C14.2 Public Health Ontario and The College of Physicians and Surgeons of Ontario_Mandy Deeves

Public Health Ontario (PHO) and The College of Physicians and Surgeons of Ontario (CPSO): Collaboration to Achieve Common Goals Presentation to: Public Health/Primary Care Conference: Prevent More, Treat Less (June 5, 2014) By: Mandy Deeves Network Coordinator Regional Infection Control Networks of Public Health Ontario

Objectives • Introduce Public Health Ontario (PHO) and the Infection Prevention and Control (IPAC) team.

• Share details of a PHO partnership in promotion of Infection Prevention and Control in Clinical Office Practice settings, using the Knowledge to Action cycle.

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PHO and CPSO • Different mandates: • IPAC team at PHO develops, implements, and evaluates strategies and programs to prevent and control infectious diseases.

• CPSO regulates the practice of medicine to protect and serve the public interest.

• Mutual interest to promote health and wellbeing of the public related to infection prevention and control practices in officebased practices • Collaborated to create the document titled Best Practices for Infection Prevention and Control in Clinical Office Practice (2013) PublicHealthOntario.ca

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Why? “The need for infection prevention and control measures in medical settings has probably never been more apparent to the general public and to the medical community at large than it is now. Experiences with Severe Acute Respiratory Syndrome (SARS) in 2003 and pandemic H1N1 virus in 2009, as well as events related to inadequate sterilization and disinfection of medical equipment, have underscored the notion that every person is vulnerable if proper safeguards are not in place to prevent the transmission and acquisition of infection.”

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee.

Best practice for infection prevention and control in clinical office practice. 1st ed. Toronto, ON: Queen’s Printer for Ontario; 2013. p. 4.

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IPAC team at PHO • The IPAC team develops, implements, and evaluates strategies and programs to prevent and control infectious diseases.

• Our primary focus is on healthcare associated infections​.

• Here are our roles and functions: • • • • • •

Regional Infection Control Networks (RICNs) Provincial Infectious Diseases Advisory Committee (PIDAC) Core Competencies online learning program Just Clean Your Hands (JCYH) Antimicrobial Stewardship Program (ASP) Infection Control Resource Teams (ICRT)

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Best Practices for Infection Prevention and Control in Clinical Office Practice

Image Credit: Public Health Ontario

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What’s in the Document?

• Legislation relating to IPAC practices in the clinical office setting • Staff education and training • Transmission of microorganisms in clinical office settings • Routine Practices

• Medications, vaccines and skin antisepsis • Control of the environment • Reprocessing medical equipment/devices • Surgical/invasive Procedures • Administrative controls

• Additional Precautions

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Knowledge Translation “A dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the healthcare system.�

CIHR, 2007

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Knowledge to Action Cycle

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Image Credit: CIHR Knowledge to Action Process http://www.cihr-irsc.gc.ca/e/39033.html

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Knowledge Translation Activities • What should be translated to what audience?

• Physicians, clinical office managers, nurses, nurse practitioners, administration staff, cleaning staff, and any other staff that may work in a clinical office practice setting • Integrated Knowledge Translation (IKT): stakeholders or potential research knowledge users are engaged in the entire process • CPSO representative and 2 peer assessors involved in document creation • Ongoing discussion for implementation activities includes PHO and CPSO representatives PublicHealthOntario.ca

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Diffusion • Passive and broadly aimed strategy of disseminating information and often does not lead to behaviour change • This method includes publications, websites, social network, and mass media • Just posting the Best Practices for Infection Prevention and Control for Clinical Office Practice document is an example of diffusion

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PIDAC Clinical Office Practice

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www.publichealthontario.ca/clinicalpractice Image Credit: Public Health Ontario

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Dissemination • Active process, targeted to individuals and organizations with shared interests • Webinar: provided by the chair of PIDAC-IPC with presentation posted on the PHO website • Second educational opportunity: March 2014 as part of the IPAC Canada Southwestern Ontario chapter meeting. This webcast presentation (recorded) was delivered by Dr. Mary Vearncombe, chair of PIDAC-IPC

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Implementation • Knowledge to Action • It is “critical to ensure agreement from all players on the need for change; the nature of the evidence for change; methods and the evaluation of the impact of the change; and who is responsible for each of the components.” (CIHR, 2007. p. 5.)

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Jointly identify the following to guide further implementation activities: • What are the changes CPSO perceived as important?

• What are the high-risk practices PHO identifies as priorities?

• What is the evidence for change?

• Does the target audience buy in to these changes?

• How do we share evidence/recommendations for change?

• How do we evaluate?

• Who is responsible for each component of this process?

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Past Activities • Implementation is active and involves systematic efforts to encourage the uptake of knowledge • The IPAC Resources department at PHO has provided workshop over two days on reprocessing of medical equipment to nurse assessors from the CPSO • The CPSO partnered with the IPAC department at PHO to deliver targeted educational sessions at their annual peer assessor meeting April 7, 2014

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Ongoing Activities • Self-assessment tool • Physician engagement • Further tool development • Long-term strategy (3-5 years) to implement IPAC best practice in clinical office settings

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Adapted Knowledge to Action Cycle

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Knowledge to Action Process adapted for Infection Prevention and Control for Clinical Office Practice

Image Credit: Public Health Ontario 18

Future Activities • Continue working with CPSO to develop a framework for future implementation activities • Reconvene to discuss evaluation and impact of activities to date • Get input from all parties regarding priorities moving forward – how do we get this input? E.g. survey, focus group.

• Define approach to messaging – who is responsible for what?

• How is messaging about IPAC best practice delivered? E.g. online learning opportunities that will meet the needs of those working in clinical office settings • Explore opportunities to be innovative in developing tools to support the adoption of best practices

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Evaluation • Develop or adapt measures of each step of the knowledge to action cycle (CIHR, 2007. p. 5) • Incorporate evaluation expertise into planning process • • • • •

Partnership Process Products Awareness Practice change

• Overall benefit to health care workers and the public is decrease in health care-associated infections in these settings.

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References 1. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Jamal H. Translating evidence into practice: PIDAC’s success with the knowledge to action cycle. Toronto, ON: Poster presentation; 2013 2. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practice for infection prevention and control in clinical office practice. 1st ed. Toronto, ON: Queen’s Printer for Ontario; 2013 Available from: http://www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_ 2013.pdf 3. Tetroe, J. Knowledge translation at the canadian institutes of health research: a primer. Focus. Technical Bulletin. 2007; 18 Available from: http://www.ktdrr.org/ktlibrary/articles_pubs/ncddrwork/focus/focus18/Focus18.p df

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