INFECTION PREVENTION AND CONTROL (IPAC)
We review and assess IPAC practices in physician offices and clinics.
Education is our priority
We help ensure Alberta physicians meet the highest standards for infection prevention and control.Rules for Member Participation
IPAC Courses | MDR Toolkit | Standards & Assessment Tools | PPE Education | Guidelines & Resources | Rules | Committee
Policy & Procedure Templates now available for General Infection Prevention & Control
Use these templates as starting documents to support best practices for general infection prevention and control in your medical office. Do not simply print and use these templates as written as some sections are incomplete and others may require amendments to reflect your specific clinic operations and actual practices.
These templates support the IPAC Program’s release of standards for general infection prevention and control in private, non-governmental medical facilities not accredited by the CPSA (effective date: June 16, 2016).
IPAC CORE Competencies (Public Health Ontario)
Basic skills and knowledge all health care workers need to understand about IPAC. This course helps protect workers, their patients, and co-workers from infections; regardless of their role, position, education, and experience.
Go to: IPAC Core Competencies
Reprocessing in Community Health Care Settings (Public Health Ontario)
Following best practices helps prevent the transmission of infection to healthcare providers and clients/patients. If you are responsible for reprocessing in community healthcare settings, this course is for you.
MDR In Community Healthcare Settings (CSA Group)
Four modules available depending upon your unique community healthcare practice and area of expertise. The first module contains core lessons and is necessary for the completion of the course. The other three modules build on the first module and are optional as they are setting and/or device specific.
MDR Course (CPSA)
Prepare for your assessment and earn credit. We offer a free online course to highlight your physician obligations under provincial legislation and to help ensure a safe working environment for you, your medical office staff and patients.
CFPC Mainpro participants may claim Mainpro-M2 credits for this activity, while participants of the Royal College MOC Program may use this course as a stimulus to develop a personal learning project.
Go to: mdrcourse.cpsa.ca
Practical tools for you and your staff to meet best practices when reprocessing medical equipment. Includes suggested supplies required for reprocessing, templates to assist writing policies and procedures, factors to consider when purchasing a sterilizer and much more.
Download & print the entire toolkit or review specific sections below.
Know what you are looking for? Click on a section below to find specific resources:
Personal Protective Equipment (PPE)
- Face Protection: eye protection (safety glasses or goggles) with mask or full face shield. Reusable eye protection should be cleaned and disinfected between uses.
- Gloves: gloves must be of sufficient weight to be highly tear resistant (regular exam gloves are not appropriate protection for reprocessing). Tear and chemical-resistant gloves covering much of the forearm must be worn during the cleaning steps in reprocessing. If gloves are reusable, they should be cleaned and disinfected at least daily and each staff member should have their own pair. Tear- and chemical- resistant gloves are also required when disinfectants, enzymatic cleaners and instrument detergents are handled.
- Gowns: moisture-impervious gown (isolation gowns are not appropriate).
- Brushes (reusable or disposable) or cloths for physical cleaning. Disposable brushes are recommended. Reusable cleaning brushes must be sterilized or high-level disinfected between uses.
- Approved instrument detergent or enzymatic cleaning solutions (e.g. Medzyme).
High Level Disinfection
- High level disinfectant solution (e.g. Glutaraldehyde). Products must have a Drug Identification Number (DIN) from Health Canada.
- High level disinfectant solution chemical test strips.
- Log and documentation record forms.
(manufacturers may have starter kits which include all of the products listed here)
- External chemical indicator/autoclave tape (may be built-in with peel pouches) placed on packages with each load.
- Internal chemical indicator: placed inside each package for sterilization.
- Biological indicator (spore-laden strips or vials) (usually Geobacillus stearothermophilus for steam sterilizers). Used once each day the sterilizer is in use, or with every load if sterilizing implantable devices.
- Logs books/forms for documentation of sterilization parameters and autoclave maintenance.
Steam sterilization is the “gold standard” of sterilization methods
It kills microorganisms rapidly without the use of toxic chemicals. Unfortunately, it can only be used for reusable devices that tolerate high temperatures.
Types of Table-top Steam Sterilizers
When purchasing a sterilizer, insist on written information from vendor or manufacturer demonstrating that the sterilizer is capable of sterilizing the devices and packaging used in your office.
Steam sterilizers replace air in its chamber with steam. Air is evacuated either through gravity displacement or by dynamic air removal. Dynamic air removal (as in pre-vacuum or vacuum sterilizers) is more efficient and is required for sterilizing several types of devices. Dynamic air removal sterilizers are generally preferred unless the office is sterilizing material that can only be sterilized by gravity displacement sterilizers (such as open liquids).
Prior to Purchasing
Consider whether steam sterilization is cost-effective for your office. Single-use instruments or 3rd party reprocessing may make more sense than does reprocessing reusable devices in-house. Consider capital outlay, equipment maintenance, staff training and staff time, sterilizer packaging materials and quality control supplies.
Consider also whether the space in your office can accommodate reprocessing. It must allow for the required separation of soiled and clean devices and the steps in the cleaning process.
What to consider when choosing a third party reprocessor
- Transportation arrangements and turn-around time
- Number and cost of instruments that you will need while some are away being reprocessed
- Reprocessing fees
- Proof that the 3rd party reprocessor meets accepted medical device reprocessing standards
What to consider when choosing to reprocess reusable medical devices in your office or clinic:
- The purchase price of the sterilizer
- Time and cost required for daily testing and maintenance
- Cost of preventive maintenance and periodic testing
- Operational costs (electricity, distilled water, detergents, cleaners, insurance, etc.)
- Cost of additional instruments to accommodate prolonged cycle times
- Cost of training staff
- Cost of packaging
- Cost of Biological Indicator monitoring and other quality controls required by the manufacturer
- Cost of personal protective equipment (PPE) required for staff that reprocess.
- Time to document each load and results of monitoring
- Availability of adequate space to locate the sterilizer within the designated “clean” area where reprocessing will take place in your office. Prior to purchase, obtain dimensions (e.g. height, width and depth) of sterilizer to ensure that it will fit.
Purchasing a Sterilizer
When seeking quotes from suppliers, it is important to specify the type of load and instruments you intend to reprocess. The manufacturer should state clearly the type of load and instruments for which the sterilizer is suitable. Purchase only the type of sterilizer that is suitable for the types of loads you intend to process. Ensure the sterilizer has a Health Canada medical device license.
Consider the following:
- Clarity of instructions for use and for maintenance (daily, monthly, annually)
- The number of instruments that will be reprocessed per load and per day
- Whether the devices are solid (e.g. forceps, dental probes) or porous or lumened (e.g. textiles, suctions tips, dental hand-pieces)?
- For lumened devices, the limitations of the sterilizer with respect to length and diameter of lumens.
- The type of wrapping required and manufacturer’s instructions for use of wrap
- The presence or absence of a printer or electronic log for documenting each sterilizer cycle. It is recommended that this capability be present on the sterilizer at the time of purchase to facilitate the requirement to log physical parameters of each cycle.
Ensure that you have documentation which:
- Specifies who is responsible for installation and for performing tests to ensure the sterilizer will perform to specifications.
- Specifies the qualifications of technical service providers
- Indicates that the sterilizer can sterilize the medical devices you will be using
- Indicates how to load the sterilizer (e.g. lumened instruments, hollow instruments, textiles, power tools, dental hand pieces, wrapped sets of instruments)
- Indicates if there are any unique requirements for operating the sterilizer. This might include operational constraints specific to altitude (e.g. Calgary is at approximately 3500 feet and ft. McMurray is at approximately 1213 feet elevation) and water supply (e.g. reservoir, potable, treated water).
- Defines recommended sterility assurance monitoring:
- Appropriate biological and chemical indicators
- Appropriate Class II (Bowie-Dick) chemical indicator for dynamic air removal sterilizers.
Service and Maintenance
Ask the vendor if they:
- provide a sterilizer for a trial period prior to committing to a purchase
- provide onsite training for the use of the sterilizer
- provide a service contract
- provide periodic testing
- provide evidence that the test person is qualified
- have the necessary calibrated test equipment
- have loaner equipment in case of shutdown for repairs and guarantee a response time
- place restrictions on the provision of loaners
IF NOT, then ask whether the vendor recommends a particular servicing agent.
You Purchased a Sterilizer. Now What?
A sterilizer must be tested after installation and before it is put into service. Successful testing includes no growth of organisms (“negative” tests) after the placements of appropriate biological indicators in the empty chamber for at least 3 sterilizer cycles, and then again with a full test load of devices.
Dynamic air removal sterilizers must also be tested three times with an air detection test pack (a Bowie-Dick test) in an empty chamber.
A sterilizer that fails these tests must not be put into service until the cause is found and corrected and repeat testing confirms effective operation.
The same pre-use testing requirements apply after the following circumstances:
- major repairs to a sterilizer
- relocation of the sterilizer to another office
- unexplained sterilization failures
- changes in steam supply or delivery
Sterilization of medical equipment is a two-step process involving:
- Decontamination (aka cleaning) to remove >80% of microbes; and
- Sterilization to kill the remaining microbes.
Steam autoclaves are the most efficient and non-toxic method of sterilization in a physician office setting. Because of the difficulty in proving the sterility of a medical instrument, the effectiveness of the sterilization process must be monitored.
Three complementary types of monitoring are required:
- Mechanical/Digital indicators to monitor the autoclave’s physical parameters (time, temperature and pressure) for each cycle/load;
- Chemical indicators – external indicators on the outside of each wrapped package and internal chemical indicators inside each package, which change color when exposed to the right conditions for sterilization; and
- Biological indicators that confirm the actual annihilation of microbial spores.
All three types of monitors are important to confirming that the conditions necessary to achieve sterility have been met. Among these, biological indicators may be the most unfamiliar to physicians. Options for biological monitoring include:
- Purchasing a self-contained testing kit with incubator for on-site monitoring; or
- Purchasing only the spore strips, and then transporting them to a microbiology laboratory that offers environmental testing. (Unfortunately, few laboratories in the province offer this service.)
- Biological Monitoring is not being performed.
- That all required Personal Protective Equipment is either not available or not worn by staff when reprocessing.
- The manufacturer’s instructions for reprocessing equipment are not available.
- Sterilization monitoring parameters (digital, mechanical chemical and biological) are not documented.
- High level disinfectant chemical test strip results are not documented.
- Quality procedures on new containers of chemical test strips, and lots of biological indicators, are not performed and/or documented.
- That reprocessing is occurring in patient care areas with patients present.
- That re-useable cleaning accessories are not cleaned and minimally high level disinfected or sterilized between uses.
- That documented policies and procedures are not developed for all steps of reprocessing and training procedures for reprocessing staff.
- Inappropriate wrapping materials and tape used for packaging equipment for sterilization. Use self sealing pouches.
- Internal, chemical indicators not being placed in each package for sterilization.
Instrument Detergents and Enzymatic Cleaners
Instrument Cleaning Accessories
Glutaraldehyde High Level Disinfectant & Test Strips
Cidex OPA (orthophtalaldehyde) and test strips
Chemical Indicators for Sterilization
Bowie-Dick Air Removal Test Packs
Post HLD Rinsing
How to don & doff PPE
In just 5 minutes you’ll see how to put on and remove Personal Protective Equipment (PPE)!
Credits: Shanda Naylor, Ian Albert, Jamie Bone, Dr. Kumar Ramlall, Laura Wright (Dynacor Media), Dustin Delfs and Dwayne Martineau (Laughing Dog Photography), and Randy Smith (Capital Colour Press Ltd.)
- Cleaning and Disinfection of Reusable Instruments that Contact the Surface of the Eye
- Cleaning of Reusable Ear Cleaning Equipment
- Renovating or Developing New Clinical Office Space
General Infection Prevention & Control:
- Infection Prevention and Control for Clinical Office Practice
- Routine Practices and additional precautions for preventing the transmission of infection in healthcare settings
Medical Device Reprocessing:
- Reprocessing Critical & Semi-Critical Equipment – A Physician Toolkit
- Standards for Cleaning, Disinfection and Sterilization of Reusable Medical Devices for Health Care Facilities and Settings
- Best Practices for Cleaning, Disinfection and Sterilization in all Healthcare Settings
Occupational Health & Safety:
- A Physician’s Guide to Occupational Health & Safety (OH&S) Responsibilities
- Handbook of Occupational Hazards and Controls for Community Clinics and Doctors’ Offices
- Government of Alberta Best Practice Guideline for Workplace Health & Safety During Pandemic Influenza
IPAC improves patient safety!
The IPAC program worked closely with 2491 physicians reprocessing in Alberta, providing on-site education and various tools to help them meet Alberta’s reprocessing standards. See our IPAC Report (Fall 2013)
Medical equipment/devices that enter sterile tissues, including the vascular system (e.g. biopsy forceps, foot care equipment, dental hand pieces, etc.). Critical medical equipment/devices present a high risk of infection if the equipment/device is contaminated with any microorganisms, including bacterial spores. Reprocessing critical equipment/devices involves meticulous cleaning followed by sterilization.
Medical equipment/device that comes in contact with non-intact skin or mucous membranes but ordinarily does not penetrate them (e.g. respiratory therapy equipment, transrectal probes, specula etc.). Reprocessing semi-critical equipment/devices involves meticulous cleaning followed by, at a minimum, high level disinfection.
Equipment/device that either touches only intact skin (but not mucous membranes) or does not directly touch the client/patient/resident. Reprocessing of noncritical equipment/devices involves cleaning and may also require low level disinfection (e.g. blood pressure cuffs, stethoscopes
Read the fine print. It’s no small matter with product labels.July 3, 2014
Why is the public calling the College?April 2, 2014
IPAC program summed up in 10 words: Alberta physicians continue to reprocess and are meeting best practicesOctober 4, 2013
Are you Making your Patients Sick?August 7, 2013
Under the Health Professions Act, College Council is required to approve rules for physician participation. The Rules for Member Participation were approved in December 2015, after formal consultation with the profession.
780-969-5004 or 1-800-561-3899 ext. 5004 (in Canada)