My role in the Canadian Health Care System

As a preface, my career in Infection Prevention and Control (IPAC) started in local and provincial public health and continued in acute care.  I believe these are symbiotic relationships that all contribute to promote and protect public/patient safety.

The SARS (Severe Acute Respiratory Syndrome) outbreak of 2003 in Toronto Ontario highlighted system-wide under-emphasis and decline IPAC (Ontario., & Campbell, A. G., 2006).  I was a part of this event and played an important role in protecting healthcare workers and the public in a SARS assessment clinic.  This event was a turning point for public health renewal and enhancing IPAC in healthcare.  It included the creation of the Public Health Agency of Canada and the establishment of a Federal/Provincial/Territorial Public Health Network and Council (PHNC) to serve as a forum for collaboration, coordination and governance (CCDR, 2018).   PHNC in conjunction with the Council of Chief Medical Advisory can now form a Special Advisory Committee (SAC) to coordinate and manage public health emergencies (CCDR, 2018).  For Ontario, the Provincial Infectious Diseases Advisory Committee (PIDAC) was established in 2004 to advise the Chief Medical Officer of Health and to act as a resource to the Ontario Health System.  As public health experienced a re-birth, funding from the province also addressed the shortcoming of trained and experienced IPAC in both local public health units and acute care settings.  Local public health units across Ontario received 100% funding for 180 infectious disease control staff and 36 IPAC nurses; acute care funding is now provided on the basis of 1 IPAC practitioner per 100 hospital beds (Ontario., & Williams, D.C., 2008).  Emerging diseases and novel pathogens, also termed high-consequence pathogens, pose a constant threat with the ease and speed of global travel.   An effective, sensitive and responsive system is necessary to contain spread and prevent outbreaks.

One aspect of my role requires collaboration with system partners such as Public Health to function properly and meet regulatory requirements such as the reporting of communicable diseases under the Ontario Health Protection and Promotion Act and Communicable Diseases Regulation.  To meet the demands of this role, we must have rigorous surveillance and screening tools that can detect communicable/reportable diseases or outbreaks.  Surveillance reports from Health Canada, Ministry of Health and Long-Term Care and Toronto Public Health also provide guidance regarding national, provincial and local transmission that inform system pressures/risks.

Communicable and infectious diseases are a significant part of my portfolio but an IPAC professional also wears many other hats that span across a variety of standards, guidelines, regulations and Acts.  For example, the Canadian Standards Association sets forth standards for design and construction of hospitals which include many areas applicable to IPAC that also intertwine with each and every program or area of the hospital.  I participate with program stakeholders in all stages of functional planning, hospital design, renovation and construction for all projects.  This is an important function as it relates to the healthcare system as it helps to advance projects such as the development of the new Complex Malignant Hematology (CMH) program in Ontario which has been pushed to send patients out-of-country for treatments (Cancer Care Ontario, 2017).

In addition, Sunnybrook Health Sciences Centre IPAC program is a resource to the Emergency Medical Assistance Teams for Ontario which are accountable to the Emergency Management Branch of Ontario.  This provincial resource can deploy a mobile medical field unit to anywhere in the province within 24 hours.  This team has contributed to providing support for local, provincial and even nationally supported activities that occurred within the province of Ontario.

IPAC is a support service bound by standards, guidelines, Regulations and Acts that span across the entire healthcare sector.

References:

Canada Communicable Disease Report (CCDR).  (2018).  Fifteen Years Post-SARS: Key Milestones in Canada’s Public Health Emergency Response.  Retrieved from  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-5-may-3-2018/article-1-post-sars-key-milestones.html

Cancer Care Ontario.  (2017). Complex Malignant Hematology Services in Ontario.  Retrieved from https://archive.cancercare.on.ca/common/pages/UserFile.aspx?fileId=381199

Ontario., & Campbell, A. G. (2006). Spring of fear: The SARS Commission final report. Toronto: SARS Commission.  Retrieved from http://www.archives.gov.on.ca/en/e_records/sars/report/v2-pdf/Vol2Chp3.pdf

Ontario., and Williams D. C.  (2008).  Infectious Disease Prevention and Control in Ontario:  Continuing the Investment in 2008.  Retrieved from  http://www.health.gov.on.ca/en/common/ministry/publications/reports/cmoh08/cmoh08.pdf

Ontario Ministry of Health and Long-Term Care, Health System Emergency Preparedness Branch.  (2017).  Emergency Medical Assistant Team.  Retrieved from http://www.health.gov.on.ca/en/pro/programs/emb/emat/

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