FAQs: Infection Prevention Webinar Questions (please read Disclaimer)

• Disclaimer

  These are questions that were submitted by physiotherapists for the Infection Prevention webinar hosted by the College in partnership with Public Health Ontario. 
  
  The answers to the following questions were submitted by Public Health Ontario and contain lots of pertinent information however it is a PTs responsibility to stay up to date on best practices related to infection control which can often change based on new evidence. 
  
  For more please visit the Public Health Ontario website and review their infection prevention and control resources. 

• What is the best before or expiry date on acupuncture needle boxes?

  If sterile items are stored in clean, dry conditions and the packing is intact, there may not be a best before or expiry date. However, if the manufacturer provides such a date, it indicates the item (stored properly) can be considered sterile up to that date and should be discarded or reprocessed, depending on the manufacturer’s instructions for use. 

• What are infection control measures surrounding acupuncture (needle storage, disposal, etc.) and pelvic floor (gel, spill kits, etc.)?

  All equipment should be stored in a clean dry space. You need appropriate storage to prevent contamination (e.g., shelves in closed cupboard). Dispose of used acupuncture needles in a sharps container as close as possible to point of use.

  Gels should be single use sterile for mucous membranes or broken skin (see IPAC Canada Position Statement on Medical Gels).

  Body fluid spills: You need to have policies to deal with spills and staff exposure to blood or body fluids. Use personal protective equipment (gloves at minimum) to remove soiling and clean and disinfect the area with an appropriate product. Bleach is recommended for disinfecting. Having a spill kit ready for such events is recommended.
  
  Review the  PIDAC Best Practices for Environmental Cleaning for guidance on spills, especially Appendix 12.

• I use stanhexadine as a skin prep for acupuncture as our organization recommends this as opposed to alcohol swabs. Is this ok?

  Chlorhexidine in alcohol (2% in 70%) is recommended for skin prep when needles are staying in place (e.g., IV insertion), but alcohol is acceptable for acupuncture as the needles do not stay in for long.

  Learn more about skin preparation from the Council of Colleges of Acupuncture and Oriental Medicine. 

• Do Norwex (microfibre) cleaning clothes meet safety standards for wiping beds and ultrasound heads?

  Microfibre cloths are excellent cleaners and remove organisms from surfaces well. However, in health care settings, they should be used with an appropriate cleaner/disinfectant. Ensure that you are using a hospital-grade/low level disinfectant (with a DIN number unless it is bleach or alcohol) that is compatible with the surface being cleaned, and follow the manufacturer's instructions for use for the cloth, cleaner/disinfectant, and item being cleaned and disinfected.
  
  See PIDAC Best Practices for Environmental Cleaning for more information.

• Can adhesive/gel electrodes for IFC/TENS be re-used on different clients?

  Adhesive/gel electrodes are generally single use but be sure to consult and follow the manufacturer's instructions for use. 

• How can you properly clean ultrasound equipment (including sound heads) between clients?

  In physiotherapy, ultrasound is applied to intact skin, so cleaning and low-level disinfection is required between patients or clients. Follow the ultrasound manufacturer's instructions for use for the appropriate process and product.

• Can we reuse ultrasound gel bottles? Are we allowed to refill individual sized ultrasound gel and massage lotion bottles from bulk sized bottles if properly labelled?

  There are reports of contamination of gels and lotions from clients’ skin and users’ hands. Containers would need to be thoroughly washed and sanitized/disinfected and dried before being refilled and they can also become contaminated in the refilling process. There is also no guarantee that there are no spores in the container as it has not been sterilized. Refilling/reusing bottles is therefore not recommended.
  
  See the  IPAC Canada Position Statement on Medical Gels for more information. 

• What is the College’s position on flu shots as preventative for us passing on germs to clients?

  Note the College does not have an official position on flu shots and recommends following the advice of Public Health Ontario.
  
  

  Public Health Ontario recommends annual influenza immunization for all health care workers. Even if you stay home when ill, you can be contagious for 24 hours before symptoms develop. See our Public Health Ontario Influenza page for more info.

• Is having a water bottle on your desk, and using it throughout your day considered a high point of contact for infection?

  There should be no food or drinks in patient care areas. If the water bottle is on a desk that is outside the treatment area, that would be fine. It is important to thoroughly clean and dry your water bottle at least daily.
  
  Review the  PIDAC Routine Practices and Additional Precautions for more information. 

   

• What should we be doing at the front desk to ensure our staff does not get sick from touching so many things, such as patient’s plastic IDs or credit cards?

  Have alcohol-based hand rub at the desk and use it between handling materials, especially between patients. Keep hands away from your face. There should also be signage for clients noting that if they have respiratory symptoms (cough, fever, etc.), they should clean their hands, apply a mask, and notify the receptionist.
  
  Review the  PIDAC Routine Practices and Additional Precautions Annex A and Public Health Ontario Clinical Office Practice for signage and further information.

• What are your recommendations if a therapist has a cold sore and is working with young children or other high-risk patients?

  As per routine practices, you need to do an individual risk assessment.

  The OMA/OHA Communicable Diseases Surveillance Protocol for Herpes Simplex provides direction that is recommended across health care settings:

  “Work restrictions or modifications vary with the type of herpes simplex infection and the type of patients with whom the person has contact. Health care workers excluded from direct patient contact because of HSV infection may safely be assigned to duties that involve no patient contact. Health care workers working with high-risk patients may continue to work as long as they maintain meticulous hand hygiene, and cover the lesions (e.g., wear a surgical mask or dressing) to discourage hand-to-lesion contact. The health care worker should wear gloves for direct hands-on contact with high risk patients. Perform hand hygiene after removing gloves, as per Routine Practices. Health care workers who do not work with high-risk patients may continue to work with no special precautions, as long as they maintain meticulous hand hygiene.”
  
  Note: 

  Direct patient contact involves skin-to-skin contact of the type that occurs in patient care activities that require direct, personal “hands-on” care (e.g., bathing, washing, turning patient, changing clothes, continence care, dressing changes, care of open wounds/lesions, toileting).
  
  High-risk patients include newborns, patients with extensive skin damage such as burns and chronic eczema, and patients who are immunocompromised.

• What are the requirements for use of N95 respirators for pandemic influenza or other airborne biological agents, especially for clinics and physiotherapists working in the community and stock piling?

  Guidance is provided in the MOHLTC Pandemic Plan, especially Chapter 5, for a 4-week stock pile, based on risk assessment and the number of staff and client interactions.
  
  A reminder that fit-testing is required every two years or when facial shape has changed (e.g., weight loss, new beard, etc.) Check that your masks are properly stored and in date (rubber can biodegrade). 

• What precautions are needed in an outpatient clinic for a patient living with an active bed bug infestation?

  Bed bugs do not usually travel on the clothes of people. They usually hide in seams of mattresses during the day and come out to feed at night. Routine practices should be sufficient when providing care and treatment. If you have a concern, you can ask the patient to come at the end of the day, have a plastic cover over the plinth that you can roll up and discard, and vacuum surfaces thoroughly after the patient has left. Your local health unit can provide additional information, e.g., Toronto.

• What are the best practices for clostridium difficile and Methicillin-resistant Staphylococcus Aureus (MRSA)?

  Both require routine practices and contact precautions - application can be adapted for the specific setting and patient.

  See IPAC Routine Practices and Additional Precautions – Annex A for antibiotic resistant organisms (ARO) and Annex C for clostridium difficile infection (CDI) and contact your local Public Health Ontario Region IPAC Office if you have specific questions.

• I have an autoclave in my office. How am I supposed to dispose of the biological indicators after testing?

  Be sure to dispose of biological indicators after use and documentation in a sharps container (Biohazardous waste bin). There is no need to keep them.

• What are the updated autoclave regulations for physiotherapists who do pessaries?

  Pessaries are sterile individually packaged and can be used on one patient only.

  Pessary fitting kits will have manufacturer's instructions for use regarding appropriate cleaning and sterilization. The autoclave manufacturer's instructions for use should also be followed.

  See Public Health Ontario’s recommendations for reprocessing medical devices, including pessary fitting kits.

• Does gynecological gel for pelvic evaluations need to be in single use packages? Can a patient bring their own lubricant to be used for the exam?

  Lubricating gel should be sterile single use as there is contact with mucous membranes.

  It is not recommended that a patient bring their own gel unless it is in a single use sterile package.  

• What advice do you have if the owners of the clinic where I work are reluctant to provide gloves? What should I tell them?

  Gloves are required when there is risk of contact with body fluids or contaminated surfaces, as well as for cleaning when handling certain chemicals (refer to product label). Under the Occupational Health Act, employers are required to ensure workers are protected.

  Feel free to have your employer to contact the College’s Practice Advisor who is happy to chat with them about the rules physiotherapists are required to follow in Ontario. 1-800-583-5885 ext. 241, 647-484-8800 or advice@collegept.org.

• How can I clean/disinfect the muscle stim machine that I lend my patients to use for their pelvic floor strengthening exercise (for their home use)? They buy their own probe.

  The machine should be cleaned and disinfected according to manufacturer's instructions for use. A low-level disinfectant is suitable for equipment that will only be in contact with intact skin and not with mucous membranes. If the biofeedback wires come in contact with body fluids or mucous membranes they may require more extensive cleaning/disinfection. Again, refer to manufacturer's instructions for use.

  The PIDAC Best Practices for Cleaning contains useful information regarding disinfectants and processes.

• If I have a patient who is HIV positive or has hepatitis, should I store their linens in a separate bag to be washed? Should I let the washing service know about those particular linens?

  All used linen is considered contaminated (see PIDAC Routine Practices and Additional Precautions and Environmental Cleaning) and should be handled with care.

  Those used by someone with HIV or hepatitis pose no more of a risk than any other.

  Neither organism is transferred from linens, but rather from blood. For linens that are heavily soiled with body fluids, you are best to dispose of excess soiling in a toilet, and you may wish to separate these. Check with the company that does your laundering regarding their preference when handling these.