Occupational Health and Safety Act (OHSA): It is the responsibility of employers/supervisors to take necessary precautions to prevent transmission of pathogens to workers. It is the responsibility of workers to comply with OHSA regulations and the workplace’s health and safety policies and procedures. For more information visit: OHSA

Workplace Hazardous Materials Information System (WHMIS): Employers must ensure that the workplace is a safe environment for workers and patients. They must ensure that there is compliance with WHMIS standards. For more information visit: WHMIS

An employer of a health care worker is expected to ensure staff have timely, unimpeded access to appropriate PPE for the task to be performed, and the necessary education/training to ensure competency on its appropriate use, care, and limitations (e.g., appropriate disposal of PPE, length of use etc.).

Risk Assessment
The first step in effective use of Routine Practices (see Routine Practices and Additional Precautions In All Health Care Settings, 3rd edition) includes organizational risk assessment and personal risk assessment (see ‘Recommended Risk Assessments’ on page 4 of IPAC Recommendations for Use of PPE for Care of Individuals with Suspect or Confirmed COVID‑19).

Public Health Ontario (PHO) Resources

• PHO’s Clinical Office Practice webpage offers expertise and tools to help health care workers understand and implement infection prevention and control practices.
• IPAC Core Competencies – Risk Assessment and Chain of Transmission
• IPAC Checklists for Clinic Self-assessment:
  • IPAC Checklist for Clinical Office Practice – Core Elements (English | French) provides an overview of core elements that should be present in IPAC policies and procedures of a regulated health clinic in Ontario. 
  • IPAC Key Principles for Clinical Office Practice During the COVID-19 Pandemic (English | French) provides guidance for COVID-19 specific IPAC elements to be followed in addition to IPAC best practices.
• Best Practices for Hand Hygiene in All Health Care Settings, 4th edition (English | French)

As per Infection Prevention and Control for Clinical Office Practice (Public Health Ontario, 2015), optometric office settings will usually feature two components: 

1. Public component is the public areas of the clinical office that are not involved in patient care. This includes waiting rooms, offices, corridors, and service areas. Areas designated in the public component are cleaned with a detergent.
2. Clinical component is the area involved in patient care. This comprises the clinical areas of the office, including examination rooms, procedure rooms, bathrooms, and diagnostic and treatment areas. Areas designated in the clinical component are cleaned with a detergent and then disinfected with a hospital grade disinfectant. ‘High touch’ surfaces may require more frequent cleaning.

Surfaces must be cleaned of visible soil before being disinfected, as organic material may inactivate a disinfectant. Some products may combine cleaning and disinfecting agents. Items that are not touched frequently and are not likely to become contaminated with blood or body fluids do not require daily cleaning, but should receive periodic, scheduled cleaning and disinfection. 

Clinical office cleaning regimens include daily cleaning and disinfecting surfaces and objects with an approved surface cleaner and a hospital-grade, low-level disinfectant. Examination rooms should be kept free of clutter to facilitate cleaning. Surfaces in the clinical office and waiting rooms need to be cleaned and disinfected immediately when they are visibly soiled with blood or other body fluids, excretions or secretions.

Every device or appliance that patients encounter must be cleaned and disinfected before use with the next patient. For information on levels of disinfection, see Public Health’s At a Glance Disinfection Tables. You may also wish to reference Infection control guidelines for optometrists 2016, ‘Appendix 2. Recommended cleaning and disinfection procedures’* for more information on recommended levels of disinfection and cleaning for optometric equipment.

_{*Follow the manufacturer’s instructions regarding appropriate contact time and the use of agents to ensure appropriate cleaning and disinfection without damaging equipment or appliances.} 

It is strongly recommended that optometrists post their infection control Standard Operating Procedures on their website and in their office reception area where they will be available to patients.

Emergency Planning and Preparedness

The Ontario Ministry of Health provides information on emergency planning and preparedness, as well as on the unique programs and services that are available to the health care system and professionals during times of emergency. For more information: Emergency Planning and Preparedness

Considerations During an Outbreak or Pandemic

During the course of an outbreak, additional IPAC measures must be implemented in healthcare settings to minimize pathogen transmission. These measures can be adjusted accordingly during periods of increasing and decreasing transmission rates, with the safety of patients and workers always being of the utmost priority. Routine practices are required for all clinical interactions, independent of any concern for the possibility of COVID-19 or other infectious diseases.

Over the course of the COVID pandemic, several IPAC measures were implemented in addition to routine practices in healthcare settings to further minimize viral transmission and preserve operations. These additional IPAC measures have included, but are not limited to, vaccination policies for staff and visitors, visitor restrictions, active and passive screening for visitors, staff and patients, distancing and cohorting of staff and patients, universal masking, and routine eye protection use.

When there is an outbreak that affects the broader population, information provided by Public Health Ontario and local public health units, as well as those with IPAC and occupational health expertise, will aid in risk assessment and the application of additional IPAC measures.

Diseases of Public Health Significance

Diseases of public health significance (suspected or confirmed cases) must be reported to the Medical Officer of Health under the Health Protection and Promotion Act, R.S.O., 1990, Chapter H7.

If a physician or a practitioner* forms the opinion that a person has or may have a disease of public health significance, they are required to report this to their local medical officer of health (i.e., the public health unit where professional services are being provided).

*A practitioner is defined under the HPPA as:

• a member of the College of Chiropractors of Ontario
• a member of the Royal College of Dental Surgeons of Ontario
• a member of the College of Nurses of Ontario
• a member of the Ontario College of Pharmacists
• a member of the College of Optometrists of Ontario
• a member of the College of Naturopaths of Ontario

The current list of reportable diseases as well as reporting instructions are found on your regional public health unit website.

Ontario Public Health Unit locator: https://www.phdapps.health.gov.on.ca/phulocator/Default.aspx

Infection Prevention and Control Canada (IPAC Canada): The goal of IPAC Canada is to prevent infections and improve outcomes for patients, residents, clients and staff in hospitals, healthcare facilities and communities. For more information visit: IPAC Canada.