Ontario Best Practice Manual : Preventing Febrile Respiratory Illnesses

This information requires knowledgeable interpretation and is intended primarily for use by health care workers and facilities/organizations providing health care including pharmacies, hospitals, long-term care facilities, community-based health care service providers and pre-hospital emergency service in non-pandemic settings.

Below is a summary of the report's general principles. The full report is available at the bottom of this page.

About This Document
How and When to Use This Document
Assumptions and General Principles for Infection Prevention and Control

This document deals with the control of droplet spread respiratory illness ONLY.

Droplet spread illnesses are spread when people cough or sneeze, and droplets of their respiratory secretions come into direct contact with the mucous membranes of the mouth, nose or eyes of another person. Because microorganisms in droplets can survive on other surfaces, droplet spread illnesses can also be spread indirectly when people touch contaminated hands, surfaces and objects.

In cases of suspected or known airborne spread respiratory illnesses, such as tuberculosis, see :

• The Canadian Tuberculosis Standards 5th ed. (Canadian Lung Association; 2000) and Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care, 1999 (Can Commun Dis Rep. 1999; 25 Suppl 4:1-142).

Preventing Febrile Respiratory Illness: Protecting Patients and Staff sets out the infection prevention and control practices required to :

• prevent transmission of droplet-spread febrile respiratory illness (FRI) to other patients and to health care providers;
• help the health care system quickly detect and contain clusters and outbreaks of common respiratory infections; and
• help the health care system detect and contain any new or virulent microorganism causing respiratory infections.

The document reflects the best expert opinion on the prevention and control of droplet spread febrile respiratory illness available at this time. The recommendations in this document will be reviewed and updated from time to time.

Information in this document is consistent with Public Health Agency of Canada recommendations. It is also consistent with the Communicable Disease Protocols developed jointly by the Ontario Hospital Association (OHA) and the Ontario Medical Association (OMA). Physicians should also see the College of Physicians and Surgeons of Ontario publication : Infection Control in the Physician's Office, 2004.

The best practices for febrile respiratory illness set out in this document should be part of ROUTINE practice for ALL patient care in all settings where health care is provided. They should be integrated with existing infection prevention and control programs for other illnesses, and be part of a comprehensive organization-wide effort to maintain acceptable standards for infection prevention and control.

This document has been written to address the continuum of care, INCLUDING acute care, long-term care, complex continuing care and rehabilitation, physicians’ offices, clinics, home health care and public health. Application of these guidelines may vary depending on the care setting.

In the event of an outbreak of febrile respiratory illness, health care settings should contact their local public health unit (see full document, section #4: Reporting), and follow appropriate outbreak management procedures (see MOHLTC directives for respiratory outbreaks).

The best practices set out in this document are based on the assumption that health care settings in Ontario already have basic infection prevention and control systems or programs in place. If this is not the case, health care settings will find it challenging to implement the practices recommended for febrile respiratory illness. These settings must work with organizations that have infection prevention and control expertise, such as regional academic health science centres, regional networks, public health units that have infection prevention and control expertise, and local infection prevention and control associations (e.g., Community and Hospital Infection Control Association – Canada chapters), to develop evidence-based programs. (Note: requirements for a comprehensive infection prevention and control program are currently being developed; see also the chapter on infection control in A Plan of Action. Final Report of the Ontario Expert Panel on SARS and Infectious Disease Control. April 2004. For a list of infection prevention and control resources, see Appendix 5 of the full document).

In addition to the general assumption (above) about basic infection prevention and control, these best practices are based on the following assumptions and principles :

1. Health care settings routinely implement best practices to prevent and control the spread of infectious diseases, including Health Canada’s Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care (Can Commun Dis Rep. 1999;25 Suppl 4:1-142).
    
2. Health care settings devote adequate resources to infection prevention and control.
    
3. Health care settings provide regular education (including orientation and continuing education) and support to help staff consistently implement appropriate infection prevention and control practices.
   
   Effective education programs emphasize :
   • the risks associated with infectious diseases (including FRI) and the benefits of case finding/surveillance
   • the importance of immunization against infectious diseases
   • hand hygiene (including the use of alcohol based rubs or hand washing);
   • principles and components of Routine Practices as well as additional transmission-based precautions;
   • assessment of the risk of infection transmission and the appropriate use of personal protective equipment, including safe application, removal and disposal;
   • appropriate cleaning and\or disinfection of care equipment, supplies and surfaces or items in the care environment (for example, beds, bed tables, call bells, toilets, privacy curtains);
   • procedures that are considered high risk and why;
   • individual staff responsibility to keep residents/patients/themselves and fellow staff members safe; and
   • collaboration between occupational health and safety and infection prevention and control.
   
   NOTE: Education programs should be flexible enough to meet the diverse needs of the range of health care providers and other staff who work in the health care setting. The local public health unit may be a resource and can provide assistance in developing and providing education program for community settings.
    
4. All health care settings promote collaboration between occupational health and safety and infection prevention and control in implementing and maintaining appropriate infection prevention and control standards that protect workers.
The facility is to be in compliance with the Occupational Health and Safety Act, R.S.O. 1990, c.0.1. and associated Regulations including the Health Care and Residential Facilities – O. Reg. 67/93.
 
5. All health care settings have established communication with their local public health unit and have access to ongoing infection prevention and control advice and guidance to support staff and resolve any uncertainty about the level of precautions required in a given situation.
    
6. Health care settings have established procedures for receiving and responding appropriately to all international, regional and local health advisories (e.g., countries or regions with significant respiratory illnesses. For example, see the Public Health Agency of Canada Travel Medicine Program Webpage.
   
   They also communicate health advisories promptly to all staff responsible for case finding/surveillance and provide regular updates (e.g., rates of the febrile respiratory illness subject to the health advisory; morbidity and mortality associated with the febrile respiratory illness subject to the health advisory).
    
   Health care settings report back to staff on the impact of their surveillance efforts (e.g., benefits of case finding/surveillance and preventive practices in the workplace in terms of patient safety, patient and staff illness; outbreaks)..
    
7. Health care settings have effective working relationships with their local public health unit. They maintain clear lines of communication, contact public health for information and advice as required, and fulfill their obligations (under the Health Protection and Promotion Act, R.S.O. 1990, c.H.7) to report reportable and communicable diseases. Public health provides regular aggregate reports of outbreaks of any infectious diseases, including FRI, in facilities and/or in the community to all health care settings.
    
8. All health care settings regularly assess the effectiveness of their infection prevention and control education programs and their impact on practices, and use that information to refine their programs.
    
9. All health care settings have a process for evaluating personal protective equipment (PPE) to ensure it meets quality standards where applicable.

Preventing Febrile Respiratory Illnesses : Protecting Patients and Staff 39 pages | 622 Kb | PDF

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