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Quality Assurance

Association of Hearing Instrument Practitioners of Ontario

Standards of Practice

Overview  

To ensure high standards of equipment and techniques in the testing of hearing, selection  and fitting of hearing instruments and associated devices, and where the practice includes  it, in the removal of cerumen from the external ear canal as per section 9.1.3 of the  Association By-Laws.  

1.0 Purpose of Policy 

1.1 Maintenance of high standards by all members is in the best interest of the hard of  hearing and the profession.  

1.2 These standards are the minimally acceptable level of standards with respect to  equipment, testing of hearing, selection and fitting of hearing instruments and associated  devices.  

2.0 Scope of Practice 

2.1 Members must practice within the limit of their competence as determined by their  education, training and professional experience.  

2.2 The Scope of Practice of the Hearing Instrument Specialist H.I.S. and Hearing Instrument Dispenser H.I.D. is outlined within the Association By-Laws, Articles 3.1.1  and 3.1.2. 

2.3 Members must make appropriate referrals to other healthcare individuals when  encountering procedures that exceed their limits of competence or scope of practice.  

2.4 “Must” statements establish standards that members must always follow. 

2.5 Members may exercise professional judgement, taking into account the  environment(s) and their patients’/clients’ needs when considering deviating from the  guidelines. The reason(s) why guidelines were not followed must be recorded. 

2.6 A “Contraindication” is a specific situation in which a procedure cannot be  performed because it may have a negative effect or cause harm to the patient/client.

3.0 Restrictive Activities (Prescription) 

3.1 Members will not violate any law, rule or regulation applicable to the provision of  hearing instruments and associated devices.  

3.2 As per section #31 (Dispensing Hearing Aids) of the Regulated Health Professions  Act 1991 S.O. 1991, c. 18. “No person shall dispense a hearing aid for a hearing impaired  person except under a prescription by a member authorized by a health profession Act to  prescribe a hearing aid for a hearing impaired person.” Prescription of a hearing aid is an  authorized act under the Medicine Act, 1991 S.O. 1991, c.30 and the Audiology and  Speech-Language Pathology Act, 1991, S.O. 1991, c.19. 

4.0 Referral to Physician 

4.1 The patient/client must be referred to a physician for medical clearance as per Ontario Medical Association – Red Flag List (See Appendix A). 

5.0 Insurance 

5.1 Members must ensure they carry Professional Liability Insurance for a minimum of  $2,000,000. 

5.2 A copy of Certificate of Insurance must be submitted to the AHIP office with the  completed membership renewal application by the 31st of December of each year.  

6.0 Equipment Requirements 

6.1 Hearing Instrument Dispenser H.I.D. required equipment: 

  1. High resolution otoscope 
  2. Programming interface.  
  3. Electro-acoustic hearing instrument analyzer 

6.2 Hearing Instrument Specialist H.I.S. required equipment: 

  1. High resolution otoscope 
  2. Programming interface.  
  3. Electro-acoustic hearing instrument analyzer  
  4. Sound attenuation booth 
  5. A diagnostic audiometer with air conduction, bone conduction, narrow  band masking noise, speech audiometry and speech masking noise capabilities that utilize insert and/or TDH style transducers.  
  6. Full range acoustic immittance measurement system for tympanometry  and acoustic reflex measures 
  7. Real ear measurement system 

6.3 All equipment that is not self-calibrating must be calibrated annually in accordance  with current ANSI standards. Equipment must be in proper working order at all times.  

6.4 A copy of current calibration certificate must be submitted to the AHIP office upon  request.  

7.0 Testing Environment 

7.1 The testing environment must meet one of the following requirements:

  1. Within a sound attenuation booth
  2. Outside a sound attenuation booth 

7.2 When testing outside a sound attenuation booth, every effort must be made to ensure  the ambient noise level in the room does not exceed 40dB SPL. Use of a sound level  meter is recommended to determine the noise level in the room. The acoustic  characteristics of the room must be recorded on the audiogram form.

8.0 Assessment Protocol 

8.1 A complete hearing assessment must include the following components (See  Appendix B), unless contraindicated.  

  1. Case History  
  2. Otoscopy 
  3. Impedance Audiometry (Acoustic Immittance):
    1. Tympanometry 
    2. Acoustic Reflex 
  4. Pure Tone Audiometry:
    1. Air Conduction Testing (AC) 
    2. Bone Conduction Testing (BC) as necessary 
  5. Speech Audiometry:
    1. Most Comfortable Level (MCL) 
    2. Speech Reception Threshold (SRT) 
    3. Speech Awareness Threshold (SAT)  
      Test will be performed when SRT may not be obtained 
    4. Word Recognition Scores (WRS) 
    5. Speech-In-Noise (SIN) as necessary 
    6. Loudness Discomfort Level (LDL) 
  6. Masking as necessary 
  7. Tinnitus:
    1. Assessment 
    2. Counselling 
    3. Follow up care 

9.0 Recording Test Results 

9.1 The results of each hearing assessment must be recorded on the audiogram form.  

9.2 Symbols used to record air conduction, bone conduction and masking thresholds  must be noted in a key on the audiogram form.

9.3 All audiogram symbols must conform to current ASHA standards (American  Speech-Language-Hearing Association 1990)1. 

10.0 Selection and Fitting of Hearing Instruments and Assistive Listening  Devices 

10.1 Selection and fitting of hearing instrument(s) must be in accordance with the  following, unless contraindicated. 

  1. Complete hearing assessment 
  2. A new hearing assessment must be completed if more than six (6) months  has elapsed since the last hearing assessment 
  3. In situations where it is not possible to have a new hearing assessment completed, the reasons must be recorded. 
  4. Ear Impression as necessary 
  5. Programming of the hearing instrument(s) 
  6. Instruction and counseling for the proper use and care of the hearing instrument(s) and/or assistive listening device(s) 
  7. Verification of the benefit of the hearing instrument(s) 
  8. In all cases where a patient/client is fitted with the hearing instrument(s), the Member must allow the patient/client a minimum thirty (30) day trial period 
  9. Maintain an ongoing follow-up service to encourage the continued use of the hearing instrument(s) and/or assistive listening device(s) 
  10. Repairs and maintenance of the hearing instrument(s), assistive listening device(s) and accessories 

1http://www.asha.org/policy/GL1990-00006/

11.0 Ear Impression 

11.1 Ear impressions are taken to fabricate products for amplification and hearing/ear  protection. 

11.2 Hearing Instrument Specialist H.I.S. and Hearing Instrument Dispenser H.I.D. are ethically responsible to ensure they are competent in ear impression taking and to keep  their patient/client safe during the procedure. 

11.3 The ear canal must be examined with an otoscope prior to taking an ear impression  and after the removal of the ear impression. 

11.4 Infection control must be followed to ensure the health and safety of the  patient/client and Member. Infection control procedures include but are not limited to:  hand washing, waste management and criteria for disinfection and sterilization. Refer to  5.01 Ear impression procedures in Infection Control Policy.  

11.5 Equipment requirements: 

  1. Otoscope with speculum 
  2. Earlight with removable tip 
  3. Otoblock with thread 
  4. Syringe or impression gun 
  5. Impression material 

11.6 Contraindications, subject to medical clearance: 

  1. Impacted or excessive cerumen in the ear canal 
  2. A foreign body in the ear canal 
  3. External and/or middle ear condition  

12.0 Fitting Verification 

12.1 Verification procedures are an essential component of successful hearing  instrument fittings.

12.2 Hearing aid recommendations must be verified to ensure appropriate amplification,  unless contraindicated. 

12.3 Real Ear Measurements (REMs), also known as probe microphone measures, are  the preferred method, specifically in situ REM using probe tubes rather than coupler measures. 

12.4 Real Ear Measurement measures the performance of a hearing instrument in the  patient’s/client’s ear to ensure sounds are audible, comfortable and tolerable across the  frequencies of the patient’s/client’s reduced dynamic range.  

12.5 The results must be recorded including patient’s/client’s name, date and hearing aid  serial number(s).  

13.0 Records 

13.1 Records of all tests performed and/or subsequent follow-up services must be  recorded.  

13.2 All records relating to the services provided to the patient/client including the case  history, audiogram, all results of testing including verification, referral information and  follow-up services and dates will be kept on file for a minimum period of seven (7) years  or ten (10) years past the 18th birthday of a minor. 

14.0 Clinical Placements and Internship 

14.1 Students completing clinical placement or graduates completing the Hearing  Instrument Specialist H.I.S. Internship Program will only complete those tasks that are  geared to their level of competence under the supervision of a Hearing Instrument  Practitioner, Member in good standing of AHIP or an Audiologist, in good standing  registered under CASLPO. 

14.2 All students on clinical placement must be covered under the respective  educational institution Professional Liability Insurance.  

14.3 All Interns must have Professional Liability Insurance coverage.

15.0 Continuing Competencies 

15.1 In order to maintain membership in the Association, a minimum of twelve (12) hours of AHIP approved, Continuing Education Units (CEU’s) must be obtained per  calendar year as outlined within the Association By-Laws, Article 9.1.2 (ii).  

 

References 

Audiometric Symbols. (1990). Retrieved March 9, 2015, from http://www.asha.org/policy/GL1990-00006/

Association of Hearing Instrument Practitioners of Ontario

Infection Control Policy

1.0 Purpose of the Policy 

Members of the Association of Hearing Instrument Practitioners of Ontario (AHIP) are aware of the  need to disinfect the various hearing aid devices and related equipment they work with as a required task  under current standards of practice. Since infection control is extremely important to the health and  safety of both patients/clients and practitioners, the following document describes in detail, strategies for  both the prevention of transmission of infectious disease and procedures for infection control in the  hearing aid clinic.

These guidelines serve a number of purposes:

  • Serve as a reference document for AHIP registered Hearing Instrument Practitioners in identifying appropriate procedures for infection control in the context of their practice
  • Assist the AHIP registered Hearing Instrument Practitioner in his/her ongoing practice  assessment
  • Provide guidance for pursuing continuous learning
  • Provide guidance for managing the hearing aid clinic in relation to infection control
  • Assist in the development of college curricula and training relating to infection control
  • Inform other stakeholders, i.e. other professions, clinic owners, regulators and the public on the infection control procedures considered advisable for the AHIP registered Hearing Instrument  Practitioner

The Association of Hearing Instrument Practitioners of Ontario recommends these guidelines to its  members as appropriate strategies to prevent infectious disease transmission in the hearing aid clinic.  The control of infectious disease is an ongoing responsibility of the health care workers, and systems  need to be in place to disinfect:

  • All hearing aid work received by the clinic
  • Work areas in the facility
  • Laboratory equipment and accessory material
  • All hearing aid work prepared for shipping

2.0 Guidelines Respecting Infection Control 

Infection control involves taking steps to prevent the spread of infectious agents to you and your  employees. Developing an effective and efficient infection control plan in the hearing aid clinic requires  that you understand:

  1. How to prevent transmission of infectious diseases,
  2. Management, if exposure occurs, and
  3. Guidelines for your infection control plan.

3.0 Importance of Infection Control / Rationale 

Every health professional has the responsibility towards the safety of all their patients/clients. They are  responsible with creating and maintaining healthy and safe work environments. There is an abundance  of direct patient care within a hearing aid clinic, and therefore patients/clients and clinicians are  potentially exposed to an infectious environment.

There are many procedures commonly undertaken within the hearing aid clinic that are specific to  hearing aids.

Specifically, these guidelines have been developed to assist Hearing Instrument Practitioners to meet  professional standards and government regulations relating to infection control measures.

3.01 Standard Precautions 

A special note must first be made concerning terminology. There are several terms used when referring  to infection control in health care. These include “universal precautions”, “routine precautions”, and  “standard precautions”. 

The Laboratory Centre for Disease Control, Health Canada, the Public Health Agency of Canada and the  U.S. Centers for Disease Control developed the strategy of Universal Precautions or guidelines on the  prevention of transmission of blood borne pathogens in health care settings to prevent contact with  patient blood and body fluids. In 1996, Centers for Disease Control expanded the concept and changed  the term to Standard Precautions. Standard Precautions apply to contact with: 1) blood; 2) all body  fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) non-intact  skin; and 4) mucous membrane.

The Standard Precautions contained within the Infection Control Policy for Hearing Instrument  Practitioners of Ontario refers to protective and standard care steps to be used when Hearing Instrument  Practitioners are in direct or indirect contact with all patients/clients. All patients/clients should be  considered potential carriers of or susceptible hosts to infectious disease.

4.0 Independent Procedures 

The following independent procedures follow the general protective and standard care steps outlined by  the Standard Precautions. These independent procedures are commonly incorporated as sub-steps in the  hearing aid specific procedures.

4.01 Personal Protection 

a) Hand Hygiene
“In health care settings, adherence to hand hygiene recommendations is the single most  important practice for preventing the transmission of pathogens in health care and  directly contributes to patient safety.”  

An acceptable hand hygiene procedure clearly indicates when and how hand hygiene should be  executed. As described in the Best Practices for Hand Hygiene the four moments for hand  hygiene in health care include;

  1. BEFORE initial patient/patient environment contact
  2. BEFORE aseptic procedures
  3. AFTER body fluid exposure risk
  4. AFTER patient/patient environment contact

There are two methods of killing/removing microorganisms on hands;

1) Hand sanitizing with a 70 – 90% alcohol based hand rub (ABHR) is the preferred method  (when hands are not visibly soiled) for cleaning hands.

Using easily-accessible ABHR in health care settings takes less time than traditional hand  washing and has been shown to be more effective than washing with soap (even when using an  antimicrobial soap) and water when hands are not visibly soiled.

2) Hand washing with soap and running water must be performed when hands are visibly  soiled.

The effectiveness of alcohol is inhibited by the presence of organic material. The mechanical  action of washing, rinsing and drying is the most important contributor to the removal of  transient bacteria that might be present.

Cleaning with alcohol-based hand rub Hand washing with soap and water 

(Taken from “Just Clean Your Hands”, Ontario’s hand hygiene program for hospitals. Available online  at: www.justcleanyourhands.ca)

b) Personal Barriers 

Personal barriers include gloves, masks, eye protection, gowns, head covers and more. For  the purpose of these guidelines gloves will be discussed in detail.

Common hearing aid procedures for which gloves should be worn. 

Gloves should be worn in the hearing aid dispensing environment during procedures:

  1. where open wounds and/or blood is present
  2. involving handling of earmolds or hearing aids including, but not limited to, accepting  earmolds or hearing aids from patients/clients, during cleaning or disinfecting stages of  earmolds or hearing aids, during earmold or hearing aid modification procedures 3. involving removal or handling of earmold impressions
  3. involving cleaning or disinfecting other instruments contaminated with cerumen or other  bodily substances
  4. requiring submersion or removal of instruments into or from cold sterilant
  5. where hands are likely to become contaminated with potentially infectious material including cerumen

4.02 Instruments and Surfaces 

Differentiation of common terms utilized in infection control procedures 

Cleaning: removal of gross contamination

Disinfecting: killing a percentage of germs

Sterilization: killing 100% of germs including endospores

a) Sterilization of Critical Instruments 

Sterilants, by definition, must neutralize and destroy spores because if the spore is not killed,  it may become vegetative again and cause disease.

Within a hearing aid clinic, reusable instruments that may contact cerumen and are intended  to be used with multiple patients/clients should be sterilized, including curettes used for  cerumen removal, immittance and otoacoustic emissions probe tips, reusable specula used for  otoscopic examination, or tools used to clean hearing aid ports. Cold sterilization should be  used within the hearing aid clinic environment. Cold sterilization involves soaking  instruments in liquid chemicals for a specified number of hours. Items must be thoroughly  cleaned for cold sterilization procedures. Sterilization of critical instruments will occur at the  end of the day, in preparation for the next business day, to allow for appropriate soaking  times according to the manufacturer’s instructions.

Cerumen as Infectious Material 

Cerumen is not an inherently infectious substance; however it may contain dried blood or  mucus. If there is visible blood in or on cerumen, then that cerumen specimen is a  potentially infectious substance and the instruments contacting it must be sterilized  before and after contact. One difficulty is that the nature of cerumen makes it very  difficult for a clinician to determine whether blood, particularly dried blood, is present.  For this reason instruments should be sterilized after use when visibly contaminated with  cerumen, ear drainage or blood.

b) Surface Disinfection 

Patient-care rooms, hearing aid repair areas and reception counters should be disinfected  regularly. Disinfectant spray can be used with paper towel as well as approved disinfectant  towelettes. This should be done at the beginning of the day and immediately following  patient/client appointments.

4.03 Waste 

Infectious waste must be disposed of appropriately.

Appropriate disposal of infectious waste in a hear aid clinic 

Regular Receptacle: Most waste contaminated with ear discharge or cerumen

Separate, Impermeable bag and then in regular receptacle:  Waste contaminated with excessive cerumen or mucus

Impermeable bags labeled for biohazard waste: Materials containing significant amounts of blood (not anticipated in hearing aid clinics)

5.0 Hearing Aid Specific Procedures 

Infection control is an important component of standard clinical practice. What dispensing professionals  do in the hearing aid clinic and how procedures are performed influence patient/client outcomes and  safety as well as, the overall health of all those involved. Recommendations for the most common  procedures in the hearing aid clinic are provided in the following sections.

5.01 Ear impression procedures 

Hands should be washed following standard hand hygiene guidelines. In the absence of visible  open wounds or ear drainage proceed with insertion of otoblock and injection of impression  material. As material sets prepare impression box and paperwork. Before removal, put on  appropriate sized gloves. Immediately place impression in box with pre-folded paperwork.  Remove gloves and close box. Disinfect patient-care surface.

5.02 Dispensing hearing aids 

Handle newly-ordered hearing aids with gloved hands. Immediately before dispensing aid clean  hearing aids with paper towel of disinfectant towelette. During the appointment, put on gloves  prior to educating patient/client about proper techniques for insertion and removal of hearing aid.  Disinfect patient-care surface.

5.03 Accepting hearing aids or earmolds from patients/clients 

Accept hearing aid from patient/client with gloved hands. If patient/client removes aid before  gloves are on, instruct the patient/client to place the aid on a paper towel of disinfecting  towelette. Wear protective eye wear when cleaning hearing aid vents or other ports with a pick.  Disinfect hearing aid with disinfectant towelette. Once finished handling hearing aid, clean any  contaminated picks and probes, then sterilize. If visibly contaminated with cerumen sterilization  is indicated. Disinfect patient-care surface.

5.04 Performing a hearing aid listening check 

Pre-clean and disinfect hearing aid surface. Attach hearing aid to listening probe tip of hearing  aid stethoscope. Once complete on one or both aids, clean and disinfect listening probe tip and  earpieces of stethoscope. Disinfect patient-care surface.

5.05 Performing electroacoustic analysis of hearing aid 

Pre-clean and disinfect hearing aid surface. Perform the analysis. Ensure that the coupler is  cleaned and disinfected. Disinfect patient-care surface.

5.06 Performing real-ear measurements 

Only perform in absence of visible open wounds or ear drainage. Be careful not to handle or  touch the contaminated tube. Immediately discard disposable probe-tubes. For re-usable probe tubes, immediately clean and disinfect the contaminated probe-tube. Disinfect patient-care  surface.

5.07 Earmold or hearing aid modification procedures 

Pre-clean and disinfect the entire surface of the hearing aid. Prior to the use of grinding or  buffing wheel;

  • Put on a pair of safety glasses.
  • Put on a mask to cover nose and mouth.
  • Put on a pair of gloves.
  • Position protective cover of grinding of buffing wheel to minimize exposure to  particles from wheel or hearing aid.

Before re-inserting hearing aid into patient’s/client’s ear, disinfect the earmold or hearing aid  with fresh disinfectant towelette. Disinfect patient-care surface.

 

References 

Bankaitis, A.U. & Kemp, Robert J. (2003). Infection Control in the Hearing Aid Clinic.  Missouri: Auban, Inc.

College of Dental Technologists of Ontario. (2005). Infection Control Guidelines for Registered Dental Technologists. Scarborough, ON.

American Academy of Audiology. (2003). Infection Control in Audiological Practice. Retrieved February 15, 2009, from http://www.audiology.org/resources/documentlibrary/Pages/InfectionControl.aspx 

Ministry of Health and Long-Term Care/Public Health Division/Provincial Infectious  Diseases Advisory Committee (2009). Best Practices For Hand Hygiene: In All Health Care  Settings (ISBN: 978-1-4249-5767-5). Toronto, ON: Queen’s Printer For Ontario.

Health Canada. (1998). Canada Communicable Disease Report Supplement: Infection  Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care (ISSN 1188-4169). Ottawa, ON: Document Dissemination Division at the Laboratory Centre for  Disease Control, Health Canada.

Association of Hearing Instrument Practitioners of Ontario

COVID-19 – Return to Practice Guidelines

Overview

Ontario is currently in the midst of a global pandemic. The Corona Virus Disease – 2019 (COVID-19) is causing an outbreak of respiratory (lung) disease. The virus typically spreads  through coughing and sneezing, personal contact with an infected person, or by touching  contaminated surfaces or objects and then touching their face, mouth, nose or eyes. While the  severity of this illness varies from person to person, most of those afflicted will experience mild  symptoms and recover, however others will suffer with serious illness requiring hospital care.  There are steps that can be taken to prevent the spread of infection.

This document will provide guidance and information to protect your employees and patients  from COVID-19 in your clinic. These guidelines are predicated on and aligned with information  provided by the Chief Medical Officer of Health, Public Health Ontario, Public Health Advisory  of Canada, the federal and provincial governments and the World Health Organization. While  some of this guidance may not apply to every practice, hearing healthcare professionals are  expected to use their professional judgment in an ethical manner.

Guiding Principles

  1. Protecting health and safety is imperative and everyone’s right and obligation.
  2. Patient needs must be balanced with the risks of spreading COVID-19 and therefore treatment plans must prioritize care with the lowest risk of COVID-19 transmission.
  3. Wherever possible, physical distancing must be maintained throughout the clinic.
  4. Appropriate personal protective equipment (PPE) must be used for the safe delivery of hearing healthcare.
  5. Observe enhanced Infection Prevention and Control (IPAC) standards and practices.
  6. Communication is vital particularly as it pertains to policies and practices related to  COVID-19.

Protective Measures to Keep Everyone Safe

  • Ensure that your clinic is clean and hygienic.
  • Clean and disinfect frequently touched objects and surfaces.
  • Clean your hands often, using soap and water or a alcohol-based (70%) hand sanitizer.
  • Keep two metres distance from others.
  • Avoid touching your face.
  • Cover your cough or sneeze into your elbow or a tissue. Discard tissue immediately after  use and wash your hands.
  • Stay home when you are sick.
  • Personal protective equipment (PPE) or at a minimum a face mask or covering should be  used, especially when you are unable to maintain a two metres distance from others.
  • Avoid greetings such as handshaking or hugging/touching.

Policy for Employee Attendance

Employers must ensure that staff do not attend work if they are sick. Consider implementing  strategies listed below.

  • Implement telepractice/teleworking options as practical and if available.
  • Stagger work shifts or allow flexible work hours and/or schedules.
  • Should staff be taken ill with COVID-19, they must self-isolate for a period of 14 days.
  • Provide flexible policies so staff may stay home to care for a sick family member, or if  they must self-isolate because they have been in close contact with an individual with  COVID-19.

Screen Staff for COVID-19 Symptoms before Work

It is suggested that clinics consider measuring temperature of their staff before each work shift.  A no touch forehead thermometer is recommended. Refer to Appendix 1.

Keep Patients Safe

  • Walk-in appointments should be discouraged.
  • Conduct phone pre-screening and day of appointment screening. See Appendix 2.
  • Minimize waiting room time. When scheduling appointments, allow extra time between patients in order to facilitate adequate cleaning and disinfecting of the treatment room.
  • Reduce overcrowding. No visitor/companion in consultation, treatment room.
  • Increase use of online or phone services.
  • Consider curb side delivery.
  • Make hand sanitizers available for patients and visitors at entry and exit locations.
  • Be cognizant of continued privacy obligations as they pertain to telepractice/teleworking.

Screen all Patients and Visitors

Adopt the practice of taking the temperature of all individuals entering the clinic, including  employees, vendors, patients and guests. A no touch forehead thermometer is recommended.  Refer to Appendix 2 and Appendix 3.

Infection Control Practices and Procedures

All personnel must continue to observe infection prevention and control practices and procedures  in the workplace, in order to prevent COVID-19 transmission. You may refer to AHIP’s  Infection Control Policy, IPAC Canada or Public Health Ontario for further guidance.

Clean Hands Often

Before

  • Initial contact with a patient
  • Putting on PPE
  • Preparing or handling equipment
  • Eating or drinking

After

  • Contact with blood, secretions of a patient (i.e. earwax), even if gloves were worn ▪ Removing PPE such as gloves
  • Contact with a patient
  • Hands are visibly soiled
  • Handling waste
  • Cleaning contaminated and visibly soiled equipment (e.g. otoscope)
  • Using the bathroom

Use and Provide Personal Protective Equipment (PPE)

Personal protective equipment refers to face masks, gloves and protective eyewear including face  shields and safety glasses. The Ontario Government has developed an online PPE Supplier  Directory and may be accessed at ontario.ca/ppe.

Clinic wear should be changed daily and only worn in the clinic. At a minimum, 3/4 sleeved clothing is strongly encouraged.

Cleaning and Disinfectants

Step up efforts to clean and disinfect high-touch areas (i.e. chairs, handles, tables, counters, etc.)  more often than usual. Treatment Rooms must be cleaned and disinfected after each  appointment taking care to wear appropriate PPE. For additional information you may refer to  https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid19/list.html#tbl1

Engineering Controls/Workplace Controls

  • Reposition workstations to increase physical distances.
  • Install barriers, partitions and/or shields.
  • Make hand hygiene supplies readily available and highly visible.
  • Post signs of safety measures throughout your clinic including in the bathrooms.
  • Increase ventilation rates in the clinic.
  • Install high-efficiency air filters.
  • Establish policies to limit number of employees and/or visitors within the clinic at any  given time.
  • Provide personal protective equipment to staff (and visitors) and provide training and  education in the proper use of such protective wear.
  • Discourage physical cash/currency payments and encourage payment by debit or credit  card.
  • Prohibit work gatherings.
  • Permit breaks/meals outside the clinic for social distancing.
  • Encourage virtual meetings.
  • Discourage sharing of equipment and work spaces.
  • Telework/telepractice whenever possible.
  • Implement staggered work shifts.
  • Limit the number of people in the clinic at any given time.

Communication

  • Stay informed by monitoring the media, applicable government websites (as outlined in  the Resources section of this document).
  • Stay tuned for membership mailings from the AHIP Office.
  • Share pertinent information.
  • Establish a communication process in order to update staff and patients on changes to  your clinic practices during COVID-19, as appropriate. Regular and timely  communications are a good business practice and may allay fear, anxiety, rumours and  misinformation.
  • Educate staff on preventative measures to reduce the risk of spreading COVID-19. ▪ Display posters and information throughout the clinic. Refer to Resources Section for  examples.

APPENDIX 1

Staff Screening

Date
Staff Name
Temperature 37.8 C  or greater
Positive COVID-19  Screening?
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No
 
 
 
Yes or No

 

APPENDIX 2

Patient Screening

Name of Patient:               Prior to Appointment (date)                Day of Appointment (date)
1) Did you have close contact with anyone with acute respiratory  illness or travelled outside of Ontario in the past 14 days? Yes or No Yes or No
2) Do you have a confirmed case of COVID-19 or had close contact  with a confirmed case of COVID-19? Yes or No Yes or No

3) Do you have any of the following symptoms:

▪ Fever

▪ New onset of cough

▪ Worsening chronic cough

▪ Shortness of breath

▪ Sore throat

▪ Difficulty swallowing

▪ Decrease or loss of sense of taste of smell

▪ Chills

▪ Headaches

▪ Unexplained fatigue/malaise/muscle aches

▪ Nausea/vomiting, diarrhea, abdominal pain

▪ Pink eye

▪ Runny nose/nasal congestion without other known cause

 Yes or No Yes or No

4) If you are 70 years of age or older, are you experience any of the  following symptoms:

▪ Delirium

▪ Unexplained or increased number of falls

▪ Acute functional decline, or worsening of chronic conditions

 Yes or No Yes or No
5) Do you have a temperature higher than 37.8 C? Yes or No Yes or No

 

If the response is Yes to any of the questions, then patient be instructed to contact their family physician  or Telehealth Ontario on 1.866.797.0000

APPENDIX 3

Visitor Screening

Date
Name
Reason for Visit

Temperature  37.8 C or greater

Positive COVID-19 Screening?
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No
 
 
 
 
Yes or No

 

DOWNLOAD & PRINT POSTERS FOR YOUR CLINIC

COVID-19 – Cover Your Cough – https://www.toronto.ca/wp-content/uploads/2020/03/97a9-COVID-19-CoverYourCough.pdf

Help Reduce the Spread of COVID-19 – https://www.canada.ca/content/dam/phac aspc/documents/services/publications/diseases-conditions/coronavirus/help-reduce-spread-covid 19/help-reduce-spread-covid-19-eng.pdf

How to safely put on and take off a mask – https://www.who.int/docs/default-source/epiwin/how-to-use-mask-v0-1-print.pdf?sfvrsn=64ba1493_2

How to Self Isolate – https://www.publichealthontario.ca/-/media/documents/ncov/factsheetcovid-19-how-to-self-isolate.pdf?la=en

Infection Prevention and Control Canada – Posters, Graphics, Videos – https://ipaccanada.org/posters-graphics-and-videos.php

Reduce the Spread of COVID-19: Wash Your Hands – https://www.canada.ca/content/dam/phacaspc/documents/services/publications/diseases-conditions/coronavirus/covid-19-handwashing/covid-19-handwashing-eng.pdf

Physical Distancing – https://www.publichealthontario.ca//media/documents/ncov/factsheet/factsheet-covid-19-guide-physical-distancing.pdf?la=en

Protect yourself – https://www.toronto.ca/wp-content/uploads/2020/03/900d-COVID-19-ProtectYourself.pdf

Recommended Steps: Putting On Personal Protective Equipment (PPE) – https://www.publichealthontario.ca/-/media/documents/ncov/ipac/ppe-recommended-steps

Public Health Ontario. (2020). https://www.publichealthontario.ca/-/media/documents/ncov/factsheet/factsheet-covid-19-hand-hygiene.pdf?la=en

Reduce the Spread of COVID-19: Wash Your Hands – https://www.canada.ca/content/dam/phac aspc/documents/services/publications/diseases-conditions/coronavirus/covid-19- handwashing/covid-19-handwashing-eng.pdf

Stop the Spread of Germs – CDC – https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop the-spread-of-germs.pdf

OTHER RESOURCES

Ontario

Government of

Ontario:

 Sector-Specific resources to prevent COVID-19 in the  workplace

Public Health

Ontario:

 IPAC Recommendations for Use of Personal Protective  Equipment for Care of Individuals with Suspect or Confirmed  COVID-19
Health and Safety  Ontario Occupational Health and Safety Act

Ontario Human

Rights

Commission:

Policy Statement on the COVID-19 Pandemic

COVID-19 and Ontario’s Human Rights Code – Questions  and Answers

Toronto Public

Health:

 COVID-19 Guidance for Workplaces / Businesses and  Employers
Personal Protective  Equipment

Ontario.ca/ppe

https://www.publichealthontario.ca/-

/media/documents/ncov/ipac/report-covid-19-universal-mask use-health-care-settings.pdf?la=en
Canada

Government of

Canada:

Risk-informed decision-making guidelines for workplaces and  businesses during the COVID-19 pandemic

Preventing COVID-19 in the workplace: Employers,  employees and essential service workers

Cleaning and disinfecting public spaces during COVID-19

Hard-surface disinfectants and hand sanitizers (COVID-19):  List of hand sanitizers authorized by Health Canada

Travel restrictions, exemptions and advice

Laws and regulations protecting Canadians

 

REFERENCES

Chartered Professionals in Human Resources Canada. (2020). Coronovirus (COVID-19) Advice  for Employers. retrieved from https://cphrbc.ca/wp-content/uploads/2020/04/COVID-19- Fact-Sheet-April-24update.pdf

College of Denturists of Ontario (2020). Guide for Return to Practice for Denturists Additional  Infection and Prevention Control Precautions for Return to Practice During the COVID 19 Pandemic. retrieved from https://denturists-cdo.com/Resources/Regulatory Framework/Guidelines/Guide-for-Return-to-Practice-for-Denturists.aspx

College of Denturists of Ontario (2020). Guidelines Infection Prevention and Control in the  Practice of Denturism. retrieved from https://denturists-cdo.com/Resources/Regulatory Framework/Guidelines/Guidelines-Infection-Prevention-and-Control-in-th.aspx

Government of Canada. (2020). COVID-19 pandemic guidance for the health care sector.  retrieved from https://www.canada.ca/en/public-health/services/diseases/2019-novel coronavirus-infection/health-professionals/covid-19-pandemic-guidance-health-care sector.html

Hicks Morley. (2020). Ensuring a Successful Return to Work in a COVID-19 world. retrieved  from https://hicksmorley.com/2020/05/20/ensuring-a-successful-return-to-work-in-a covid-19-world/

Infection Prevention and Control Canada. (2020). retrieved from https://ipac canada.org/coronavirus-resources.php

Ministry of Health. (2020). COVID-19 Guidance: Essential Workplaces. retrieved from  http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_ essential_workplaces_guidance.pdf

Osler. (2020). The Employer’s COVID-19 Return to the Workplace Playbook. retrieved from  https://www.osler.com/en/resources/regulations/2020/the-employer-s-covid-19-return-to the-workplace-playbook

Province of Ontario. (2020). Resources to Prevent COVID-19 in the Workplace. retrieved from  https://www.ontario.ca/page/resources-prevent-covid-19-workplace

Public Health Ontario. (2020). Cleaning and Disinfection for Public Settings – COVID-19. retrieved from https://www.publichealthontario.ca/-/media/documents/ncov/factsheet covid-19-environmental-cleaning.pdf?la=en

Public Health Ontario. (2020). How to Wash Your Hands – COVID-19. retrieved from  https://www.publichealthontario.ca/en/diseases-and-conditions/infectious diseases/respiratory-diseases/novel-coronavirus/public-resources

Public Health Ontario. (2020). COVID-19 Public Resources. retrieved from  https://www.publichealthontario.ca/en/diseases-and-conditions/infectious diseases/respiratory-diseases/novel-coronavirus/public-resources

Public Health Ontario. (2020). How to Self-Monitor – COVID-19. retrieved from  https://www.publichealthontario.ca/-/media/documents/ncov/factsheet-covid-19-self monitor.pdf?la=en

WeirFoulds. (2020) https://www.weirfoulds.com/covid-19

World Health Organization. (2020). https://www.who.int/health-topics/coronavirus#tab=tab_1