Infectious Disease/Infectious Agent Policy
This policy and its associated guidelines are intended to protect City of Toronto employees from potential adverse health effects as a result of exposure to infectious diseases/agents by:
- providing guidance in the development of a program to prevent or minimize adverse effects from employee exposure to infectious diseases/agents
- outlining appropriate infection prevention and control practices to reduce the risk to City employees from exposure to such diseases/agents
Purpose of the Infectious Disease Policy Associated Guidelines
The policy assigns responsibility with respect to:
- Conducting risk assessments to determine risk of employee exposure to infectious diseases
- Putting in place measures and procedures (infection control prevention practices, exposure control plans) for employee protection
- Communicating with employees measures and procedures that are established
- Following measures and procedures that are established
The associated guidelines provide additional information to assist divisions in:
- Developing a program to prevent and minimize risk from employee exposure to infectious agents
- Identifying safe work practices and working conditions for the control of infections
- Establishing measures and procedures for workers to report incidents of exposure (e.g. needlesticks) or illnesses acquired as a result of exposure
- Developing job-specific safe handling procedures for discarded sharps
This policy and its associated guidelines apply to all City divisions (and employees) where employees may be exposed to infectious diseases or agents in the course of their work activities. It is understood that this is a minimum standard. Given the nature of contact with infectious agents, the risk of exposure to infectious diseases/agents and strategies for control will vary in different settings. Certain City divisions will have additional legislation that must also be followed (e.g. health care facilities, emergency responders). It is expected that divisional procedures and programs will be reflective of this policy and any additional requirements.
Additional Precautions (AP)
Additional Precautions (i.e., Contact Precautions, Droplet Precautions, and Airborne Precautions) are necessary in addition to Routine Practices for certain pathogens or clinical presentations. These precautions are based on the method of transmission (e.g., contact, droplet, airborne).
Dispersion of solid and liquid particles suspended in a gas (e.g. in air)
Alcohol-Based Hand Rub (ABHR)/Sanitizer
A liquid, gel or foam formulation of alcohol (e.g., ethanol, isopropanol) which is used to reduce the number of microorganisms on hands in situations when the hands are not visibly soiled. ABHRs contain emollients to reduce skin irritation and are less time-consuming to use than washing with soap and water.
The physical removal of foreign material (e.g., dust, soil) and organic material (e.g., blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents and mechanical action.
The presence of an infectious agent on hands or on a surface, such as clothing, gowns, gloves, bedding, toys, surgical instruments, patient care equipment, dressings or other inanimate objects.
A product that is used on equipment/devices which results in disinfection of the equipment/device.
The inactivation of disease-producing microorganisms. Disinfection does not destroy bacterial spores. Equipment/devices must be cleaned thoroughly before effective disinfection can take place.
Exposure Control Plan
A document that describes how workers will be protected from infectious diseases/agents in the workplace; including information on the nature of the hazards, the risks associated with exposure, as well as controls that will be used to protect workers.
A device that covers the eyes and is used to protect the eyes when it is anticipated that a procedure or activity is likely to generate splashes or sprays of blood, body fluids including, secretions or excretions, aerosols from potentially contaminated waste water, or within two metres of a coughing client/patient/resident. Eye protection includes safety glasses, safety goggles, face shields and visors.
Personal protective equipment that protect the mucous membranes of the eyes, nose and mouth from splashes or sprays of blood, body fluids, secretions or excretions or infectious aerosols. Facial protection may include a mask or respirator in conjunction with eye protection, or a face shield that covers eyes, nose and mouth.
A qualitative or quantitative method to evaluate the fit of a specific make, model and size of respirator on an individual. Fit-testing is to be done prior to use of a respirator, then periodically, at least every two years and whenever there is a change in respirator face piece or the user’s physical condition which could affect the respirator fit.
A general term referring to any action of hand cleaning. Hand hygiene relates to the removal of visible soil and removal or killing of transient microorganisms from the hands. Hand hygiene may be accomplished using soap and running water or an alcohol-based hand rub.
The physical removal of microorganisms from the hands using soap (plain or antimicrobial) and running water.
The entry and multiplication of an infectious agent in the tissues of the host. Asymptomatic or sub-clinical infection is an infectious process running a course similar to that of clinical disease but below the threshold of clinical symptoms. Symptomatic or clinical infection is one resulting in clinical signs and symptoms (disease).
Infection Prevention and Control
Evidence-based practices and procedures that, when applied consistently, can prevent or reduce the risk of transmission of microorganisms.
A microorganism, i.e., a bacterium, fungus, parasite, virus or prion, which is capable of invading body tissues and multiplying.
A disease due to a specific microbial agent or its toxic products that can be transmitted from an infected person, animal, plant or inanimate source e.g. water, food, soil etc. to a susceptible host.
A device that covers the nose and mouth, is secured in the back and is used by health care providers to protect the mucous membranes of the nose and mouth.
A personal protective device that is worn on the face and covers the nose and mouth to reduce the wearer’s risk of inhaling airborne particles. A NIOSH-certified N95 respirator filters 95% of particles as small as three micron in size and provides a tight facial seal.
The National Institute for Occupational Safety & Health is a federal US agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness.
Personal Protective Equipment (PPE)
Clothing or equipment worn by staff for personal protection against hazards.
Personal practices that help prevent the spread of bacteria and viruses that cause acute respiratory infections (e.g., covering the mouth when coughing, care when disposing of tissues).
An evaluation of the interaction between the worker, the client/patient/resident and/or the area/environment where the work is performed to assess and analyze the potential for exposure to infectious diseases/agents. For the purposes of this policy and associated guidelines, divisional and individual risk assessment is referenced.
Routine Practices (RP)
A set of infection control strategies and standards designed to protect workers from exposure to potential sources of infectious diseases.
Objects capable of causing punctures or cuts (e.g., needles, syringes, blades, clinical glass). Sharps are defined as any material that has the potential to cut or penetrate skin. Examples are razor blades, broken glass, sharp or jagged metal (i.e. tin cans, etc.), needles, syringes, blades, lancets, clinical glass (glass possibly contaminated with blood, body fluids or chemicals). Sharps contaminated or potentially contaminated with blood or bodily fluids are considered bio-hazardous wastes.
- Identify the hazard(s) ( e.g. sources of infection –blood/bodily secretions, waste-human/animal faeces, infectious aerosols, etc), that are, or may be, in the workplace
- Identify whether jobs present risk of exposure to infectious diseases/agents and the type/nature of the exposure (inhalation, skin contact). Consult with Occupational Health and Safety, as needed.
- Develop safe work procedures/exposure control plans/infection control plans based on concept of routine practices and additional precautions which address the degree of hazard encountered to minimize the exposure to risk of infection (i.e. minimize the risk of contracting or transmitting an infectious disease). Procedures/plans should be in writing, be regularly reviewed and reflect current knowledge and practice.
- Ensure that all at-risk employees are informed, of and familiar with:
- The potential hazard of infectious disease/agent exposure in their workplace
- The measures to be taken to protect against the hazard (routine practices, additional precautions)
- The post-exposure protocol and the process for reporting infectious disease exposures
- Maintain documentation regarding infection prevention and control training
- Provide personal protective equipment that offers the appropriate degree of protection and instruct on its use and disposal.
- Develop and promote a Hand Washing/Hand Hygiene Program.
- Encourage the reporting of exposures, including needle-stick injuries
- Communicate the importance of immunizations.
Those with supervisory responsibilities will:
- Implement safe work procedures on infection prevention and control
- Ensure that the personal protective equipment required is accessible and available to employees, and that the employees are trained regularly on the usage
- Ensure that workers are aware of the appropriate steps to take in the event of an exposure.
- Ensure that the workers are aware of reporting procedures with regards to an occupational illness exposure
- Ensure all procedures on infection prevention and control and training plans are reviewed by the joint health and safety committee
- Attend required training and education sessions to become familiar with infection prevention and control practices relevant to the work setting
- Follow safe working procedures appropriate to the nature of work performed
- Use the appropriate personal protective equipment for the situation
- Know and follow the appropriate post-exposure protocol and reporting procedures to be used in the event of an exposure
[Note: Although not mandated by this policy, immunization against infectious diseases is strongly recommended. Employees should be aware of their immunization status.]
Human Resources – Occupational Health and Safety will:
- Assist in the selection of personal protective equipment
- Assist with the implementation of the policy and the development of safe work procedures
- Ensure proper reporting/notification of incidents to the Workplace Safety and Insurance Board and Ministry of Labour
- Keep statistics on exposures to assist in planning prevention strategies
Joint Health and Safety Committees will:
- Review incident and accident reports to assess trends in infectious agent exposures and infectious disease
- Make recommendations for the development of, or improvements to, existing safe work procedures, as needed
The Occupational Health and Safety Coordinating Committee will:
- Regularly review this policy and associated guidelines and recommend amendments, as needed
Infectious Disease/Agent Risk Assessment Tool
Occupational Health and Safety Act (R.S.O. 1990, c. 0.1)
Occupational Health and Safety Coordinating Committee (December 11, 2001)
Executive Management Team (February 18, 2002)
Reviewed and Amended: Occupational Health and Safety Coordinating Committee, December 6, 2011)
Reapproved: City Manager, (February 9, 2012)
December 1, 2001
February 9, 2012
Reviewed by OHSCC
April 26, 2016