Infection Prevention and Control (IPAC) in the Medical Office

⚠ As COVID-19 cases and contacts continue to climb in Ontario and here in Ottawa, we expect that the Ministry of Health approach to COVID-19 testing will change with new prioritization criteria that will focus on vulnerable populations and essential workers. In the interim, Ottawa Public Health advises in the event that you are unable to access timely PCR testing and regardless of your vaccination status, you must self-isolate if: 

  • you or anyone in your household has tested positive on a rapid antigen test 
  • you are a household member of someone who has tested positive on a PCR test 
  • you or anyone in your household are experiencing any of the most common symptoms of COVID- 19 
    • Fever (Temperature of 37.8 C or greater) and/or chills
    • Cough (new or worsening)
    • Shortness of breath
    • Decrease or loss of taste or smell
    • Extreme tiredness, lack of energy, feeling of being unwell (not related to receiving a COVID-19 vaccine in the past 48 hours)
    • Muscle aches and pains (not related to receiving a COVID-19 vaccine in the past 48 hours)
    • Nausea, vomiting and/or diarrhea

Please be aware that COVID-19, in particular Omicron, often presents with minor symptoms (cough, fatigue, and/or congestion or runny nose) or causes no symptoms at all.

Last update: December 17, 2021

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Infection prevention and control (IPAC) measures protect healthcare providers, 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.

NEW Webinar: Supporting Community Physicians/ Helping community physicians and nurse practitioners see patients safely in the time of COVID 19.

  • Please note: As new information emerges surrounding the Omicron (B.1.1.529) variant of concern, guidance may change. Since the webinar of Dec 7th and the development of the Q&A document, the Interim IPAC Recommendations for use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (PDF) has been released from PHO (Dec 15th).
  • We encourage physicians to read the guidance to inform their point of care risk assessment. Note that this is interim guidance that is taking a precautionary approach in the absence of studies specific to the use of PPE when providing care to patients with the Omicron (B.1.1.529) variant of COVID-19.
  • The notable change in the guidance include:
    • “Given the undetermined impact of the Omicron (B.1.1.529) variant, the interim 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 surgical/procedure (medical) 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 or greater protection) should be used when aerosol generating medical procedures (AGMPs) are performed or anticipated to be performed on patients with suspect or confirmed COVID‑19.
    • These recommendations are interim and will be re-evaluated as more information on the Omicron (B.1.1.529) variant emerges”
  • Recorded December 7th, 2021 at 7 pm to 8:15 pm (English only)
  • Recorded version.

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 source: National Institute for Occupational Safety and Health National Institute for Occupational Safety and Health

Elimination and substitution
This layer of IPAC protection prevents people with COVID-19 from coming into the setting without knowledge of the health care provider, through active and passive screening. Pressures that existed early in the pandemic that required prioritizing virtual care have now diminished and, in most instances, in-person care can now be provided safely and appropriately through other control measures. Ontario’s Ministry of Health COVID-19 Guidance: Primary Care Providers in a Community Setting (PDF, Oct. 19, 2021) encourages healthcare workers to take a patient-centered approach in deciding whether to book a visit in-person or virtually.
  • Screening: Ensure the screening tool is current.
    • Screen staff and patients before they enter the clinic; staff who screen positive must not enter the clinic.
    • Seat patients who screen positive apart from other patients and have them wear appropriate PPE as tolerated. Patients who are symptomatic for COVID-19 or have a recent exposure must wear a medical mask.
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. Ensure waiting area allows for two metres of distance between waiting patients if no physical barrier exists. Where this is not possible, try to maximize distance and minimize contact and ensure proper masking is followed.
  • 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 providers 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 to wear a mask as tolerated; and provide masks if needed. At a minimum, all health care providers and office staff need to be masked. (See Personal Protective Equipment below)
  • 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: 
    • Eye protection + medical mask. For protection against acute respiratory illness spread through droplets, a medical mask and eye protection are currently advised. Ensure proper hand hygiene when donning and doffing any PPE.
    • Fit tested mask. 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.

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Additional Resources

Ontario College of Family Physicians

Ministry of Health

Public Health Ontario         

The Centre for Effective Practice

  • The Centre for Effective Practice has developed its Primary Care Operations webpage as a point of reference for accurate and up to date information on COVID-19, including the latest IPAC recommendations.

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

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