What are the Challenges

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What are the Challenges?

• Jennifer Amyotte ACP, ICP
• Barb Goulet BHlthSc., EMT-P, ICP
• CHICA-Canada 2008 National Education
  Conference

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Mission

• Our mission is to become part of the
• overall mosaic to ensure all pieces
• of the health care continuum join together
• to achieve a greater whole.

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Where does the continuum of health care start?
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Objectives

• The audience will
• experience the unique practice settings showing
  the many varying challenges
• become familiar with the challenges PHC providers
  experience in implementing ICP best practices
• have an awareness of some of the obstacles in
  standardizing IPC educational curriculum

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Levels of PrehospitalCare Providers

• Emergency Services EMS/Fire/Police
• Specialty Teams SAR, CBRNE, Tactical
• Volunteer units
• Industrial
• Mine rescue, protection/safety officer
• Community
• Certified health care providers -after hour
  clinics, physician offices, dental services,
  midwifery, physio
• lifeguards, ski patrol, sport trainers, park/game
  wardens

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PHC vs Health Care Facility
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Top Ten Challenges
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Challenge 10Training Levels EMS

• Non-regulated health care professionals highest
  delegated acts
• Training service levels vary
• Province to province
• Region and counties
• City and towns urban versus rural
• Tiered response EPS / Fire or volunteers
• Minimal or inconsistent education in IPC in
  colleges and services

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Challenge 9No Legislated ICPs

• ICPs funded and/or highly recommended in acute
  care settings and often required in LTCF
• Prehospital care providers perform invasive and
  high risk procedures in the field (IV / IO /
  needle thoracotomy, intubations)
• OHSA requires employers to ensure ESW have
  information, training and equipment to protect
  themselves
• Very few qualified ICP in EMS/Fire/Police etc.

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Challenge 8Lack of IPC Standards

• Most best practice manuals, directives developed
  for acute care facilities not in the field
  acute care
• Community care documents developed for
  physicians, dentist offices
• Ontario safety engineered sharps in effect 2008
  (required in hospitals only)

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Challenge 7Uncontrolled Environment

• Variety of settings (crack house to nursing home)
  
• Acute interventions or routine pt. transfers
  usually minimal information
• Temperature and lighting extremes confined
  working spaces hazardous working areas

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Welcome to our world!
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Additional Considerations

• Teams of two some medics work alone in primary
  response units
• Increased risk for personal safety ambulance
  accidents, violent patients. traffic
• Scene time critical golden hour
• Increased length off load delays in EDs impact
  on response times and public safety
• Multiple casualty incidents, field triage
  requires interagency communication and teams not
  all trained to same level
• EMS benchmarked by times chute, response, scene
  and turn around

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Dispatch service provides only second hand
information Mobile units increase difficulty
when performing high risk tasks
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Challenge 6Working Diagnosis

• Medics do not make definitive diagnosis
• Minimal access to previous medical history
• Rely on scene, bystander info
• Rely on empirical evidence i.e. patient
  observation
• No posted warning for precautions -use verbal FRI
  / SRI screening to mitigate risk

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Challenge 5Equipment

• Increased bulk and weight of equipment
• Diagnostic equipment / tools designed for stable
  environment
• No access to lab testing or results
• PPE disposable gowns / coveralls limited in
  size difficult to cover duty gear XL nitrile
  gloves many find too small

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Challenge 4Limited Resources / Staff

• No ID specialists for immediate support or
  consults
• Some services have no infection control manual
  for easy reference
• Some services have on board computers with
  resource library however not able to stop and
  refer to PPE, treatment or transport
  decisions..memory only

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Challenge 3Culture Change

• Routine practice with additional precautions
  becomes second nature
• Current focus on cost effectiveness and time
  factors does not measure pt. outcome or ICP
  issues
• Consider future focus towards proactive planning
  such as illness, injury prevention strategies,
  patient outcome, staff safety Designated Officer
  Program

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Designated Officer Program

• Developed to provide knowledge of infectious
  disease transmission be service liaison to MOH
  (or designate)
• To allow timely assessment and treatment for the
  exposed worker - designated officer 24/7 access
  to the MOH

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Designated Officer cont.

• Make the focus proactive teaching IPC best
  practices rather than reactive occupational
  exposure reporting rather than
• Designed to ensure inclusion of emergency
  responders in disease notification with contact
  tracing

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Challenge 2Cleaning Disinfecting

• Criteria for product selection
• Ease of use, single product, short contact time,
  dispensing packaging
• Promote single item/disposable versus
  reprocessing (sterilization/disinfection)
• Education cleaning disinfection
• Services with no identified vehicle service
  attendants
• Engineering controls standards for vehicles and
  equipment aid in IPC

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Cleaning Disinfecting
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And the 1 Challenge Is Our Challenge to You!

• Get Involved in Best Practice policy
  development with language that is inclusive of
  all health care providers.
• Ask questions request a ride-a-long with your
  local service
• Join us CHICA-Canada Prehospital Interest Group

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Reasons for Change

• Decrease HAIs
• Safer Healthcare Now Patient Safety Institute
  campaign
• Decrease pt. morbidity and mortality
• Decrease provider and public risk
• Recent experiences with SARS
• C. Diff / AROS

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Next steps 1

• Canadian Paramedic Association is currently
  pursuing a national College of Paramedics with
  self-regulation
• National training curriculum standardized
  levels Primary, Advanced Critical care
  paramedics
• Develop more National/Local organizations for
  ICP training encourage Paramedic CBIC
  certification
• Develop National required immunization program
  for all PHC providers
• Encourage employee health programs address the
  working sick

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Next steps 2

• Establish links now before an outbreak or
  pandemic is declared
• IPC not a free standing program a thread woven
  through all education programs
• IPC consultation for equipment selection,
  vehicle and station construction
• Safety engineered sharps
• Single use disposable equipment
• Single use patient medications
• Lobby manufacturers to develop products to meet
  PHC ICP requirements

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Next steps 3

• Development of current evidence based standards
  inclusive of prehospital care
• Consultation with IPC trained paramedics in the
  development of guidelines and/or standards
• Promote quality care based research in EMS
• Incidence of pneumonia after field intubations
• IV site infections / BSI for field IV
• Community surveillance (ILI)

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We cannot wait for scientific certainty before
we take reasonable steps to reduce risk
Justice Campbell December 2006 Thank you