Physiotherapists and physiotherapy employers are required to be cognizant of and comply with the legislation that applies to their practice.5 In the case of IPC, the relevant legislation includes the Occupational Health and Safety Act (OHS) and may include requirements contained within the Act regarding the use of the Workplace Hazardous Materials Information System (WHMIS).
Under occupational health and safety legislation, employers are required to inform employees about hazards in the workplace and to train employees on how to mitigate the risks posed by hazards when the hazard cannot be eliminated.6 This includes the requirement to provide and train staff in the use of PPE, such as gloves, gowns and masks to prevent the spread of infection, and to provide information and training about any chemical hazards present in the practice environment.
Hand Hygiene and Point of Care Risk Assessment
Hand hygiene is widely recognized as the single most important IPC practice and helps to break the chain of transmission by acting on one of the primary modes by which infectious agents are spread – health-care workers.
Hand hygiene using alcohol-based cleaner (with an alcohol concentration between 60-90%), or hand washing using soap and water is an essential element of all IPC efforts; however, some estimates indicate that compliance with routine hand hygiene practices is as low as 40% among health professionals.7
Physiotherapists are expected to practice routine hand hygiene according to any practice setting or disease-specific recommendations that may apply, and consistent with the World Health Organization’s “5 Moments for Hand Hygiene:”8
- Before touching a patient
- Before clean/aseptic procedures
- After body fluid exposure or risk
- After touching a patient
- After touching patient surroundings
A point of care risk assessment should also be conducted prior to each patient contact to determine the degree of risk of infection or transmission of communicable diseases to patients, staff, colleagues, and others.
Figure 2. 5 Moments for Hand Hygiene. Source: World Health Organization. WHO Guidelines on hand hygiene in health care: First global patient safety challenge-Clean care is safer care.
A risk assessment should include consideration of the likelihood of exposure to an agent:9
- From a specific interaction
- Assessment/treatment interventions planned or conducted
- With a specific patient
- Health condition of the patient
- Patient ability to perform hand hygiene, respiratory hygiene
- In a specific environment
- Health and immunization status of people in practice environment including the physiotherapist, colleagues and other patients
- Degree of infection risk present in the clinical practice setting and community at large (including local, national and international considerations as appropriate)
- Under available conditions
- Current best practices in IPC protocols relevant to their professional practice, and the ability to mitigate the risk of infection or transmission through the use of IPC measures
While some measures help to prevent the spread of infection by disrupting the mode of transmission, physiotherapists also have a role to play in breaking the chain of transmission by eliminating reservoirs of infectious agents. This can be accomplished through environmental cleaning.
Although the individual physiotherapist may not be expected to routinely clean the facility in which they work, they do have a professional responsibility to ensure that the practice environment is equipped, operated, and maintained in a manner consistent with IPC standards and guidelines.5
They also are responsible to report identified deficiencies to those parties responsible for the management of the practice environment, and to participate in environmental cleaning when appropriate.
Environmental Cleaning and the Workplace Hazardous Materials Information System
WHMIS is a classification and communication system used to convey information about hazards present in work environments. It is relevant to the discussion of IPC because the chemicals used for environmental cleaning to prevent the spread of infectious agents can pose a hazard to employees and may be subject to the rules outlined in the WHMIS system.
The system is designed to ensure that all employers and employees are informed and trained properly about hazardous materials used in the workplace.10 WHMIS provides consistent reporting related to chemical hazards that employees may encounter in the work environment.10
WHMIS classifies chemicals into controlled and non-controlled products. Employers are required to ensure that containers of controlled products are labelled with WHMIS labels, provide employees with Safety Data Sheets (SDS) outlining the chemical’s characteristics and hazardous properties, and provide employees with education and training regarding the safe handling, use, storage, and disposal of a controlled product.10,11
However, consumer products are not controlled by WHMIS. Consumer products are those products packaged in quantities appropriate for and available to the public through retail outlets. These products fall under the Consumer Chemical and Containers Regulations.12
Depending on your specific situation, the chemicals you use, and the quantities of those chemicals that you have onsite, you may or may not need to comply with WHMIS requirements for labelling and employee training. Generally speaking, private physiotherapy clinics use consumer products and are therefore not required to provide WHMIS training or adhere to other WHMIS requirements. This does not alter the employer’s legislated responsibility to inform employees about hazards in the workplace, to provide controls to mitigate the risks these hazards pose, and to train employees in the use of these controls.
Personal Protective Equipment, Administrative and Engineered Controls
Physiotherapists know about how infectious agents are spread because of the measures they are instructed to use to prevent these agents from spreading. For example, physiotherapists routinely use gloves, gowns and masks as barriers between themselves and contagious infectious agents. Other examples of PPE include goggles and face shields.
While PPE may be the first thing that comes to mind when thinking of IPC, these measures are also considered the weakest controls, as they require adherence to be effective. Other types of controls include administrative and engineered controls. Administrative controls include policies, procedures and routine practices that are intended to prevent exposure to a workplace hazard.13 Examples include hand hygiene policies, or mandatory hepatitis B immunization. Engineered controls alter the design of work or tools used in practice to remove a hazard instead of depending on adherence to policy or PPE use13 and are generally considered the strongest controls. An example would be the use of safety engineered devices that reduce the risk of blood-borne virus exposure from a needle stick or similar injury.
All health-care workers have the potential to be reservoirs of, a mode of transmission, or a susceptible host to an infectious agent. For example, research has indicated that health-care workers are considerably more likely to contract the flu or to be asymptomatic carriers of the flu virus than members of the general public.14 As asymptomatic carriers of the flu they are unlikely to stay home from work despite being a reservoir of the virus.14,15 Physiotherapists also routinely work with individuals who are very ill, meaning that the risk of the physiotherapist being a reservoir of an infectious agent and their patient a susceptible host are greater than in non-health care related professions.
Physiotherapists are expected to comply with “infection prevention and control measures to support the health and safety of clients, health-care providers, her/himself, and others.”5 Immunization, when not medically contraindicated, is one such measure.
Physiotherapy Alberta strongly encourages members to be immunized against the infectious agents present in their practice environments, for their own protection and for the safety of their patients and colleagues.