Prevention and control of infections in your practice: New tools

The Provincial Infection Prevention and Control Program (PIPCP), located at BCCDC Laboratory Services, offers province-wide consultation services. The program provides leadership by developing guidelines for infection prevention and control that set direction for standards of practice. PIPCP, when needed, supports health care providers in all health authorities in their efforts to prevent and control nosocomial infections or infectious disease. PIPCP also promotes and provides educational opportunities and research initiatives. 

In response to many post-SARS reports, this area is being strengthened. Specifically, links between public health and institutional infection control are under review. PIPCP has recently been working on two important collaborations that begin to address some of the noted gaps. These include a revision to the existing guidelines for infection prevention and control in the physician’s office and the development and promotion of a program to provide rapid diagnosis of viral (and other microbial) respiratory pathogens. 

Infection prevention and control in the physician’s office

In 1992, Dr Douglas Drummond and the College of Physicians and Surgeons of British Columbia published the booklet The Prevention of Cross Infection in the Physician’s Office in response to the noted inconsistency in sterilization techniques and infection control practices in medical offices. In collaboration with many partners, PIPCP has produced a new guideline intended as a revision to Dr Drummond’s original document. Included are updates for routine infection control practices, including handwashing, sterilization, disinfection, and the use of gowns, gloves, and masks. In light of the recent emergence of new pathogens including MRSA, VRE, influenza H5N1, and SARS-CoV, this document addresses antibiotic-resistant organisms and the role of respiratory droplets in the transmission of infectious disease. The complete Infection Prevention and Control in the Physician’s Office document is available at www.cpsbc.ca/physician/documents/Infection_Control.pdf.

In addition to updating routine infection prevention and control practices, this guideline supports the development of a “new normal” in addressing the risk of acquiring emerging respiratory viruses and antibiotic resistant organisms in the outpatient setting. Until more detailed epidemiology of the resulting morbidity and mortality becomes available, we feel that a precautionary approach is reasonable and in the best interest of both patients and providers of health care in BC.

VIRAP (rapid diagnosis of viral respiratory infections)

Following the SARS outbreak of 2003, rapid diagnosis for viral respiratory infections was identified as a high priority need in British Columbia. VIRAP is a new PHSA-sponsored program, a collaboration between the laboratories at Women’s and Children’s Health Centre (WCHC) and BCCDC, establishing the concept of utilization management for maximum patient and health care benefit by joining collection of proper specimens, quick laboratory turnaround time, extended laboratory opening hours, and timely reporting.

The aim of VIRAP is to assist hospitals, long-term care facilities, and community physicians in best practice for the rapid diagnosis of viral respiratory disease. The laboratory leadership in PHSA, in consultation with the microbiology leadership in Vancouver Coastal and Vancouver Island Health, has determined that the best specimen for the rapid diagnosis of viral respiratory infections is a nasopharyngeal wash (NPW). With such high-quality specimens, VIRAP is able to provide a turnaround time for results in approximately 4 hours. This rapid turnaround time may lead to decreased antibiotic/antimicrobial usage, decreased hospital admissions, and less costly investigative procedures—saving significant health care dollars.

The Infection Program at WCHC, in collaboration with PIPCP, has developed teaching guidelines, an instructional video, and NPW collection kits. PIPCP continues to support this program through education and train-the-trainer sessions on specimen collection for NPW. For more information on the VIRAP program, contact Dr Eva Thomas (604 875-2345) or the VIRAP information line at 1 888 711-7770.

Acknowledgments 
The authors wish to thank the Infection Control Program at WCHC and the VIRAP laboratory team.

—Bruce Gamage, RN, CIC 
Infection Control Consultant, BCCDC Laboratory Services
—Trevor A. Corneil, MD, MHSc, CCFP
Community Medicine Resident, BCCDC Epidemiology Services
—Eva Thomas, MD, PHD, FRCPC
Director Microbiology/Virology/Infection Control, Women’s and Children’s Health Centre of BC
—Judith Isaac-Renton, MD, DPH, FRCPC
Director, BCCDC Laboratory Services