| In all health care settings |
This document is intended to provide best practices only. Health care settings are encouraged to work towards these best practices in an effort to improve quality of care.
| How and when to use this document |
The cleaning practices set out in this document must be practiced in all settings where care is provided, across the continuum of health care, with the exception of cleaning of the client’s home in home health care. This includes settings where emergency (including pre-hospital) care is provided, hospitals, complex continuing care facilities, rehabilitation facilities, long-term care homes, mental health facilities, outpatient clinics, community health centres and clinics, physician offices, dental offices and offices of other health professionals.
| Assumptions and general principles for infection prevention and control |
The best practices in this document are based on the assumption that health care settings in Ontario already have basic infection prevention and control systems and practices such as those described in the following document:
These settings should work with organizations that have infection prevention and control expertise, such as academic health science centres, regional infection control networks, public health units that have professional staff certified in infection prevention and control and local infection prevention and control associations (e.g., Community and Hospital Infection Control Association – Canada chapters), to develop evidence-based programs.
In addition to the general assumption (above) about basic infection prevention and control, these best practices are based on the following additional assumptions and principles:
- Best practices to prevent and control the spread of infectious diseases are routinely implemented in health care settings, including:
- Health Canada’s ‘Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care’ (Can Commun Dis Rep. 1999; 25 Suppl 4:1-142).
- PIDAC’s ‘Routine Practices and Additional Precautions'.
- Adequate resources are devoted to infection prevention and control in all health care settings. See PIDAC’s ‘Best Practices for Infection Prevention and Control Programs in Ontario’.
- Programs are in place in all health care settings that promote good hand hygiene practices and ensure adherence to standards for hand hygiene. See:
- PIDAC’s ‘Best Practices for Hand Hygiene’.
- Ontario’s hand hygiene improvement program, ‘Just Clean Your Hands’.
- Programs are in place in all health care settings that ensure effective disinfection and sterilization of used medical equipment according to PIDAC‘s Best Practices for Cleaning, Disinfection and Sterilization’.
- Regular education (including orientation and continuing education) and support to help staff consistently implement appropriate infection prevention and control practices is provided in all health care settings.
- Effective education programs emphasize:
- The risks associated with infectious diseases, including acute respiratory illness and gastroenteritis
- Hand hygiene, including the use of alcohol-based hand rubs and hand washing
- Principles and components of Routine Practices as well as additional transmission-based precautions
- Assessment of the risk of infection transmission and the appropriate use of personal protective equipment (PPE), including safe application, removal and disposal
- Individual staff responsibility for keeping clients/patients/residents, themselves and co-workers safe
- Collaboration between professionals involved in infection prevention and control and occupational health and safety (OHS).
NOTE: Education programs should be flexible enough to meet the diverse needs of the range of health care providers and other staff who work in the health care setting. The local public health unit and regional infection control networks may be a resource and can provide assistance in developing and providing education programs for community settings.
- Collaboration between professionals involved in occupational health and infection prevention and control is promoted in all health care settings to implement and maintain appropriate infection prevention and control standards that protect staff.
- There are effective working relationships between the health care setting and local public health. Clear lines of communication are maintained and public health is contacted for information and advice as required and the obligations (under the Health Protection and Promotion Act, R.S.O. 1990, c.H.7) to report reportable and communicable diseases are fulfilled. Public health provides regular aggregate reports of outbreaks of any infectious diseases in facilities and/or in the community to all health care settings.
- Access to ongoing infection prevention and control advice and guidance to support staff and resolve differences is available to the health care setting.
- There are established procedures for receiving and responding appropriately to all international, national, regional and local health advisories in all health care settings. Health advisories are communicated promptly to all staff responsible for case finding/surveillance and regular updates are provided. Current advisories are available from public health, MOHLTC, Health Canada and the Public Health Agency of Canada websites as well as local regional infection prevention and control networks.
- Where applicable, there is a process for evaluating personal protective equipment (PPE) in the health care setting, to ensure it meets quality standards.
- There is regular assessment of the effectiveness of the infection prevention and control program and its impact on practices in the health care setting. The information is used to further refine the program.
- The MOHLTC’s Long-Term Care Home Compliance and Enforcement Program requirements shall be met. Specific legislative requirements for long-term care providers may be found in:
In addition, all long-term care providers shall comply with all requirements outlined in the MOHLTC’s ‘Long-Term Care Homes Program Manual’, which is the core text governing the operation of long-term care homes in the province of Ontario. This manual contains policies, standards and norms covering various aspects of the Long-Term Care Homes Program such as:
- Risk Management, including:
- Infection control
- Health and safety
- Internal and external disaster planning
- Monitoring, evaluating and improving quality
- Environmental Services, including:
- Waste management
- Pest control
- Housekeeping services
- Laundry services
- Maintenance services
- Education, including:
- Orientation
- Ongoing in-service education
- Mandatory education programs
- For more information, please contact your local Ministry of Health Service Area Office.
- Occupational health and safety requirements shall be met: Health care facilities are required to comply with applicable provisions of the Occupational Health and Safety Act (OHSA), R.S.O. 1990, c.0.1 and its Regulations. Employers, supervisors and workers have rights, duties and obligations under the OHSA.
The OHSA places duties on many different categories of individuals associated with workplaces, such as employers, constructors, supervisors, owners, suppliers, licensees, officers of a corporation and workers. Here is a guide to the requirements of the OHSA.
Specific requirements for certain health care and residential facilities may be found in the Regulation for Health Care and Residential Facilities.
In addition, the OHSA section 25(2)(h), the ‘general duty clause’, requires an employer to take every precaution reasonable in the circumstances for the protection of a worker. There is a general duty for an employer to establish written measures and procedures for the health and safety of workers, in consultation with the joint health and safety committee or health and safety representative, if any. Such measures and procedures may include, but are not limited to, the following:
- Safe work practices
- Safe working conditions
- Proper hygiene practices and the use of hygiene facilities
- The control of infections
At least once a year the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice. The employer, in consultation with the joint health and safety committee or health and safety representative, if any, shall develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to the workers’ work.
A worker who is required by his or her employer or by the Regulation for Health Care and Residential Facilities to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction and training. The employer is reminded of the need to be able to demonstrate training, and is therefore encouraged to document the workers trained, the dates training was conducted, and materials covered during training. Under the OHSA, a worker must work in compliance with the Act and its regulations, and use or wear any equipment, protective devices or clothing required by the employer.
For more information, please contact your local Ministry of Labour office. A list of local Ministry of Labour offices in Ontario may be found at: http://www.labour.gov.on.ca.
Click below to download Best Practices for Environmental Cleaning for Prevention and Control of Infections (151 pages, PDF, 3 MB).
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