Residents in LTCHs have a higher risk of acquiring infections because they are older and more vulnerable to infections (Office of the Auditor General of Ontario, 2009). In addition, there is a high risk of infectious diseases spreading among residents due to close proximity to other residents and contact during recreational and other activities (Office of the Auditor General of Ontario, 2009).
LTCHs are governed by the Long-Term Care Homes Act (LTCHA), 2007 in which IPAC requirements are outlined (Office of the Auditor General of Ontario, 2009). The MOHLTC sets standards of care for each home and conducts annual unannounced inspections to monitor compliance with legislation and policies (Office of the Auditor General of Ontario, 2009). Each LTCH is responsible for adopting, following and monitoring effective IPAC policies (Office of the Auditor General of Ontario, 2009). In addition, physicians and nurses have a professional responsibility related to IPAC as set out in their respective regulatory colleges (Office of the Auditor General of Ontario, 2009).
According to the LTCHA (2007), all LTCHs are required to have an IPAC program that includes daily monitoring to detect the presence of infection in residents and measures to prevent the transmission of infections. An infection control practitioner (ICP) is a person knowledgeable in IPAC, designated by the LTCH to be responsible for IPAC practices (Smith, et al, 2009). IPAC experts from Canada and the United States of America have recommended that there be a minimum of one full-time equivalent IPAC professional for every 150 to 250 residents in LTCHs (Smith, et al, 2009 & PIDAC, 2012). “Regardless of the size of the facility, the expected number of hours per week that are devoted to IPAC must be clearly stated and protected” (PIDAC, 2012). Research has shown that there is an increased need for more ICPs and IPAC training for ICPs (Zoutman, Ford & Gauthier 2009). Unfortunately, due to work demands and staffing, the majority of ICPs have many other duties (Smith, et al., 2008).
Healthcare-associated infections (HAIs) can have a significant impact on residents and the health-care system (Office of the Auditor General of Ontario, 2009). The emergence of antibiotic-resistant organisms (AROs) such as methicillin-resistant staphylococcus aureus (MRSA) has also significantly increased health care costs (PIDAC, 2012). For example the median cost associated with MRSA is more than twice the cost of methicillin-sensitive staphylococcus aureus in LTCH (PIDAC, 2012). IPAC programs have been shown to be clinically effective and cost-effective and appropriately resourced IPAC programs must be a standard of practice (PIDAC, 2012).
An outbreak is defined as an increase in the number of cases above the number normally occurring in a particular health care setting over a defined period of time (PIDAC, 2012). According to the LTCHA (2007), LTCHs are required to have an outbreak management system in place for detecting, managing and controlling infectious disease outbreaks. This includes defined staff responsibilities, reporting protocols, communication plans, protocols for receiving and responding to health alerts and a written plan for responding to infectious disease outbreaks (LTCHA, 2007). LTCHs are responsible for reporting outbreaks to their local Public Health Unit in a timely fashion. LTCHs reporting a suspect or confirmed outbreak to the Public Health Unit are provided with assistance regarding outbreak management based on the current respiratory and enteric outbreak guidelines set out by the MOHLTC.
Local Public Health Units are required to support LTCHs with outbreak management and provide consultation on IPAC matters as outlined in the Ontario Public Health Standards (2015). In accordance with these standards, Health Unit staff participate on committees, advisory bodies, or networks that address IPAC practices and are consulted on the development and/or revision of IPAC policies and procedures, surveillance systems for infectious diseases of public health importance and, response plans to cases and outbreaks of infectious diseases of public health importance. Additionally, Health Unit staff provide management of reportable disease cases and outbreaks to minimize the public health risk in accordance with the Infectious Diseases Protocol, 2015, the Institutional/Facility Outbreak Prevention and Control Protocol, 2015 and provincial and national best practices.