Infection prevention and control program

Background

• IPAC programs result in fewer healthcare-associated infections, reduced length of stay, less antimicrobial resistance, and decreased cost of infection treatments
• See also Infection control precautions by disease

Components

• Surveillance, based on systematic data collection and subsequent data analysis and dissemination
  • Process measures, often requiring process audits
  • Outcome measures, such as rates hospital-acquired infections
  • System for detecting, investigating, and controlling outbreaks
  • Reportable disease reporting to public health agencies
• Policies and procedures
  • IPAC policies and procedures
  • Care policies and procedures that impact IPAC
• Compliance and accreditation
• Occupational health and safety
  • Includes requirement for annual influenza vaccination as a rerequisite of employment
• Education and training
  • Continuing education for healthcare providers in IPAC
  • Education of clients, patients, residents, and visitors
• Antimicrobial stewardship program

Miscellaneous Components

• Hand hygeine program
• Routine practices and precautions program
• Resident health program for longterm care facilities, such as immunization programs
• Timely access to microbiology laboratory reports and expertise
• Active participation in facility maintenance standards, facility design, and construction and renovation
• Product review and evaluation
• Continuous quality improvement activities
• Review of practices for reprocessing of equipment
• Review of practices for environmental cleaning
• Participation in research activities for programs affiliated with academic health science centres, teaching hospitals, and other settings

Process Surveillance

Component	Acute Care	CCC	LTC	HHC
Adherence to ARO screening protocols for clients, patients, and residents	X	X	X
Adherence to ARI screening protocols for clients, patients, and residents	X	X	X	X
Adherence to screening protocols for TB in clients and residents		X	X
Adherence to screening protocols for acute GI infections in clients, patients, and residents	X	X	X	X
Influenza vaccination rates for clients and residents		X	X
Pneumococcal vaccination rates in clients and residents		X	X
Adherence to screening protocols for hepatitis, MRSA, and VRE in hemodialysis patients	X	X	X
Tuberculosis screening for staff	X	X	X	X
Vaccination rates including influenza vaccination for staff	X	X	X	X
Sharps injury surveillance	X	X	X	X
Adherence to central line protocols	X	X	X	X
Adherence to ventilator use protocols	X	X
Adherence to protocols related to surgical procedures (e.g. preoperative antibiotics)	X
Adherence to hand hygiene protocols	X	X	X	X
Adherence to Routine Practices protocols and PPE	X	X	X	X
Adherence to reprocessing practices protocols	X	X	X	X
Adherence to environmental cleaning protocols	X	X	X
Adherence to IPAC construction and renovation protocols	X	X	X
Adherence to recommendations of the ASP	X	X	X
Adherence to practices limiting the use of urinary catheters	X	X	X	X

• CCC = complex continuing care; LTC = long-term care; HHC = home healthcare

Outcome Surveillance

Component	Acute Care	CCC	LTC	HHC
Facility-acquired respiratory infection in clients, patients, and residents	X	X	X
Facility-acquired ARO in clients, patients, and residents	X	X	X
Facility-acquired Clostridioides difficile disease in clients, patients, and residents	X	X	X
Facility-acquired acute GI infection in clients, patients, and residents	X	X	X
Facility-acquired group A streptococcal infections in clients, patients, and residents	X	X	X
Tuberculin skin test or IGRA conversions in staff	X	X	X	X
Procedure-specific surgical site infections	X			X
Central line-associated bloodstream infections in high risk areas	X			X
New acquisition of hepatitis in hemodialysis patients	X	X	X
Skin and soft tissue infections in clients and residents		X	X

Staffing Requirements

IPAC Committee

• Membership must includes ICPs, the IPAC physician (or medical director of LTC facilities), an OHS representative, a public health representative, an environmental services representative, senior nursing and MD representatives, and a senior management representative
• Can also include microbiologist or infectious diseases specialist, a pharmacy representative, am equipment processing representative, an OR representative, an epidemiologist, and a quality assurance or risk management representative

Infection Control Professional (ICP)

• In general, for an acute care facility, should have around 1 ICP per 100 occupied beds
  • This number can vary based on complexity of patient care

IPAC MD

• Must have available a physician trained in IPAC
• Sits on the committee and is available as-needed otherwise

Administrative Assistant

• Helps to coordinate the program

Guidelines & Resources

• Public Health Agency of Canada. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings. Ottawa, ON: November 2016.
• Ontario Agency for Health Protection and Promotion. Provincial Infectious Diseases Advisory Committee. Best Practices for Infection Prevention and Control Programs in All Health Care Settings, 3rd edition. Toronto, ON: Queen's Printer for Ontario; May 2012.
• Association for Professions in Infection Control and Epidemiology (APIC)
• Heymann D. Control of Communicable Diseases Manual. 20th edition. Washington, DC: American Public Health Association; 2008.
• American Academy of Pediatrics. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st edition. Elk Grove Village, IL: American Academy of Pediatrics; 2018.
• CDC Guidelines Library