Infection Prevention and Control (IPAC) in the Medical Office

Last update: March 3, 2023

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Infection prevention and control (IPAC) measures protect healthcare professionals, staff, and patients from the spread of disease, including COVID-19. A risk assessment of your clinic and exam rooms prior to any interaction with patients will help to determine which IPAC measures are needed, depending on the specific setting and procedures being performed. The resources below may assist as you implement appropriate IPAC measures within your practice.

 Public Health Ontario: Interim IPAC Recommendations for use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (PDF).

  • Incorporates evidence to date on modes of transmission, effectiveness of personal protective equipment (PPE) in healthcare workers (HCWs) and the undetermined impact of the emergence of variants and their lineages. Recommendations will be updated as needed based on emerging information

Recommendations in the guidance include:

    • The recommended PPE when providing direct care for patients with suspect or confirmed COVID-19 includes a fit-tested, seal-checked N95 respirator (or equivalent or greater protection), eye protection, gown, and gloves. Other appropriate PPE includes a well-fitted medical (surgical/procedure) mask, or non-fit tested respirator, eye protection, gown and gloves for direct care of patients with suspect or confirmed COVID-19.
    • Fit tested N95 respirators (or equivalent) should be used with all other recommended personal protective equipment when aerosol generating medical procedures (AGMPs) are performed or anticipated to be performed on patients with suspect or confirmed COVID‑19.

Preparing your office

The Hierarchy of Controls is an occupational health and safety framework for controlling hazards in the environment. The controls at the top of the hierarchy inverted triangle are the most effective measures, with personal protective equipment (PPE) being the least effective measure of control. All the levels of the framework are important, as they create many layers of protection. This framework can help to structure the approach to COVID-19 IPAC in a clinical setting:

Image from National Institute for Occupational Safety and Health National Institute for Occupational Safety and Health on hierarchy of controls with a triangle outlining 5 different sections in different colours

Photo: The National Institute for Occupational Health and Safety

Elimination and substitution

This layer of IPAC protection prevents people with COVID-19 from coming into the setting without knowledge of the health care professional, through active and passive screening..

  • Screening:
    • Screen staff and patients before they enter the clinic.
    • Seat patients who screen positive apart from other patients and have them wear as medical mask as tolerated. Patients who are symptomatic for COVID-19 must wear a medical mask.
  • Resources
Engineering controls
COVID-19 can be spread by people with asymptomatic infections. Ventilation, physical barriers, and re-designed work areas to facilitate physical distancing can help decrease the risk of COVID-19 spreading from an infectious person.
  • Physical Distancing. Try to maximize distance and minimize contact and encourage patients and visitors to wear a mask.
  • Cleaning and disinfection: All shared items and spaces must be properly cleaned and disinfected between uses.
    • Environmental cleaning: Ensure daily environmental cleaning takes place in all common areas, including patient areas, staff areas, and shared spaces such as lunch/break rooms.
    • Shared items or devices: Clean and disinfect shared items or devices (e.g. blood pressure cuff) between patients using a hospital-grade cleaning product.
    • Clinical office/waiting rooms: Clean and disinfect surfaces in the clinical office and waiting rooms immediately when they are visibly soiled with blood or other body fluids, excretions, or secretions (e.g., examination tables, floors, toilets).
  • Hand hygiene: Ensure hand hygiene supplies are available to health care professionals and patients. Hand hygiene supplies must be present in all areas where patient care occurs (e.g. hand hygiene sink or alcohol-based hand rub). 
  • Ventilation: Review the HVAC systems and ensure they are in compliance with applicable regulations related to the facility type (see resources)
Administrative controls
IPAC policies and procedures; healthy workplace policy; education and training; signage.
Personal protective equipment (PPE)
  • Universal Masking. Encourage all patients and visitors to wear a mask as tolerated; and provide masks if needed. Offices may establish a masking policy for staff, patients and other visitors when in the office.

  • Personal Protective Equipment. Appropriate PPE can protect a worker in conjunction with the other control measures. A Point of Care Risk Assessment helps determine if additional protection is needed beyond universal masking: 

    • Recommended PPE when providing direct care for patients with suspect or confirmed COVID-19:
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          • Fit-tested, seal-checked N95 respirator (or equivalent or greater protection), eye protection, gown, and gloves.
          • Other alternate appropriate PPE includes a well-fitted medical mask (surgical/procedure), or non-fit tested respirator, eye protection, gown and gloves for direct care of patients with suspect or confirmed COVID-19
          • Wear a fit tested N95 mask when there are concerns about possible aerosol generation. Examples of aerosol generating procedures (AGP) can be found in the PHO Technical Briefing on Recommended use of PPE.
          • Ensure proper hand hygiene when donning and doffing any PPE.

Resources:

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Additional Resources

For more information on Infection Prevention and Control, please see our page Infection Prevention and Control Resources for Healthcare Professionals.

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