unit  environmental 

cleaning:  an  evaluation  in  sixteen  hospitals  using  a  novel  assessment  tool.  J  Hosp 

Infect 2008;68(1):39‐44. 171.  

17.  Blue  J, O'Neill  C,  Speziale P, Revill  J,  Ramage L,  Ballantyne L. Use of  a  fluorescent 

chemical as a quality indicator for a hospital cleaning program. Can J Infect Control 

2008;23(4):216‐9. 

18. Hersey,  J.C., & Martin, L.S.  IC. (1995) Use of IC guidelines by workers in healthcare 

facilities  to  prevent  occupational  transmission  of  HBV  and  HIV:  results  from  a 

national survey. Todays Or­Nurse.17(3), 37­48, 1995. 

19. Villeneuve, J. (1998) The ceiling lift: An efficient way to prevent injuries to nursing 

staff. Journal of Healthcare Safety, Compliance and IC, 9‐24. 

20. Begue, R.E., & Gee, S.Q. (1998) Improving influenza immunization among healthcare 

  7), 518‐20. workers. Infect Control Hosp Epidemiol, 19(

21.   Friedman,  C.,  &  Petersen,  K.H.  (2003)    IC  in  Ambulatory  Care:  Jones  &  Bartlett 

Publishers. 

22. Davis,  J.E.  (1993)  Ambulatory  surgery  ...  how  far  can we  go? Med  Clin North Am, 

77(2), 365‐75. 

23. Manian,  F.A.  (1997)  Surveillance  of  surgical  site  infections  in  alternative  settings: 

exploring the current options. Am J Infect Control, 25(2), 102‐5. 

24. Joint Commission on Accreditation of Healthcare Organizations. (2000) Surveillance, 

Prevention and Control of Infection Standards for Ambulatory Care. #6332. 

 

 

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Additional Relevant References 

1‐ Gamage  B,  Moore  D,  Copes  R,  et  al.  BC  Interdisciplinary  Respiratory  Protection  Study 

Group.  Protecting  health  care  workers  from  SARS  and  other  respiratory  pathogens:  a 

review of the infection‐control literature. Am J Infect Control 2005; 33(2):114‐121. 

2‐ Talbot TR, Bradley SE, Cosgrove SE et al. Influenza vaccination of healthcare workers and 

vaccine  allocation  for  healthcare  workers  during  vaccine  shortages.  Infect  Control  Hosp 

Epidemiol 2005;26(11):882‐890. 

3‐ Wilde JA, McMillan JA, et al. Effectiveness of influenza vaccine in health care professionals: 

a randomized trial. JAMA 1999; 281(10):908‐913. 

4‐ Johnson DF, Druce JD, Birch C, et al, A quantitative assessment of the efficacy of surgical and 

N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 

2009; 49(2):275‐277. 

5‐ Grayson ML, Melvani S Druce J, et al. Efficacy of soap and water and alcohol based hand‐rub 

preparations  against  live  H1N1  influenza  virus  on  the  hands  of  human  volunteers.  Clin 

Infect Dis 2009;48(3):285‐291. 

6‐ Sydnor  ERM  and  Perl  TM.  Hospital  Epidemiology  and  Infection  Control  in  Acute‐Care 

Setting. Clin Micro Rev 2011; 241:141‐173. 

7‐ Loeb M Dafoe N, Mahony J. et al. Surgical mask vs N95 respirator for preventing influenza 

among health care workers: a randomized trial [published online Oct 1, 2009] JAMA 2009, 

302(17) 1865‐1871. 

 

 

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APPENDIX I- Logical Framework Analysis ACTIVITIES (INPUTS)  OUTPUTS  OUTCOME/IMPACT Design Development of a comprehensive occupational health and infection control program

-Establishment of policies and procedures -Staff education programs in place -Surveillance

-a comprehensive, consistent and sustained occupational health and infection control program designed specifically for the ambulatory care setting

Implementation Staged implementation with priorities as follows: a) Education*

b) Policies and Procedures c) Surveillance *Education preceded policy/procedure development as clinical situations (eg. H1N1, norovirus) dictated its immediacy.

-reduction in number of needlestick injuries -elimination of hazards -reduction in the number of infectious disease exposures -confident personnel with good understanding of workplace conditions -safer workplaces (specific to ambulatory care settings) -decrease in the number of identified hazards safer, healthier workplace and workforce -decreased incidents - increased reporting -decreased absenteeism -increased public knowledge regarding IC issues

Establish a joint occupational health and safety committee with IC representation

-8 individuals selected for committee (representing VCH, UBC, and BLJC) -Clear and defined committee mandate

-an active, functioning occupational health and infection control committee at GLDHCC -presence at monthly building managers meeting

Ongoing Comprehensive Evaluation Plan further program enhancements -1 formal program evaluation conducted at 6 months

post intervention and annually after program is finalized

-feedback from staff regarding value of program -implementation of changes and recommendations -an up-to-date and fully functioning program

Disseminate findings and promote knowledge translation

- distribution of meeting minutes to all staff after each committee meeting -findings presented to key decision makers on a regular basis -a strengthened occupational health and infection control team

-a sustainable, comprehensive program -reduction in gaps in cleaning -informed review of process -cleaning staff educated re infection control issues

Ensure sustainability of program -1 dedicated IC champion in the facility -involvement of management

-long term success of the program -management support

Strengthen Collaborations and Linkages Meet with all relevant stakeholders -1 meeting with all relevant stakeholders per year

-Hold quarterly meetings with clinic supervisors to communicate and reinforce OH/IC awareness.

-strong stakeholder relations and buy-in -clear roles and responsibilities

Regular Occ Health and IC committee meetings -2 committee meetings per year -valuable programmatic input from committee -ownership of the program

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APPENDIX II- Workplace Assessment Tool Name of Department/Unit :_____________________________

Date of Inspection:______________________________________

No. examination rooms:___________ No. Patients:_______________ Persons Conducting Inspection:___________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________

Unit Supervisor:___________________________________

Number of Employees on unit: ____________

Number of Employees working at this moment: ____________

Number of Nurses:_____

Number of Nursing Assistants: _______

Number of Doctors: ______

Number of Unit Clerks/receptionists:_____

Number of Contracted Workers:__________

Number of “other” personnel: _______ Unit’s Worker Health & Safety Rep. present? Y / N Name:_______________________________________________

Hazard classification Hazard Elements Physical hazards Ionising and non-ionising radiation, noise, vibration, heat, cold, ventilation, illumination,

electricity, fire, sharps Chemical hazards Natural and synthetic compounds that may be in the state of a dust, gas, vapour or fluids Biological hazards Viruses, fungi, parasites, bacteria, pests, reptiles, animals Ergonomic hazards Equipment, tools, work processes, poor lighting, workplace layout and design Safety hazards Trip, slip, fall, unsafe and unguarded equipment, confined spaces, obstructed work areas and

passageways Psychosocial hazards

Aggression, violence,, shift work, emotional stress, over-crowding, understaffing, excessive pace of work, poor interpersonal relationships, fatigue, harassment

Inspection categories:

Satisfactory (S) Hazard requires correction but not an immediate hazard (C)

Hazard requiring immediate correction (IC)

Not Applicable (N/A)

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ITEM / DESCRIPTION INSPECTION CATEGORY

Comments/Recommended Controls Person Responsible & Due Date

PHYSICAL ENVIRONMENT S C IC N/A

1) Floors, walls, doors, shelves and ceilings

a) floors slip- proof

b) floors, walls, doors and ceilings clean and intact

c) floors and doors clear of obstructions

d) good drainage for spills

e) changes in floor levels clearly marked

f) no moulds (eg. mildew) or fungus

g) no cords on floors or other tripping hazards

h) asbestos labeled and properly removed

i) shelves present and adequate to support material

j) steps and rails

k) ramps for disabled

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2) Lighting/Electrical S C IC N/A

a) Lighting adequate, maintained

b) Task specific lighting present where appropriate

c) Natural lighting adequate

d) Emergency lighting provided and maintained 

e) Electrical outlets well located

f) Outlets sufficient to avoid overloading

3) Ventilation/Air Exchange S C IC N/A

a) Natural ventilation adequate

b) Adequate air exchange(s) for services rendered

c) Appropriate ventilation in Sterile Processing unit

d) mechanical exhaust ventilation for hazard emissions such as sterilizing chemicals,e.g., radiology

4) Emergency Exits and Fire protection S C IC N/A

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a) Emergency exits visible

b) Emergency exits free from obstruction

c) Emergency evacuation plan posted

d) Fire extinguishers present

e) Fire extinguishers regularly inspected

f) Fire protection equipment (e.g. hoses) accessible and maintained

g) Sprinkler systems maintained 

5) Clean and Orderly Appearance, enough room to work

S C IC N/A

a) Hallways

b) Examination/treatment rooms

c) Storage rooms

d) Utility rooms

e) Medication rooms

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f) Equipment Storage

g) Chemical Storage

h) Staff areas

i) Work areas (e.g., maintenance rooms)

j) Containers with proper lids 

6) Signage present and instructions clear S C IC N/A

a) Blood Body Fluid Exposure Management

b) Hazardous Chemicals: Labels and MSDSs

c) Restricted Area

d) Fire Exits

e) Evacuation Routes

f) Isolation Signs

g) Wet floors

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h) Eye wash stations (eg, in laboratories, chemical storage areas)

i) Instructions for use of Personal Protective Equipment

j) Noise protection required

k) Biohazardous area

l) Radiation area

m) Hand hygiene posters 

7) Waste Disposal S C IC N/A

a) Written Biohazardous waste protocol present

b) Written regular waste disposal protocol present

c) Appropriately labeled containers/bags for biohazardous waste

d) Waste facility are clean and well maintained

e) Body fluids, feces disposed of in bedpan cleaner 

SPECIFIC OCCUPATIONAL HEALTH PRACTICES AND HAZARDS

S C IC N/A

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8) First aid

a) appropriate contents

b) at least 1 kit per work area present

c) kits maintained

d) easily accessible

e) personnel trained in first aid, posted and available

f) disaster plan posted (eg, fire or emergency evacuation route)

9) Occupational Health and Safety Act accessible

S C IC N/A

a) OHS Reporting procedures posters displayed

b) Workers’ Compensation Reporting procedures posters displayed

c) Basic Conditions of Employment Act displayed

d) Incidents/accidents reported, registers kept and investigated

e) Health and safety complaint forms available, used and responded to

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f) Occupational Health and Safety procedures accessible

g) Minutes of OHS Committee posted or passed out 

h) Copy of the compliance certificate displayed

i) Injury On Duty register available

j) The facility have an OH physician

k) The facility’s mission/value statement mentions the health and safety of workers as being a priority

l) Vaccination are mandatory for HCWs as a condition of employment

m) The facility provides baseline skin testing for TB exposure monitoring

n) There is a policy or mechanism in place that allows workers to provide feedback to management regarding workplace health and safety concerns

o) There are at least monthly communication methods of OH information to staff

p) Staff training have an occupational health component

10) Psychosocial hazards S C IC N/A

a) Measures in place for reporting workplace violence

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b) Procedures for handling aggressive patients

c) Staff identification badges worn

d) Contact numbers for Security posted

e) Security available and immediately accessible

f) Entrances Exits, parking areas and outside walkways well lit and secure

g) Access is controlled

h) No working alone

i) staffing patterns and workload

j) teamwork

k) Nurse autonomy for decision-making

l) Effective Communication

m) Supportive Climate

n) Education to meet staff learning needs on violence in the workplace

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o) Protective security devices

11) Chemical hazards    

S C IC N/A

a) All chemical containers labeled

b) Material Safety Data Sheets (MSDSs) available and up-to-date

c) Workers educated and trained about chemical hazards

d) More hazardous chemicals replaced with less hazardous chemicals

e) Adequate time for pesticide residue to be reduced; Switch to less hazardous types of pest control. 

12) Radiation Hazards S C IC N/A

a) Lasers shielded, ventilated and eye protection provided

b) X-ray equipment shielded and tested regularly

c) Adequate distance of the exposure button from machine (>1m)

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SPECIFIC INFECTION CONTROL PRACTICES S C IC N/A

13) Sinks

a) Number of sinks present in area

b) Sink for each examination/treatment room

c) Sinks clean and well maintained

d) Sink present in dirty utility room

e) Sink present in clean room

f) “Clean” and “Dirty” sinks identified

g) Antiseptic soap or alcohol hand rub available

h) Towels available

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14) Suitable Personal Protective Equipment Adequate supplies of:

S C IC N/A

a) Non-sterile gloves, non-latex

b) Sterile gloves, non-latex

c) Surgical masks

d) N95 respirators supplied

e) N95 respirators in adequate amounts

f) N95 respirator training on fit checking and/or fit testing

g) Protective eyewear

h) Fluid impermeable gowns

i) Isolation gowns or aprons

15) Infection control organizational resource

a) The facility has an IC officer

b) There is active surveillance of nosocomial infection in your facility

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c) IC policies have been updated with respect to protecting staff from infectious disease at work in the last two years

d) Information about rates of hospital-acquired infections disseminated to the staff

e) Staff training has an infection control component

16) Sharps handling S C IC N/A

a) Sharps disposal container point-of-use

b) Needles not recapped

c) Sharps containers not overfilled (2/3 full)

d) Safety engineered needles available and used

e) Segregation of waste adhered to

17) Isolation Practices S C IC N/A

a) Signage clearly posted outside isolation rooms

b) Instructions for personal protective equipment posted

c) Infection control protocols for categories of isolation available 

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d) Effective education and training in all infection control procedures

18) Patient Care areas: Treatment Room/Examination Room

S C IC N/A

a) No evidence of food consumption by staff

b) No evidence of consumption of beverages by staff

c) No evidence of food storage in medication refrigerators

d) No evidence of smoking by staff

e) Adequate distance (greater than one metre between beds

f) Infection Control Manual accessible

19) Staff areas S C IC N/A

a) Staff toilets clean

b) Staff toilets with adequate toilet paper and towels (preferably paper) and soap

c) Staff lounge present and clean with no medical supplies or devices present

d) Staff lockers/change area accessible and available

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EQUIPMENT AND PROCEDURES S C IC N/A

20) Patient Care Areas

a) Glucometers, oximeters, monitoring equipment clean and well maintained

b) Patient lifts available, maintained and clean

c) Bedpans, commodes available and clean

21) Laboratory Areas: Outpatient Laboratory S C IC N/A

a) Centrifuges, automated equipment clean and well maintained

b) Biosafety cabinets present and regularly inspected

c) Chemical hoods present and regularly inspected

d) Splashguards in place where specimens are opened

e) Compressed gases secured, regularly inspected and maintained

f) Chemical flammable safety storage cabinets available and used

g) Equipment and supplies designated as single use not reused (e.g. blood tubes)

h) Chemicals clearly labeled

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i) Goggles and face shields available

j) Eye wash facilities and safety showers maintained

k) Fire extinguishers available

22) Radiology S C IC N/A

a) Rooms properly marked and only authorized workers permitted in

b) Room doors closed when equipment in use

c) Rooms lead lined

d) Where portable X ray units used, only patient and authorized worker allowed in room

e) Personal dosimeters worn by workers

f) Exposure levels recorded and analyzed

g) Appropriate eye protection provided

h) Lead aprons and collars worn  

i) Radiological solutions handled appropriately

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j) Lead aprons clean and intact

k) Staff in radiology have exposure badges

23) Maintenance areas S C IC N/A

a) Motorised equipment maintained and inspected regularly

b) electrical tools and cords maintained and grounded

c) Hand tools maintained

d) Machine guarding provided and maintained

e) Reduce noise at source

f) Ear protection provided

g) Vessels under pressure maintained and regularly inspected (certificate of manpower)

h) Chemicals clearly labeled

i) Proper lock-out (disconnect) system for all equipment

j) Steam, gas and water pipes clearly marked

k) Ladders maintained in good condition

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l) Lifts available and maintained

ERGONOMICS S C IC N/A

a) Suitable ergonomic chairs available and workers encouraged to do at least part of their jobs sitting, if possible

b) Foot rests provided for desks and work stations

c) Countertops and workstations at appropriate height and adjustable

d) Work stations designed to reduce excessive reaching

e) Ergonomic lifting devices available

f) Procedures to eliminate or reduce heavy lifting and twisting

g) Store heavy items at waist height

h) Push carts provided with handles at comfortable level, good wheels, and not over-loaded

i) Adequate rest periods for workers to sit

j) Reduce requirements to stand in one place

k) Provide anti-fatigue mats, especially for standing jobs

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l) Comfortable, cushioned footwear provided and worn

m) Adequate numbers of staff to reduce overuse injuries

n) Pregnant workers don’t stand all shift or sit all shift

o) Provide tilt bins with hydraulic lifts

p) Use turntables and conveyors where material needs to be moved 

Description of the Service including number of rooms, floor plans, number and location of fixed equipment such as sinks, general layout by drawing a block diagram (use additional page). The block diagram is a map of the workplace and its hazards: ___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

_ 

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APPENDIX III- Glo-Germ Environmental Audit Template

Glo‐Germ Environmental Audit Diamond Centre  Date: ______________________________________ Location: ____________________________________  

  Location  Pass  Fail 

1  Door Handle     

2  Light Switch     

3  Sink      

4  Taps     

5  Soap Dispenser     

6  Paper Towel Dispenser     

7  Chairs     

8  Bedside Table     

9  Bed Rails     

10  Bed Mattress     

11  Sharps Container     

12  Handle Overhead Lamp     

13  Stool     

14  Toilet Seat     

15       

16       

17       

18       

19       

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APPENDIX IV- Knowledge, Attitudes and Practice Worker Questionnaire

HEALTH & SAFETY QUESTIONNAIRE As part of an occupational health and safety project conducted by the Infection Control & Occupational Health Subcommittee and funded by WorkSafeBC, we would like to ask you to fill out this questionnaire. This form is divided into four sections. The first section asks you to tell us about your profession and your workplace experiences. The second section asks you about previous education and training, and the third section is an assessment of your knowledge of infection control and occupational safety. The fourth section is a self-report of what your work practices are. Your answers will be confidential and free of personal identification. Your participation in this research is completely voluntary. Refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled. Please note that by completing this questionnaire, you are voluntarily agreeing to participate in this research study. You will remain anonymous and your data will be treated confidentially at all times. You may withdraw from this study at any moment. WHEN COMPLETED: PLEASE LEAVE WITH RECEPTIONIST OR SLIDE UNDER DOOR OF INFECTION CONTROL OFFICE 4221. TO BE ELIGIBLE FOR A STARBUCKS GIFT CARD, RETURN TO A RESEARCH TEAM REPRESENTATIVE. Interviewee Code (This allows us to track these forms with a follow-up study while protecting your identity.)

Please write the first three letters of your mother’s first name

And the first three letters of your mother’s maiden surname SECTION 1 Information About You

1. Are you employed by:

University of British Columbia Vancouver Coastal Health Private physician or group of physicians Private other

_____________________

2. What is your occupation? (Please, mark only one answer)

Physician Surgeon Nurse Therapist Manager/administrator Clerk/Receptionist Technologist/technician

(specify) ________________________ Student (specify) __________________ Researcher ___________________

Other (specify) ________________________

3. Age: Less than 20 20-29 30-39 40-49 50-59 more than 60

4. Sex: Male Female

5. What is the area you work in? (Please, mark only one answer)

Private ambulatory unit UBC ambulatory unit VCH ambulatory unit Maintenance Food outlet Medical

Laboratory (specify): _________________________ Housekeeping Administration Security Sterile processing

department Other: (specify) _________________________

6. Are you unionized? YES NO

Please name the union to which you belong:__________________________________

7. How many years have you worked in this clinic/office? ______________

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8. How long have you worked in this building? ______________

9. Do you know how to contact the Occupational Health Department (Worksafe & Wellness VCH)?

YES NO Can’t remember

10. Do you know how to contact your joint occupational health and safety committee representative?

YES NO Can’t remember

11. Do you know how to contact Infection Control?

YES NO Can’t remember

12. Do you know how to contact your internal unit or department safety/fire officer?

YES NO Can’t remember

13. Did you have a needle stick/sharp injury or other exposure to blood or body fluids in the last 2 years?

YES NO Can’t remember

If YES, to the above question, to whom did you report the injury or exposure?

Occupational Health Infection Control First Aid Health and Safety Committee representative Colleague Supervisor Other (please specify) ______________________ I did not report

If you have NOT reported, please check off all that apply:

Did not know how or to whom to report it Did not think it was serious or anything needed to be done for follow-up Thought I would be blamed or made to feel bad for allowing this to happen Other (please specify) ______________________

14. Have you been vaccinated for influenza this year? YES NO Can’t remember

15. Do you get vaccinated for influenza every year? YES NO Can’t

remember

16. Have you been vaccinated for Hepatitis B? YES NO Can’t remember

17. If YES to Q16, have you completed all 3 doses? YES NO Can’t

remember

18. If NO to Q15 or Q16, describe reasons: _________________________________________

19. Were you screened for tuberculosis upon employment? YES NO Can’t remember

20. Do you ever use a N95 respirator? YES NO Can’t remember

I don’t know what a N95 respirator is

21. Did you have an occupational health evaluation upon hiring? YES NO Can’t remember

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SECTION 2 Self-evaluation on learning activities and practices Please mark the option which best reflects your practices.

1. Have you received health & safety training in the last 2 years? YES NO

2. Please identify the training you have had in the past 2 years. (Mark with an X)

Training Taken YES NO Not Applicable

a. Hand Hygiene

b. Isolation Procedures

c. Use of personal protective equipment

d. Needle-stick and sharps injury prevention

e. HIV/AIDS prevention

f. Waste disposal management

g. Chemical hazards including chemicals used for cleaning

h Ventilation requirements

i. Machine hazards

j. Safe patient handling or prevention of back injuries

k. Violence prevention

l. Accessing first aid for injuries

m. Psycho-social stresses at work

n. Reporting injuries through Employee Incident Report

o. Emergency procedures

p. Online infection control module

3. Do you know how to access the online infection control manual? YES NO

4. Rate your knowledge about infection control practices. 1 Not at all

2 A bit

3 More or less

4 Quite a bit

5 Very High

5. Rate your knowledge about WHEN to use the following personal protective equipment:

1 Not at all

2 A bit

3 More or less

4 Quite a bit

5 Very High

Not applicable

Surgical mask

N95 respirator

Sterile gloves

Non sterile gloves

Goggles

Gowns/Aprons

6. Rate your knowledge about HOW to put on and take off the following personal protective equipment:

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1 Not at all

2 A bit

3 More or less

4 Quite a bit

5 Very High

Not applicable

Surgical mask

N95 respirator

Sterile gloves

Non sterile gloves

Goggles

Gowns/Aprons

7. Rate your knowledge about recommended procedures and protocol during the following outbreaks:

1 Not at all

2 A bit

3 More or less

4 Quite a bit

5 Very High Unsure

Influenza

Gastrointestinal (GI)

8. I know how to report a workplace risk/hazard YES NO Not Sure

9. I know how to report a workplace injury through an employee incident report. YES NO Not Sure

SECTION 3 Knowledge evaluation Please mark YES or NO

1. Needles should be recapped before disposing in a sharps container. YES NO

2. The most important practice to prevent infections is the frequent cleaning of the environment.

YES NO

3. The use of gloves is recommended only when the risk of blood and body fluid exposure is present.

YES NO

4. Patients with suspected tuberculosis can sit in the waiting room with other patients.

YES NO

5. All needle-stick and sharp injuries must be evaluated by an occupational health responsible/service.

YES NO

6. Having food or drinks in the clean storage places or in the medication room/ work station is permitted as long as the items are disposed of afterwards.

YES NO

7. The Infection Control manual available at the Front Desk is a valuable tool for proper cleaning protocol.

YES NO

8. Local exhaust ventilation such as hoods is needed to protect people from breathing in harmful vapours.

YES NO

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9. First aid kits should be centrally located in one area of the floor/building.

YES NO

10. Patients who are verbally abusive are permitted to do so as part of their right to care.

YES NO

11. If a patient is known to have HIV or Hepatitis you should change your work practice.

YES NO

12. As long as you know how to lift heavy things properly your risk of back injury is minimal.

YES NO

13. It’s OK to have mobile X-Ray equipment used in a clinic with a number of patients because they usually don’t stay in the clinic long enough to have significant exposure.

YES NO

14. Twisting can be as bad for your back as lifting. YES NO

15. Foot rests under desks and at work stations are primarily used to rest your legs.

YES NO

16. Blood / body fluid soaked linen can be put in any plastic bag. YES NO

17. General waste and medical waste can be mixed in the same container if there are no sharps.

YES NO

18. I am capable of recognizing potentially aggressive patients YES NO

19. I know how to assess patients potential aggressive behaviour. YES NO

SECTION 4 Infection control and occupational health and safety procedures’ evaluation Please mark the option which best reflects your practices.

1. I use eye protection (others than prescription glasses) during procedures with potential for splashes and aerosols:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

2. I clean my hands between the care of patients:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

3. I change my procedures if I know a patient has HIV, hepatitis B or C:

Never Half of the time Always

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0% 25% 50% 75% 100% Not applicable

4. I recap needles:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

5. I change gloves (if worn) between patients:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

6. I ask for help to reposition or to lift heavy objects or patients:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

7. I use local exhaust ventilation when working with harmful chemicals:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

8. I wear N95 respirators when caring for patients with airborne diseases such as TB:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

9. I wear hearing protection in noisy areas:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

10. I use lifting devices that are provided:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

11. I use guards on machinery:

Never Half of the time Always

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0% 25% 50% 75% 100% Not applicable

12. I report spills I see:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

13. I report health and safety problems to the occupational health service:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

14. I report health and safety problems to my occupational health and safety committee/representative:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

15. I make suggestions for correcting health and safety problems to the occupational health service:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

16. I make suggestions for correcting health and safety problems to my occupational health and safety committee representative:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

17. I dispose of sharps in a sharps container:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

18. I work in situations where patients suspected of having TB are seen at clinic/office:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

19. I assess patients' potential for aggressive behaviour upon admission:

Never Half of the time Always

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0% 25% 50% 75% 100% Not applicable

20. I communicate to co-workers about potentially aggressive patients:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

21. I report workplace violence incidents to managers:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

22. I make suggestions for controlling workplace violence:

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

23. I utilize the online Infection Control manual as an effective workplace tool.

Never Half of the time Always

0% 25% 50% 75% 100% Not applicable

If you do not use the online Infection Control manual, who do you seek Infection Control knowledge from (please

specify):______________________________________________________________________________

SECTION 5 In the following section, we would like to ask you about the safety climate, attitude and perception in safety and risk in your current work area. There are no “right” or “wrong” answers. Please tell us your choice for each of the following statements (check only one scale per question) 1. I think about how my job or work area can be made safer and make suggestions:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

2. I get clear supervision regarding safe work practices:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

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3. I feel safe from violence at work:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

4. I am encouraged to report injuries and illness at work:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

5. On my unit, non-compliance with infection control and safety practices are corrected:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

6. On my unit, people are recognized for complying with infection control and safety practices:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

7. In my current work area, there is open communication between supervisors and staff:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

8. In my current work area, follow-up investigations of reported incidents are a priority with management:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

9. In my current work area, supervisors and infection control representatives work together to ensure the safest possible working conditions with regards to infectious diseases:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

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10. In my current work area, I believe that management attitudes about routine infection control practices influence employee behaviour:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

11. I have too much to do to always follow routine infection control practices:

Strongly disagree

Somewhat disagree

Neither agree nor disagree

Agree Strongly agree

Not applicable

0% 25% 50% 75% 100%

12. If I contracted infectious disease from direct patient contact, I believe the impact on my own health would be:

Extremely severe

Severe Moderate Mild Minimal Don’t know

0% 25% 50% 75% 100%

13. I believe my own risk for contracting infectious disease by caring for patients with the infectious diseases is:

Extremely severe

Severe Moderate Mild Minimal Don’t know

0% 25% 50% 75% 100%

14. I believe the risk of transmitting infectious disease such as influenza to others close to me (e.g. family, friends) is:

Extremely severe

Severe Moderate Mild Minimal Don’t know

0% 25% 50% 75% 100%

15. I like to think things over carefully before I act:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

16. I follow the safety rules for infection control at work:

Never Half of the time Always Not applicable

0% 25% 50% 75% 100%

17. I make my own judgements as to when to use Personal Protective Equipment (PPE) to prevent infectious disease transmissions:

Never Half of the time Always Not applicable

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0% 25% 50% 75% 100%

18. For areas where you feel that your practices are less than what you feel is recommended, why do you think this is?

Not at all important

Not very important

More or less important

Quite important

Very Important

Not applicable

Not enough time

Unavailability of proper equipment

Unavailability of proper space

Do not feel the risk requires it

Peer pressure

Not well enough trained

Proper supervision not provided

Other (please specify)

____________________________

If you have any comments or suggestions, please write them in the space provided below. Thank you for your time and your answers.

__________________________________________________________________________________________________________________________________________________________________

APPENDIX V- FAQ Sheet  

Dear Colleagues, Thank you for taking the time to complete The Health and Safety Questionnaire for the ongoing WorkSafe BC funded project assessing occupational health and infection control needs at the Gordon and Leslie Diamond Health Care Centre. Your responses and feedback are extremely valuable and greatly appreciated. Attached are the results of the questionnaire showing percentages of CORRECT responses. Please take a moment to review and see where strengths and weaknesses in your knowledge and practice exist. Highlighted in red are results that are particularly noteworthy. We have also included some helpful key points to remember in the survey section and as an attachment. We will be re-administering the questionnaire in the near future and look forward to your continued support and participation. Starbucks gift cards will be distributed! If you have any questions or comments, please feel free to email Lyndsay at lyndsay.dybka@ubc.ca or call 604-827-3010 Dr. Elizabeth Bryce, Dr. Annalee Yassi, Linda Kingsbury and Lyndsay O’Hara

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Table 1 - Proportion of respondents correctly answering Knowledge Evaluation questions PHYSICAL ENVIRONMENT Frequent cleaning of the environment is not the most important practice to prevent infections

• Hand hygiene is the most important practice and can prevent approximately 1/3 of healthcare acquired infections. 68%

Local exhaust ventilation such as hoods is needed to protect people from breathing in harmful vapours 82% SPECIFIC OCCUPATIONAL HEALTH PRACTICES AND HAZARDS All needle-stick and sharp injuries must be evaluated by an occupational health responsible/service 91%First aid kids should be centrally located in one area of the floor/building 77%Patients who are verbally abusive are not permitted to do so as part of their right to care 99%I am capable of recognizing potentially aggressive patients 73%I know how to assess patients potential aggressive behaviour 56% SPECIFIC INFECTION CONTROL PRACTICES Needles should not be recapped before disposing in sharps container

• Needles should never be recapped 53%The use of gloves is always recommended, not only when the risk of blood and BBF exposure is present

• Gloves should be used only when you anticipate exposure to blood and body fluids. 67%Patients with suspected TB cannot sit in the waiting room with other patients 88%Having food or drinks in the clean storage places or in the medication room/work station is not permitted 91%If a patient is known to have HIV or Hepatitis you should not change your work practice 78% ERGONOMICS Twisting can be as bad for your back as lifting 92%Foot rests under desks and at work stations are not primarily used to rest your legs 76% EQUIPMENT AND PROCEDURES It's OK to have mobile X-ray equipment used in a clinic with a number of patients because they usually don't stay long in the clinic enough to have significant exposure

• Any radiation exposure is considered to be significant and cumulative over time. 11%BBF soaked linen cannot be put in any plastic bag 90%General waste and medical waste can be mixed in the same container if there are no sharps

• Health and local municipality regulations require separation of general and medical waste in clearly identifiable waste streams. 11%

  

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Table 2 - Proportion of respondents correctly answering IC and OH & Safety Procedures' Evaluation questions PHYSICAL ENVIRONMENT Always use local exhaust ventilation when working with harmful chemicals 91% Always report witnessed spills

• It is important to report so that patterns can be detected and prevented. You also may be unaware of the hazards associated with a spill and the protective measures to take. 66%

SPECIFIC OCCUPATIONAL HEALTH PRACTICES AND HAZARDS Always use eye protection (other than prescription glasses) during procedures with potential for splashes and aerosols 40% Always wear hearing protection in noisy areas 36% Always report health and safety problems to the occupational health services 51% Always report health and safety problems to occupational health and safety committee/representative 48% Always make suggestions for correcting health and safety problems to the occupational health service 27% Always make suggestions for correcting health and safety problems to the occupational health and safety committee/representative 28% Always assess patients potential for aggressive behaviour upon admission

• Although not every incident can be prevented, many can, and the severity of potential injuries can be reduced. 30%

Always communicate to co-workers about potentially aggressive patients 68% Always report workplace violence incidents to managers 78% Always make suggestions for controlling workplace violence 37% SPECIFIC INFECTION CONTROL PRACTICES Always clean hands between the care of patients

• Think of your four moments of hand hygiene (see over). 70% Never change procedures if a patient is known to have HIV, Hepatitis B or C

• The goal of Routine Precautions is to take precautions appropriate to the clinical situation. Treat everyone as potentially infectious to protect yourself and others. Be consistent in your approach! 51%

Never recap needles 68% Always change gloves (if worn) between patients 98% Always wear N95 respirators when caring for patients with airborne diseases such as TB 81% Always utilize the online Infection Control as an effective workplace tool 17% Always dispose of sharps in a sharps container 98% Never work in situations where patients suspected of having TB are seen at clinic/office 32% ERGONOMICS Always ask for help to reposition or to lift heavy objects or patients 56% Always use lifting devices that are provided

• Lifting devices or assistance with lifting should be routinely used to protect yourself from soft tissue injuries. 57%

EQUIPMENT AND PROCEDURES Always use guards on machinery 70%

Key Points to Remember  

Hand hygiene IS the single most important thing you can do to prevent infections!  YOUR 4 MOMENTS OF HAND HYGIENE: 1‐Before initial patient/patient environment contact 2‐ Before aseptic procedure 3‐After body fluid exposure risk 4‐After patient/patient environment contact 

 Routine or Standard Infection Control Practices These are the practices you use every day to prevent transmission of infections between yourself and your patient or client, yourself and other healthcare workers, and from patient to patient.  It applies to all people who may be affected such as residents, patients, staff and visitors These practices are directed at ALL body substances including blood, secretions, and excretions, as well as mucous membranes and non‐intact skin. 

 Sharps Disposal Needles should NEVER be recapped. Specially  designed  sharps  containers  are  used  for  disposal.  Please  pay  attentions when  depositing  your sharps as occasionally a sharp may protrude from the container. Ensure that sharps disposal containers are readily accessible and emptied/replaced regularly. 

 

 

 

 

Personal Protective Equipment When are GLOVES required? • Touching body secretions and excretions • Touching mucous membranes • Touching non‐intact skin • Gloves are NOT a substitute for hand hygiene • Use the right type of glove for the task • Sterile gloves are generally only used  for sterile procedures. Non‐sterile gloves can be used for most 

patient care. • Gloves  are NOT  required when  pushing  a wheelchair  or  stretcher,  between  contact with  different 

patients (always use different gloves), when feeding or dressing a patient who is not in isolation. 

When to use an N95 respirator vs. a surgical mask? N95 respirators: • For airborne isolation when entering the room. • Requires a yearly fit test. • Must perform a fit check to ensure a good seal every time you wear it. Surgical masks are recommended: • For healthcare personnel to protect patients during aseptic procedures. • For anyone entering the room of a patient in droplet isolation. • For healthcare personnel to protect patients who are immuno‐compromised. • For patients in airborne or protective isolation when leaving the room is necessary. • For healthcare personnel during patient care activities  likely to generate sprays of blood, body fluids, 

secretions or excretions.  

Waste Management 

Biomedical Waste 1. Non‐Anatomical Waste is: (Deposited in YELLOW garbage bags/containers) 

• all sharps • chemotherapy waste • suction liners, pleuravacs containing blood • any disposal item grossly soiled or that on compression leaks blood or body fluids • lab cultures or specimens 

2. Anatomical Waste is: (Deposited in RED garbage bags/containers) • human tissue or body parts • animal tissue or body parts 

Non‐biomedical Waste 

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The following is NOT biomedical waste and can be deposited in regular DARK GREEN or BLACK garbage bags: • suction  tubing  and  catheters,  empty  catheter  bags,  blue  disposable  pads,  paper  towels  or  packaging, 

intravenous bags, soiled but not leaking dressings.   

 Ergonomics Always ask for help to reposition or to lift heavy objects or patients. Always use lifting devices that are provided. 

 Rules for Safe Lifting Use the following acronym as a guide when engaging in client handling procedures: 

 Back Straight Avoid Twisting Close to Body Keep Smooth 

 BACK STRAIGHT 

• Discs can tolerate larger compressive loads when the back is straight. • Discs are weaker when lifting in a flexed position. • Maintain the spine’s neutral curves. • Keeps spine aligned and moving smoothly. • Minimizes stress on spine. • Imaginary line to maintain curves in balance 

AVOID TWISTING • Discs are weaker when lifting is combined with twisting. • Joints are designed to prevent rotation. • If you twist when you lift the joints become inflamed and sore. 

CLOSE TO YOUR BODY • If an object is at a greater distance from your body for lifting, your back muscles and joints have to 

work harder to lift the weight creating greater stress on your back. • If you keep the exact same load close to your body, the lesser distance creates a lighter load and 

less stress on your back. KEEP SMOOTH 

• Jerking increases the load on the discs.  Aggression When should a violent incident be reported? A violent incident should be reported every time a staff member is: • Threatened verbally or physically e.g., a patient makes a threat to harm staff or  family of staff; a visitor yells and swears at staff • At risk of being injured or harmed e.g., a visitor in a work area carrying a weapon; a patient kicking at staff but not connecting; a patient tries to throw or break furniture • Traumatized psychologically e.g., a staff member witnesses a co‐worker being attacked; a patient makes racist/sexual comments to staff • Physically injured as a result of aggression/violence How should violent incidents be reported? A description of the incident should be: • recorded on an employee accident/injury report  form and/or other related  forms  (e.g. a patient record, unusual incident report form) • communicated to the person in charge  Communication!  •  Develop  and  execute  a  communication  plan  to  ensure  all management,  supervisors  and workers  are informed about occupational health and infection control policies and procedures. • Ensure all levels of the organization are included in the development and execution of the communication plan to promote “buy‐in” and support from everyone. • Provide updated information to all staff on a regular basis • Ensure information is accessible to all staff •  Ensure  all  levels  of  the  organization  are  included  in  communication

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All rights reserved. The Workers’ Compensation Board of B.C. encourages the copying, reproduction, and distribution of this document to promote

health and safety in the workplace, provided that the Workers’ Compensation Board of B.C. is acknowledged. However, no part of this publication may be copied, reproduced, or distributed for profit or other

commercial enterprise or may be incorporated into any other publication without written permission of the Workers’ Compensation Board of B.C.

Additional copies of this publication may be obtained by contacting:

Research Secretariat 6951 Westminster Highway Richmond, B.C. V7C 1C6

Phone (604) 244-6300 / Fax (604) 244-6299 Email: resquery@worksafebc.com

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APPENDIX VI- Infection Control Basics for Medical Students INFECTION CONTROL & OCCUPATIONAL HEALTH SYNOPSIS 

T

 

he  goal  of  this  outline  is  to  inform  you  about  how  you  can  best  protect  yourself  and  your patients  from  acquiring  and transmitting organisms.   

Key Points to Always Keep in Mind 

Routine Practices are the infection prevention and control practices applied to prevent the spread of infectious diseases. The principle is to treat all patients as if they may be infected with, or capable of transmitting, an infectious disease.   

 

 Comply with Airborne/Droplet/Contact Precaution Signage 

Pay special attention and ask what to do if you see an isolation sign.  Wear appropriate personal protective equipment if necessary.  If you don’t know how to remove PPE safely without 

contaminating yourself; ask for help  

• •

 Take Care of Your Own Health 

inations. • Don't come to work if you are ill. 

Maintain your immunizations, particularly influenza vacc Ensure that your fit testing for N95 respirator is current. •• Practice Proper Respiratory Cough Etiquette 

and co• • ugh or sneeze into your upper sleeve if possible.  Cover your mouth and nose while coughing or sneezing 

If you use a tissue, dispose of the tissue in a waste receptacle.  Clean your hands after coughing or blowing your nose.  

Don't touch your eyes or mucous membranes with your fingers. •• Practice Correct Waste Segregation It is important to note that although biomedical material may be infectious, not all biomedical material is biomedical waste 

as referenced in the CCME guidelines. Practicing correct waste segregation is important.  Practice Safe Sharps Techniques Dispose  of  sharps  immediately  after  use  in  an  approved  sharps  container.  Always  look  at  the  sharps  container  when 

disposing of the needle. Many injuries occur because of not looking directly at the sharps container during disposal. Do not recap needles before disposal and do not expect someone else to dispose of sharps that you have used. 

 Steps to Follow When Examining a Patient   1.  Clean Your Hands • visibly If your hands are  soiled, wash your hands with soap and warm water. Dry with a single‐ use  towel. Use  the 

towel to turn off the taps and open the door.  If not visibly soiled, you may also use waterless hand sanitizer. • Clean  your  hands  between  contact with  every  patient/client,  before  eating  or  handling  food,  after  using  the  toilet, 

r PPE. whenever hands are soiled, before donning and after removal of gloves and othe

• 2.  Maintain a Clean Environment 

Discard any dirty items (i.e. tongue depressors and otoscope tips) immediately.  • removing  and  before  replacing  the  exam  paper),  countertops]  with  the 

ient/client.   Clean  surfaces  [e.g.  examining  bed  (after antiseptic wipes provided between each pat

• Clean up any body fluid spills immediately. 3. Clean Your Hands Again Before Exiting the Room 

 Test Your Knowledge…..Complete the Online Infection Control Module! http://picnetbc.ca//sites/picnetbc2/files/Online_IC_Module/lesson/IC_Basic_v3.html  For More Information: VCH Regional Infection Control Manual- http://vchconnect.vch.ca/icmanual/ How to Contact Infection Control: Sydney Scharf, Senior Infection Control Practitioner, VGH (604) 875-4002