Perspectives on Public Health Responses to Reported Infection Prevention and Control (IPAC) Lapses in the Community Liane Macdonald MD MSc FRCPC, Don Willison ScD, Colin Lee MD MSc FRCPC, (Public Health Ontario); Dr. Hsiu-Li Wang MD FRCPC (Region of Waterloo Public Health); Lise Labrecque BSW MHSc, Janet Onyango MBA (Ottawa Public Health) The Ontario Public Health Convention, Toronto, ON April 4, 2013 Educational objectives 1. Understand the roles and experiences of different stakeholders involved in risk assessment of and response to reported IPAC lapses in the community 2. Become familiar with key methodological issues associated with estimating the risk of BBI transmission associated with an IPAC lapse 3. Become familiar with a simple evaluation framework for complex interventions 4. Consider the ethical issues involved in a community IPAC lapse response www.oahpp.ca 2 Session agenda 1. 2. 3. 4. 5. 6. Introduction Local Public Health Practice Perspective I Local Public Health Practice Perspective II Scientific Perspective Ethics Perspective Public Health Practice, Scientific and Ethical Implications – Interactive/Discussion 7. Summary www.oahpp.ca 3 Setting the stage: Two case studies Metro News [homepage on the Internet]. Toronto, ON: Free Daily News Group Inc.; c2001-2012. Laurier students face slight risk of hep B, C, HIV after class test; 2012 Aug 15 [cited 2013 Mar 20]. Available from: http://metronews.ca/news/kitchener/337639/laurier-students-faceslight-risk-of-hep-bc-hiv-after-class-test/. www.oahpp.ca CBC News [homepage on the Internet]. ON. CBC; c2013.. Ottawa private clinic behind hepatitis, HIV scare; 17 Oct 2011 [cited Mar 20]. Available at: http://www.cbc.ca/news/health/story/2011/10/17/ottawa-public-health-infectionletters.html Setting the stage: The reported IPAC lapses Region of Waterloo Ottawa • Shared fingerstick • IPAC protocols not always (lancet / blood sampler) followed for disinfection device use of endoscopic and biopsy equipment • University kinesiology • Outpatient community • ~200 of ~1,200 students gastroenterology clinic • ~ 6,800 patients class setting s Available at: http://www.wlu.ca/KP322info www.oahpp.ca Available at: http://app06.ottawa.ca/calendar/ottawa/citycouncil/obh/2012/ 01-16/3_endo%20108%20jan%209.htm 5 Setting the stage: The responses Region of Waterloo Ottawa • University-led, with health unit (HU) support • Health unit-led • Risk assessment, notification, lab testing and tracking • Risk assessment, notification, lab testing & tracking, counseling, evaluation, look-back • Minimal media uptake • +++ Media attention • Small HU team • 200 (125 core) HU staff • Approx. 3 months • Approx. 11 months www.oahpp.ca Image from Microsoft Clip Art 6 Setting the stage: The reported risk estimates Region of Waterloo Ottawa Reported transmission risk Reported transmission risk estimates: estimates: • HIV: 1 in 10 million • HIV: <1 in 3 billion • HCV: 1 in 1 million • HCV: <1 in 50 million • HBV: 6 in 1 million (among vaccinated) • HBV: <1 in 1 million Wilfred Laurier University Safety, Health Environment and Risk Management [homepage on the Internet]. Waterloo, ON: Wilfred Laurier University.; c2013. KP322 Info; Aug [cited 2013 Mar 20]. Available from: http://www.wlu.ca/KP322info www.oahpp.ca Levy I. Ottawa, ON: Report to the Ottawa Board of Health.; c2012. Interim report on Ottawa Public Health’s response to the community infection control lapse.; 2012 Jan 16 [cited 2013 Mar 20]. Available from :http://app06.ottawa.ca/calendar/ottawa/citycouncil/obh/2012/0116/3_endo%20108%20jan%209.htm. 7 Acknowledgements Region of Waterloo Public Health thanks: • Wilfrid Laurier University: Karen Ostrander, Kevin Crowley, Stephanie Kibbee and their teams • Region of Waterloo Public Health: Dr. Liana Nolan, Brenda Miller, Kristy Wright, Linda Black, Kathryn Bromley and all others on the team. • PHO: Dr. Liane Macdonald, Dr. Colin Lee, Erik Kristjanson and their teams. Ottawa Public Health thanks: • OPH staff and IMS team for their input as evaluation respondents • Evaluation Team for the Community Infection Control Lapse www.oahpp.ca Ottawa Public Health thanks (cont.): • Evaluation Team: Amira Ali, Victoria Cole, Jill Courtemanche, Dr. Ed Ellis, Dr. Vera Etches, Lise Labrecque, Jackie Kay-LePors, Karen MacLeod, Maurica Maher, Cameron McDermaid, Janet Onyango, Jacqueline Willmore PHO thanks: • Our health unit and MOHLTC and partners • Dr. Colin Lee, Dr. Doug Sider, Dr. Natasha Crowcroft, Dr. Mayank Singhal, Erik Kristjansen, Michael Whelan, Naideen Bailey, Liz Van Horne, Cathy Egan, Roxine Grant (PHO) • Dr. Rob Remis (University of Toronto/PHO) • Dr. William Rutala (University of North Carolina) 8