Do you know what steps to take if you have a patient with an open wound? What if the wound is weeping or has a strange odour? What if the patient has an infection or antibiotic-resistant organism? Physiotherapists are expected to identify and minimize any risks caused by infections or the use of equipment in their practice, as outlined in the Infection Control and Equipment Maintenance Standard.

Check out these five steps to identify and minimize the risk of infection.

1. Assess the risk - to determine how to keep you, the patient and others safe from transmission of infection.

a. Conduct a visual scan of the wound and gather information from the patient
b. Consider the risk of transmission for the patient, yourself and others

• consider the potential for contamination of the patient’s skin or clothing by microorganisms in the treatment environment
• consider the potential for exposure to the patient’s blood, body fluids, secretions, and tissues for you and others in the treatment area
• consider the risks for exposure for intact vs non-intact skin, mucous membranes, equipment and surfaces

Routine Practices = A Risk Assessment + Hand Hygiene + Personal Protective
Equipment (PPE)

Hand Hygiene
Use an alcohol-based hand rub (if hands are not visibly soiled), or soap and water (if hands are visibly soiled). Wash your hands before and after contact with the patient, before invasive/aseptic procedures, and after body fluid exposure risk. 

Learn more about hand hygiene from Public Health Ontario.

Personal Protective Equipment (PPE)
PPE includes things like gloves, gowns, and facial protection.

Wear gloves if your hands will be in contact with mucous membranes, non-intact skin, tissue, blood, body fluids, secretions, excretions, or equipment and environmental surfaces contaminated with the above.

A gown should be worn if arms and/or clothing will be in contact with blood, body fluids, secretions or excretions. 

Facial protection should be worn if the mucous membranes of the eyes, nose and/or mouth will be in contact with blood, body fluids, secretions or excretions.

Learn more about PPE use. 

Additional Precautions = Routine Practices + Barriers + Environmental Controls

Additional Precautions are used in addition to Routine Practices for patients known or suspected to be infected or colonized with certain microorganisms. Appendix N of the PIDAC Routine and Additional Precautions document has a list of microorganisms/diseases that require Additional Precautions. 

Additional Precautions include the use of barriers, PPE and control of the environment, and are specific to the risk and mode of transmission (contact, droplet, airborne, combination). In some instances, specialized engineering controls may be required (e.g., airborne infection isolation room for a patient with tuberculosis) or enhanced cleaning protocols for antibiotic resistant organisms (e.g., Clostridium difficile – C. difficile, vancomycin-resistant enterococci - VRE). 

The application of Additional Precautions may differ depending on the health care setting and the needs of the patient, particularly in long-term care and the community. 

Public Health Ontario has a Routine Practice and Additional Precautions Best Practices Document that will help.  

3. Control the Environment (Placement of Signs, Cleaning of Surfaces and Equipment, Designing the Environment)

Routine cleaning practices are acceptable in most cases unless the patient has an antibiotic resistant organism. Routine practices also include changing linens between patients and having a process to safely handle soiled linens, waste and sharps to prevent exposure and transmission to others. Go to the Best Practices for Environmental Cleaning in All Health Care Settings, available on the PHO website.

4. Have Policies and Procedures and Administrative Controls (Policies and Procedures, Staff Education, Healthy Workplace Policies, Respiratory Etiquette, Monitoring of Compliance with Feedback)

Make sure staff are aware of infection prevention and control procedures in the workplace, that there is adequate training and there are policies in place to ensure best practices for infection prevention and control.

5. Go to the Experts for Advice and to Stay Up to Date

Public Health Ontario (PHO) and the Provincial Infectious Diseases Advisory Committee (PIDAC) are you source for information about Infection Prevention and Control.

Check out PHO's infection prevention and control checklists for clinical office practice settings: 

• IPAC Core Elements
• Reprocessing of Equipment/Medical Devices
• Endoscopy