Infection Prevention and Control (IPAC) in the Medical Office

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
  • Refer to the Ontario College of Family Physicians guidance document IPAC Guidance for Community Practices (pdf - Oct 2022)
  • The College of Physicians and Surgeons of Ontario (CPSO) has a COVID-19 FAQs for Physicians on their website, which includes information on balancing in-person and virtual care to patients
  • Government of Ontario Self-Assessment Tool

• 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)

• Resources:
  • HVAC related regulations can be viewed or purchased through the CSA group website Special requirements for heating, ventilation, and air-conditioning (HVAC) systems in health care facilities. (Click View Access and follow the instructions to register (at no cost), in order to view the document.)
  • Focus on Heating, Ventilation and Air Conditioning (HVAC) Systems in Buildings and COVID-19 (PDF), Public Health Ontario
  • Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings (PDF), Provincial Infectious Diseases Advisory Committee (PIDAC)

• Vaccination:  Being vaccinated with all the doses you are eligible and recommended is an important layer of protection for preventing infection with COVID-19. Ottawa Public Health’s COVID-19 Vaccine information page for physicians and NPs offers information for supporting your patients to become vaccinated and additional resources for healthcare professionals.
• Resources:
  • Summary of Infection Prevention and Control Key Principles for Clinical Office Practice, Public Health Ontario
  • IPAC Guidance for Community Practices, Ontario College of Family Physicians

• 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:

• Recommended Steps: Putting On Personal Protective Equipment (PPE), Public Health Ontario
• COVID-19 Eye Protection Guideline (pdf - 139 KB), Ottawa Public Health