As highlighted in the Walker Report (2004), there is a need for coordination and integration of infection control activities throughout the province. Gaps have also been identified as health care facilities took stock of their environments, post-SARS. While there are some current examples of collaboration in the province, as it relates to the management of infectious diseases and infection prevention and control, a regional approach would enhance the work already being provided by local Public Health Units, acute and non-acute healthcare providers, academic institutions and national/provincial professional associations.

The concept of regional networks and sharing accountability is not new to Ontario. A number of networks and associations have developed to ensure the continuity of health services as it relates to specific medical conditions. The best known of these networks include the Cardiac Care Network, Cancer Care Ontario and the Regional Coordinated Stroke Strategy.

In June of 2004, the Ministry of Health and Long-Term Care released Operation Health Protection. In it, the Ministry recognized the importance of improving the coordination and access to infection prevention and control resources across the health care continuum. The phased implementation of regional networks for infection control and communicable diseases began in 2004/05. Based on the evaluation of the initial four networks, the Ministry expects to begin fully implementing regional networks across the province by 2006/07.

The mandate of Regional Networks is to maximize coordination and integration of activities related to the prevention, surveillance and control of infectious diseases across the healthcare spectrum on a regional basis. Further, Regional Networks will strengthen the coordination between infection prevention and control activities at acute and non-acute facilities and Public Health communicable disease control activities.

The networks will not replace local infection prevention and control capacity and resources, or alter existing legal requirements. As such, hospitals and long-term care homes retain their requirement to maintain infection control programs and the powers and duties of Public Health Units set out in the Health Protection and Promotion Act (HPPA) remain unchanged.

Various systems/structures are in place throughout the province which coordinate and integrate the planning of infection prevention and control/outbreak activities at a local or regionalized level (e.g. city-wide infection control committees). The development of the Regional Networks is not intended to replace or duplicate these structures. Rather, the networks will support and enhance the planning, coordination and integration already being undertaken at the local levels.

Core network deliverables applicable to all networks province-wide will be established by the Ministry of Health and Long-Term Care; specific regional deliverables should be developed by each Regional Network. The development of multi-year regional strategic plan should be guided by the results of an inventory of infection prevention and control resources within the region, and should address regional gaps and trends. The inventory should encompass relevant resources within the region, including human resources, education, policies/procedures, and surveillance activities.

As initial steps in the implementation process, each Regional Network should ensure that the following are in place :

Network Steering Committee : Each Regional Network should establish a Network Steering Committee that will provide guidance, direction and leadership to network activities. Each Network Steering Committee will be responsible for establishing the strategic direction for the network, as articulated in a strategic multi-year plan and encompassing the outcomes from the resource inventory.

Membership of the Network Steering Committee should be representative of expertise rather than individual organizations. Limits, where appropriate and necessary, should be placed on the number of representatives from any one facility to ensure a fair cross-representation. Membership should include at a minimum: infection prevention and control (representing acute and non-acute care, if possible); Public Health; senior administration (representing acute and non-acute care), and an infectious disease specialist. In selecting members, consideration should be given to ensuring the process is transparent, and that any diverse geography/demographics of the region are taken into account.

Consideration might be given to committee appointment being for a fixed, staggered term to ensure continuity and allow for maximal participation across the region. Each region may decide to appoint or elect either a Chair or Co-Chairs to lead the committee.

Network Coordinator : The Network Coordinator is expected to coordinate the development and implementation of the Regional Network. Once the network is fully operational, the Network Coordinator will be responsible for the operational aspects of the network. This position will also :

• promote a common and standardized approach to infection prevention and control activities, based upon best practices
• ensure sharing of information between members of the network, between Regional Networks and between the network and the Ministry of Health and Long-Term Care

The Network Steering Committee should have direct input and role in the recruitment and retention of a Network Coordinator. The employer of record for the Network Coordinator will be the host hospital through which network funding is flowed. The Network Coordinator is a resource to the network and its members, and not solely a resource to the host hospital. A model job description for the Network Coordinator has been developed to ensure consistency between the regions with respect to the role and responsibilities of this position.

Recruitment strategies should take into consideration the geography, service providers and disciplines available in that region. Advertising and recruitment should also reflect breadth and composition of the region (such as advertising in all local papers throughout the region).

Medical Resource(s) : Each Network Steering Committee should determine the type of medical resources available to support (a) development and implementation and (b) ongoing operations. At a minimum, the network will need to work with a physician who can provide medical expertise and leadership on the implementation of the network, as well as to champion the network within the regional healthcare community. Depending on the geography and membership of the network, as well as the results of a regional infection prevention and control resource inventory, one or more physicians may be needed to provide ongoing support to the Network Steering Committee.

Medical resources should be compensated using network funds through mechanisms such as (but not limited to) a per diem rate, an annual stipend (based on a guaranteed minimum monthly number of hours of work), or a sessional fee.

Network support funding is not for the provision of direct clinical services on a patient or facility basis; rather it is for network support activities only. Such support activities could include :

• fostering relationships within and amongst the region(s), particularly to promote the benefits and opportunities of network participation in order to facilitate the successful development of the regional network;
• providing advice and medical guidance on the strategic plan, and a best practice model for infection prevention and control throughout the region;
• working collaboratively with the Network Coordinator and other members of the network team to facilitate successful completion of the Strategic Plan and network goals and objectives;
• providing medical advice on the standardized tools necessary to conduct an inventory of the infection control resources within the region;
• acting as a medical liaison within the network, between the networks, with the MOHLTC as well as other agencies to facilitate the implementation of the Regional Infection Control Network.

At a minimum, the qualifications for the medical resource(s) should include a valid license to practice medicine in Ontario, knowledge, experience and/or demonstrated interest/engagement in infection prevention and control, and excellent communications skills.

Should facility-to-facility provision or sharing of physician resources for clinical activities be required or desired, specific agreements between these facilities would be needed as this is outside the scope of network funded activities.

The regional infection control network is a voluntary affiliation of health care organizations designed to support cooperation and collaboration of infection prevention and control activities across the entire spectrum of care, including Public Health Units, acute care facilities, non-acute care facilities, and community agencies. Many organizations will already be part of partnerships and alliances upon which the network can be built, however, the network must be designed to support organizations from across the broad continuum of care. Those organizations not already involved in the initial planning of the network will need to be approached in order to gain commitment, communicate information and build additional linkages.

Participating organizations must clearly understand the mandate of the regional network and the benefits of membership. Each Network Steering Committee should strongly consider specifying these roles and responsibilities in a formal agreement with the member organizations (such as through a memorandum of understanding). Documentation to assist in the development of a Memorandum of Understanding will be provided at a later date.

The Network Steering Committee, through the Chair of the Committee, shall be accountable to the Public Health Division of the Ministry of Health & Long-Term Care (MOHLTC) for the progress of the network deliverables. Recommendations from the Network Steering Committee that may have implications broader than the region will be directed to the Public Health Division, MOHLTC for dissemination to the appropriate committee or resource within the Ministry (e.g. Provincial Infectious Diseases Advisory Committee (PIDAC)).

The Network Coordinator’s activities will be guided by the Network Steering Committee and linked to information received from the Public Health Division, Ministry of Health and Long-Term Care.

Communication amongst the four initial networks (and subsequent networks as they developed and implemented) is critical to the success of this initiative. The Network Coordinators and Medical Resources should meet on a regular basis as a conduit for information dissemination from the MOHLTC and to provide a forum for problem solving and feedback from the field regarding issues related to the application of infection prevention and control activities.

The Ministry of Health and Long-Term Care recently established the Provincial Infectious Diseases Advisory Committee (PIDAC). PIDAC will serve as a scientific advisory body providing advice to the Chief Medical Officer of Health (CMOH) on prevention, surveillance and control measures necessary to protect the people of Ontario from infectious diseases. PIDAC also provides the CMOH with advice on issues such as standards and guidelines for infection control, emergency preparedness for an infectious disease outbreak, protocols to prevent and control infectious diseases, and immunization programs.

Given the complementary mandate of both these initiatives, there will need to be strong linkages between PIDAC and the regional infection control networks. For example, standards and best practices developed and endorsed by PIDAC could be distributed to the appropriate health care institutions/providers through the Regional Networks, or surveillance activities established upon the advice of PIDAC could be facilitated by the Regional Networks. To aid in the communication between the Regional Networks and this scientific advisory group, a representative from the Network Coordinators/Medical Resources could sit on PIDAC.

Funding will be provided in a manner to allow for the sustainability of the networks. These funds are strictly designated for Regional Network activities, and all funds are subject to Ministry audit and report back. Guidelines for the utilization and expenditure of network-designated funds are being developed by the Ministry of Health and Long-Term Care. The Network Coordinator, guided by the Network Steering Committee, will be required to develop a budget for capital and operating costs in alignment with these guidelines.

The host hospital will serve as the employer of record for network-specific human resources such as the Network Coordinator position and administrative support. These individuals will be accountable to the host hospital in relation to employer-employee issues, and the Public Health Division, Ministry of Health & Long-Term Care, for network deliverables (as determined/ approved by the Ministry).

The Network Coordinator will also be asked to submit regular progress reports to the Public Health Division to ensure progress milestones are being achieved, to identify issues and problems that may necessitate assistance/guidance at the Ministry level and to expedite decision making. In addition, the Network Coordinator, guided by the Network Steering Committee, will be asked to submit :

1. An annual report of network activities and achievements (to all network members, to Network Coordinators of other networks and to the Ministry of Health and Long-Term Care); and
2. An annual workplan and budget for the upcoming fiscal year (to the Ministry of Health and Long-Term Care).

The Ministry will undertake an evaluation of each regional network within the first year of implementation. Ongoing evaluation criteria of the individual networks and the networks as a whole will be developed by the Public Health Division, in consultation with the regional networks. The Network Steering Committee will be advised of any changes necessitated as a result of such evaluation.

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