Establishing an Occupational Health and Infection Control Program in a Large Ambulatory Care Facility
Final Report Date: April 2011
||Annalee Yassi (UBC)
||Elizabeth Bryce, Linda Kingsbury, Sydney Scharf, Lyndsay O’Hara
For more information about this project, please contact Lyndsay O’Hara or
Health care workers are at high risk for exposure to blood-borne pathogens, respiratory infections and other workplace hazards. However, implementing occupational health (OH) and infection prevention control (IPC) in ambulatory (outpatient) care settings can be challenging, particularly when in mixed facilities involving many partners such as the facility owner, other clinics, and non-clinical occupants and services. To address this challenge, the research team created a model for OH and IPC in ambulatory health care facilities, by developing a program for a new multi-partner health care facility in Vancouver.
- The project identified significant gaps in the facility staff’s OH and IPC knowledge and practice before the intervention. Cleaning practices for the facility were also found to be deficient, and concerns were identified in the workplace assessments.
- An OH and IPC program for the facility was developed in consultation with staff. After the program was implemented, the number of concerns identified in workplace assessments decreased.
- Education sessions focusing on infection prevention and control basics were well received by both staff and the community.
- Ambulatory care settings entail hazards similar to those in acute care but this is not necessarily addressed when the infrastructure requirements are established. Building 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.
- The researchers provide several specific recommendations for how ambulatory care facilities can address OH and IPC.
- To develop and implement a comprehensive collaborative occupational health and infection control program that meets the needs of all partners in an ambulatory health care facility
- To develop a model that could be applied to other multi-partner healthcare settings
The research took place at the Gordon and Leslie Diamond Health Care Centre (GLDHCC), a new 11-storey, 365,000 square foot, healthcare facility located on the Vancouver General Hospital campus. GLDHCC is a private-public partnership formed by Vancouver Coastal Health, the University of British Columbia and a private contractor managing the physical plant. The facility houses private physician offices, VCH ambulatory clinics and services (including food services and housekeeping services), and UBC facilities (offices, classrooms, study areas, and a biomedical library).
The project included the following steps:
- A needs assessment for OH and IPC at the facility
- A review of the literature relevant to designing a comprehensive OH and IPC program for an ambulatory care facility
- Program design in collaboration with staff (both public and private)
- Environmental audits to measure the thoroughness of current cleaning practices.
- Pre- and post-intervention workplace assessments covering the physical environment, occupational health practices and hazards, infection control practices, equipment and procedures, and ergonomics
- A pre- and post-intervention survey of OH and IPC knowledge, attitudes and practices of both clinical and non clinical staff
- Staff educations sessions in basic infection control and occupational health principles
- Interactive public hand hygiene demonstrations in the lobby
- FAQ (Frequently Asked Questions) fact sheets for staff, based on the results of the first questionnaire
- The environmental audits revealed significant deficiencies in cleaning technique and frequency. Before the intervention, cleaning protocols were geared more towards office/hotel requirements than the level of cleaning needed for an active healthcare treatment centre.
- Workplace assessments identified concerns relating to:
- a lack of signage, manuals and directives
- physical plant issues
- equipment and procedures
- workplace practice
- The number of concerns identified in workplace assessments decreased after the intervention.
- Questionnaire results showed that many staff had inadequate knowledge of OH and IPC practices. For example:
- 21% did not know whento use gloves.
- 35% did not know when to use a N95 respirator.
- 47% thought that needles should be recapped before disposal in a sharps container.
- Over 20% thought they should change their work practice if a patient is known to have HIV or Hepatitis.
- In some cases participants were not applying their knowledge. For example, 76% knew when to use goggles but only 40% said they always use eye protection during procedures with potential for splashes and aerosols.
- Incorrect understanding also translated into a lack of correct practice. For example, 47% of respondents thought that needles should be recapped before disposal, and 32% reported recapping needles in practice.
- Administrative staff had significantly less IPC knowledge and correct practice than clinical staff.
The authors make the following OH and IPC recommendations for ambulatory care facilities:
- Conduct a needs assessment using tools such as a workplace assessment checklist, Glo-Germ environmental audits and worker knowledge, attitudes and practice questionnaires to inform the development and implementation of new programs, services and educational initiatives.
- Ensure that staff has access to regular, documented in-services targeted at clinical and non-clinical staff.
- Become part of the administrative structure by ensuring that occupational health and infection control is represented on relevant committees.
- Examine cleaning contracts to ensure that the cleaning requirements reflect the acuity of the population and are not biased towards office style cleaning.
- Plan for an acute patient population as ambulatory care services continue to increase.
- Consider and build in redundancies to address physical plant changes due to re-allocation of space and the development of new technologies.
- Insert Infection Control and Occupational Health in the management structure for all building partners.
- Use algorithms to identify patients at high risk for transmission of communicable diseases.
- Identify Infection Control and Occupational Health resources required considering in-services offered, workplace assessments, education and training and consultation.
The researchers also note two important areas for future work:
- Further coordinated efforts to protect workers in ambulatory care facilities from infections and occupational risks, while taking into account the characteristics of ambulatory care facilities.
- Providing appropriate training in infection control and occupational health and safety to ambulatory care staff. As suggested by the project findings, these workers may not possess the basics in infection prevention and control.
Publications and presentations
“Preventing infections in the ambulatory care workforce: What do healthcare workers know and do?” Journal of Ambulatory Care Management. (Accepted for publication with revisions)
“Infection Control Basics for Medical Students”. In Handbook for Medical Students. 2010. UBC Medical Student Orientation Manual.
“Preventing infections in the ambulatory care workforce: What do healthcare workers think?” Poster presentation at Community and Hospital Infection Control Association. June 1, 2010 (Vancouver).
The infection control audit: Taking it to the next generation an Oral presentation at International Federation of Infection Control (IFIC) Conference, September, 2010, Cape Town, South Africa.
A “Field Guide for Workplace Assessments in Healthcare.” This guide is based on the process for conducting workplace assessments at the GLDHCC and is currently being piloted in South African hospitals.