A
Health Education Resource
for
INFECTION CONTROL
in Shelters
and
Drop-In Centres
For use by service providers
Developed by:
The City of Ottawa
People Services Department, Public Health and Long Term Care Branch
Chronic Disease and Injury Prevention Division
Street Health Program
February 2002
First Edition
——
Shaping our future together
www.ottawa.ca
——
For Information about Infection Control,
or
to Report a Communicable Disease,
Please Call:
The City of Ottawa
Communicable Disease Control Program:
724-4224
Evenings, weekends, and holidays:
Medical Officer of Health
on call
580-2400
——
Shaping our future together
www.ottawa.ca
TABLE OF CONTENTS
Page
INTRODUCTION....................................................................................................................................... 1
1) RECOMMENDATIONS FOR SERVICE PROVIDERS ................................................................ 2
Immunizations ..................................................................................................................................... 3
Tuberculosis Screening for Employees and Volunteers in Shelters and Drop-In Centres ................. 4
Policy: TB Screening for Employees and Volunteers in Shelters and Drop-In Centres .................... 5
Needlestick Injury / Accidental Exposure Protocol Chart .................................................................. 6
2) CHAIN OF INFECTION .................................................................................................................... 7
Modes of Transmission of Microorganisms ....................................................................................... 9
Precautions to Prevent Transmissions of Microorganisms ............................................................... 10
3) ROUTINE PRACTICES ................................................................................................................... 12
Hand Washing................................................................................................................................... 14
Gloves ............................................................................................................................................... 20
Gowns ............................................................................................................................................... 21
Masks and Eye Protection ................................................................................................................. 22
Cleaning and Disinfecting Client Care Equipment ........................................................................... 23

Major Classes of Chemical Disinfectants and Relative Advantages and Disadvantages ....... 25

Directions for Household Bleach Preparation ........................................................................ 27
Housekeeping .................................................................................................................................... 28

Cleaning Procedures for Common Items ................................................................................ 29

Cleaning Blood Spills ............................................................................................................. 31
Laundry ............................................................................................................................................. 32
Managing Untreated Waste (Blood & Body Fluid Waste / Gloves & Dressings / Sharps) ............. 34
4) GUIDELINES FOR COMMUNICABLE DISEASE AND OTHER HEALTH ISSUES ............ 35
Methicillin-Resistant Staphylococcus Aureus (MRSA) ................................................................... 36
Vancomycin-Resistant Enterococci (VRE) ...................................................................................... 40
Summary Table: Guidelines for Communicable Disease and Other Health Related Issues in
Shelters and Drop-In Centres ............................................................................................................ 45
Report of Designated Communicable Diseases to the Medical Officer of Health (MOH)
(list of Reportable Communicable Diseases and the Reporting Form) ............................................ 64
5) ADDITIONAL INFORMATION Hepatitis B, Hepatitis C, HIV, Head Lice, Scabies, Tuberculosis
Health Facts, Positive Skin Test; TB Booklet—What I Need to Know; What to Do With Used Needles; Be Careful With Needles! ........ 65
Resources .......................................................................................................................................... 66
Appendices........................................................................................................................................ 67
Appendix I — Table 6: Transmission Characteristics and Empiric Precautions by Clinical Presentations:
Recommendations for Acute Care Centres
Appendix II — Table 7: Transmission Characteristics and Precautions by Specific Etiology:
Recommendations for Acute Care Centres
Glossary Of Terms ............................................................................................................................ 68
References ......................................................................................................................................... 72
(Dec. 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
INTRODUCTION
PURPOSE
The Health Education Resource for Infection Control in Shelters and Drop-In Centres is a
practical guide to assist service providers in preventing the transmission of infection, while
protecting him or herself from exposure to infection.
This resource for Infection Control in Shelters and Drop-In Centres can be used to develop
guidelines for local use — taking into consideration conditions within the shelters, risk of
infections, type of care provided, and the personnel providing the care.
This resource should help set a standard for infection control within the individual shelters and
enhance communication across shelters. This resource is a compilation of information from mainly
Health Canada and the City of Ottawa’s Public Health Branch; and has been reviewed by the City of
Ottawa’s Associate Medical Officer of Health— Health Protection Division.
BACKGROUND
The Ottawa Inner City Health Project, sponsored by the University of Ottawa, received federal
government SCPI (Supporting Communities Partnerships Initiative) funding in March 2001, to provide
health care to the chronically homeless at three residential sites: The Home Hospice at the Mission, the
Special Care Unit at the Salvation Army, and the Management of Alcohol Program at the Shepherds of
Good Hope. In addition, services are available to women at Cornerstone — a women’s emergency
shelter.
Community health practitioners from organizations such as Victorian Order of Nurses, Community Care
Access Centre, community health centers, Department of Medicine at the University of Ottawa, and the
City of Ottawa—Public Health Branch (Street Health Program), will work collaboratively with service
providers to facilitate a coordinated health care service for these clients.
FORMAT
This Health Education Resource for Infection Control in Shelters and Drop-In Centres has been
organized into five components:
1) Recommendations for Service Providers
2) Chain of Infection
3) Routine Practices
4) Guidelines for Communicable Diseases and Other Health Issues
5) Additional Resources, Appendices and Glossary of Terms
The information and additional resources contained in this resource should help service providers
develop and/or reinforce an understanding of infection control, and offer knowledge to provide care.
(Dec. 2001) A
Health Education Resource for Infection Control in Shelters & Drop-In Centres
1
A HEALTH EDUCATION RESOURCE FOR INFECTION CONTROL
IN SHELTERS AND DROP-IN CENTRES
Recommendations
for
Service Providers
——
2
RECOMMENDATIONS FOR SERVICE PROVIDERS
IMMUNIZATIONS
VACCINES
INDICATIONS
Measles:
One dose for those born in 1957 or later, with no documented proof of
disease, vaccination after 1st birthday or serologic immunity.
Mumps:
One dose. No documented proof of vaccination after 1st birthday or
serologic immunity.
Rubella:
One dose for those born in 1957 or later with no documented proof of
disease, vaccination after 1st birthday or serologic immunity.
Measles, mumps and rubella vaccines may be given as one vaccine: MMR.
There is no harm in giving MMR to a person who has previously had one of these diseases, or
vaccines:
Tetanus and Diphtheria:
Every 10 years as Td.
Poliomyelitis:
Persons who have not been given a full primary course should have the
series with IPV regardless of the interval since the last dose.
Booster doses of IPV are not required for health care workers in
Canada.
Hepatitis B:
Three-dose course. Post-vaccination testing for anti-HBs should be
performed between one and six months after completion of series.
Influenza:
Annual immunization for all service providers.
Note: all immunizations, hepatitis B serology results, and TB mantoux skin test results, should be on a
yellow immunization card to be retained by the employee.
Health Canada (1998). Canadian Immunization Guide. (5th Edition). Ottawa, ON: Canadian Medical Association, 54-57.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
(Dec. 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
3
RECOMMENDATIONS FOR SERVICE PROVIDERS
TUBERCULOSIS (TB) SCREENING FOR EMPLOYEES AND VOLUNTEERS
IN SHELTERS AND DROP-IN CENTRES
BACKGROUND
Tuberculosis is a disease often called TB, which is spread by tiny bacterial germs that can float in the
air. The TB germs may spray into the air if a person with TB disease coughs, shouts or sneezes. The
people nearby can breathe TB germs into their lungs and get TB infection.
Most people with TB infection will not get sick or spread TB to others. Some people will get sick and
have TB disease.
TB disease usually attacks the lungs, but sometimes it attacks the kidneys, brain or spine. People who
have TB disease need medical care because they could die. They can also spread TB to other people.
Tuberculosis—a reportable communicable disease, is well managed in the City of Ottawa, but is still
present—over the past 15 years, there have been about 40-90 cases of TB per year. In someone who has
HIV infection, the risk of TB infection (not ill, & not contagious) progressing into TB disease increases
dramatically.
People who are at risk of developing TB include:

Those infected with HIV;

Those with risk factors for HIV infection;

Aboriginal Canadians who have lived in communities with a high rate of TB;

Clients of socially and economically depressed inner city areas;

Injection drug users;

Alcoholics;

Persons from countries with a high prevalence of TB;

People with medical conditions that increase the risk of TB disease (e.g. silicosis, gastrectomy,
diabetes, end-stage renal disease, immunosuppressive therapy, prolonged steroid therapy,
lymphomas, etc.);

Those employed under circumstances where a higher than average risk exists for acquiring TB; and

Staff and clients of long-term institutions.
RATIONALE FOR TUBERCULOSIS SCREENING
The City of Ottawa, Public Health recommends that your organization requires all employees and
volunteers to be assessed for the presence of TB infection or disease for the following 3 reasons:

Provides a good baseline result in the event of a future exposure to someone with TB disease.
Any positive test after a negative baseline test, means that you are newly infected;

Identifies those who have TB infection; and

Identifies the rare case of TB disease among employees and/or volunteers.
Ontario Ministry of Health (1995). Health Facts TB Infection /TB Disease. 100M/12/95 CAT# 4129492, Toronto, ON: Queens Printer for Ontario.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (1997). Tuberculosis Screening and
Contact Management: Recommendations and Notes. Ottawa, ON, City of Ottawa, Communicable Disease Program.
(Dec. 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
4
RECOMMENDATIONS FOR SERVICE PROVIDERS
POLICY — TB SCREENING FOR EMPLOYEES AND VOLUNTEERS
IN SHELTERS AND DROP-IN CENTRES

All staff and volunteers are to be screened for tuberculosis within 4 weeks of start of employment
and/or volunteering.

Individuals whose Mantoux TB skin test status is unknown, and those previously identified as
negative Mantoux TB skin test, require a baseline two-step Mantoux TB skin test.

Individuals, who have documentation of a negative test during the preceding 12 months, require a
single-step test.

Two-step testing means that if your first Mantoux TB skin test is negative, you need a second test
1-4 weeks later.

Individuals with a previously positive Mantoux TB skin test, require a chest x-ray to rule out active
TB, unless they have had a chest x-ray within the preceding 12 months.

Many individuals with a positive Mantoux TB skin test, indicating a latent TB infection, will benefit
from preventive antibiotic treatment, to prevent future TB disease.

Individuals with TB disease must be treated.

Employers must maintain a list of all employees and volunteers, with the date of the Mantoux TB
skin test or chest x-ray. The employer is not responsible for reviewing results or follow-up.

TB skin test and or chest x-ray result and date are to be recorded on a yellow immunization card.
SUGGESTED LOCATIONS FOR TUBERCULOSIS SCREENING


Ask employees and volunteers to make an appointment with their family physician; or
Employer makes arrangements with a health care facility, e.g. health clinics.
Note: Some family physicians may charge a fee for the Mantoux TB skin test.
TUBERCULOSIS FACT SHEETS RE: TUBERCULOSIS AND POSITIVE SKIN TEST

Located in the “Fact Sheets” section of this resource
Ontario Ministry of Health (1998). Tuberculosis Control Protocol, Ministry of Health, Public Health Branch, Mandatory Health Programs Service Guidelines.
Toronto, ON: Queens Printer for Ontario.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2001). Policy for Tuberculosis
Screening in Shelters and Drop-In Centres. Ottawa, ON: City of Ottawa, Communicable Disease Program.
(Dec. 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
5
RECOMMENDATIONS FOR SERVICE PROVIDERS
NEEDLESTICK INJURY/ACCIDENTAL EXPOSURE PROTOCOL CHART
for use in shelters and drop-in centres







Manage exposure using described first aid care and infection control guidelines for cleaning,
disinfecting and waste management.
Allow injured areas to bleed freely.
Remove clothing that is contaminated with body fluids.
Thoroughly flush exposed area with water or sterile saline.
Clean area with soap and water and dry injured area.
Apply antiseptic to wound.

Employee notifies supervisor or delegate

Supervisor or delegate completes the required report as per individual agency


Employee

Proceed immediately for risk assessment, to the emergency
department of the Ottawa Hospital (Civic or General
campus), Montfort Hospital, or Queensway-Carleton
Hospital.
Source Client

Supervisor or delegate will attempt to obtain client
consent for testing.

Client will be sent to the closest hospital for testing.
Call ahead to notify ER triage nurse that client is
coming. Request source be tested for HIV, Hepatitis
B&C and to send blood STAT to the Public Health Lab.


Hospital staff will:

Assess risk and suggest appropriate base line blood test.

Post exposure vaccine or medication will be offered to
employee.
Hospital staff will

Test source client.


RESPONSIBILITIES
Supervisor (or delegate)

To supply safety equipment and guidelines.

To encourage employees to be immunized.

To identify safety hazards and address them.

To obtain source client consent if necessary.

To immediately refer employees for occupational exposure
management.

To arrange for transportation of employee and/or source client
if necessary.

To complete appropriate reports (Incident/Accidental Injury).
Employee

To utilize safety equipment.

To take appropriate precautions to prevent occupational
exposures.

To immediately report an incident to the supervisor or
delegate.

To complete required program incident report
(if applicable).
HOSPITALS AND EMERGENCY ROOM
Montfort Hospital:
Ottawa Hospital, Civic Campus:
Ottawa Hospital, General Campus:
Queensway-Carleton Hospital:
TELEPHONE NUMBERS
748-4908
761-4621
737-8000
721-4710
City of Ottawa. Public Health and Long Term Care Branch. Health Protection Division. Communicable Disease Program (2001).
Needlestick Injury/Accidental Exposure Protocol Chart for use in Shelters and Drop-In Centres. Ottawa, ON: City of Ottawa, Communicable Disease Program.
(Dec. 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
6
A HEALTH EDUCATION RESOURCE FOR INFECTION CONTROL
IN SHELTERS AND DROP-IN CENTRES
Chain of Infection
——
7
CHAIN OF INFECTION
MICROORGANISMS are organisms that are not visible to the naked eye. They are found in food,
soil, air, on and in humans and animals. Most organisms are harmless but some can cause infection or
disease. For infection to occur, the organism must enter the body, grow and multiply, thus causing
a local or systemic infection. The body’s defenses such as healthy skin and mucous membranes,
healthy immune system, proper nutrition, adequate sleep, good hygiene, and routine preventive practices
help to avoid infection.
CHAIN OF INFECTION:
Agent
Susceptible
host
Reservoir
Portal of
entry
Portal of
exit
Mode of
transmission
Agent: is the infectious microorganism which causes infection or disease.
Examples of agents are:

virus, e.g. HIV or hepatitis B or C;

bacteria, e.g. tuberculosis, neisseria meningitidis;

fungus, e.g. candida; and

larger parasites, e.g. lice.
Susceptible Host: the person getting the pathogen (infection) due to the invasion and multiplication
of the microorganism in the body.
Portal of Entry: is the point where the agent enters the host’s body.
Reservoir: is the place where the agent lives and multiplies—either on a person, in body fluids or
in/on items.
Portal of Exit: is the point where the agent exits the body (e.g. draining lesions, cough).
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
(Dec. 2001)
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CHAIN OF INFECTION
MODES OF TRANSMISSION OF MICROORGANISMS…
refers to how the agent travels to the host. There are four routes of transmission:
Contact (direct, indirect, droplets); Airborne; Vehicle; and Vectorborne.
CONTACT TRANSMISSION
Direct Contact

occurs with skin-to-skin contact between the infected or colonized person and the host. Contact
precautions should be taken with those who have diarrhea with unknown cause, major burn
wound infections, extensive skin disorder with infection or colonization, skin rashes, draining
infected wounds or abscesses, or antimicrobial-resistant organisms. Contact and droplet
precautions should be taken for viral respiratory tract infections.
Indirect Contact

involves passive transfer of microorganisms to a host by an object or surface that was
contaminated by an infected person. Strict cleaning measures are necessary to avoid
transmitting organisms to the client from contaminated objects or equipment.
Droplet Transmission

are large droplets generated by the infected person when he/she coughs, sneezes or talks.
The droplets are projected in the air a short distance and deposited on the nose, eyes, or mouth
mucosa of the new host. Examples of infections transmitted by droplets include respiratory
tract infections such as pneumonia, meningitis, streptococcus A and influenza.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
(Dec. 2001)
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9
CHAIN OF INFECTION
MODES OF TRANSMISSION OF MICROORGANISMS
Airborne Transmission

refers to very small droplets that are generated by the infected person when he/she talks, coughs or
sneezes. These droplets stay suspended in the air and travel through air currents that are inhaled by
the new host. Tuberculosis is an example where precautions should be used to prevent transmission
of this highly infectious disease.
Common Vehicle Transmission

refers to a single contaminated source such as food, water or equipment, which serves to transmit
infection to multiple hosts.
Vectorborne Transmission

refers to transmission by infected insects or animals, which transmit the agent to the host, e.g., rabies.
PRECAUTIONS TO PREVENT TRANSMISSION OF MICROORGANISMS

Contact Precautions include: Washing hands; wearing gloves; wearing gowns if there is a risk of
splashing or spraying; and cleaning client-care equipment.

Droplet Precautions include: Washing hands; wearing masks for diagnosed infectious diseases; and
cleaning client-care equipment.

Airborne Precautions include: Washing hands; wearing mask for diagnosed infectious diseases;
and cleaning client-care equipment.
For specific precautions related to Clinical Presentation and Specific Etiology refer to
Appendices I & II:

TABLE 6: Transmission Characteristics and Empiric Precautions by Clinical Presentation:
Recommendations for Acute Care Centres

TABLE 7: Transmission Characteristics and Precautions by Specific Etiology: Recommendations
for Acute Care Centres
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
(Dec. 2001)
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CHAIN OF INFECTION
Risk of transmission of microorganisms between clients involves factors related to the microbe, the
source client, the client-care environment, and the new host. (Table 1)
SOURCE CLIENT
TABLE 1: RISK FACTORS FOR TRANSMISSION AND DISEASE AFTER EXPOSURE TO
INFECTED OR COLONIZED SOURCE CLIENT
 HIGHER Risk of Transmission
 LOWER Risk of Transmission










HOST PATIENT
ENVIRONMENT
MICROORGANISM





















Incontinent of stool; stool not contained by diapers
Diarrhea
Draining skin lesions or wounds not covered by dressings
Copious uncontrolled respiratory secretions
Client requiring extensive hands-on care
Client has invasive devices
Poor compliance with hygienic practices and infection
control precautions (e.g. confused client)
Able to survive in the environment
(e.g. VRE, C.difficile, rotavirus)
Presence of large inoculum
Low infective dose (e.g. Shigella)
High pathonenicity, high virulence
Airborne
Spread by contact
Able to colonize invasive devices
Propensity for asymptomatic/carrier state
Inadequate housekeeping
Shared patient care equipment without cleaning between
clients (e.g. thermometer bases, commodes)
Crowded facilities
Shared facilities (e.g. toilets, bath, sinks)
High patient-nurse ratio
Absence of negative pressure rooms (if airborne)
Patient in intensive care unit or requiring extensive handson care
Patient has invasive procedures or devices
Non-intact skin
Debilitated, severe underlying disease
Extremes of age
Recent antibiotic therapy
Immunosuppression




Continent
Good hygiene
Skin lesions or wounds covered by
dressings
Able to control respiratory secretions
Capable of self-care
Able to comply with infection control
precautions


Unable to survive long in the
environment
Presence of low inoculum
High infective dose
(e.g. Salmonella)
Low pathogenicity, low virulence
Short period of infectivity





Appropriate housekeeping
Dedicated equipment
Adequate spacing between beds
Own bathroom facilities
Low patient-nurse ratio




Able to do self care
No indwelling devices
Intact skin and mucous membranes
Strong immune system


Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
(Dec. 2001)
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A HEALTH EDUCATION RESOURCE FOR INFECTION CONTROL
IN SHELTERS AND DROP-IN CENTRES
Routine Practices
——
12
ROUTINE PRACTICES
ROUTINE PRACTICES:
Formerly known as Universal Precautions, is a system of practice where service providers assume that
all clients are considered to be carriers of infectious pathogens. The shelter population is becoming
increasingly immunocompromised and at greater risk for infection. Some persons may have symptoms of
infection and others may not. It is recommended that all service providers handle blood and body
substances as if infected with pathogens. Precautions should be taken when handling blood and body
fluids—including secretions and excretions, and drainage from open wounds.
Blood and certain body fluids can be infected and transmit blood-borne pathogens such as HIV, hepatitis
B and C. Body substance precautions imply that all body substances may be infectious. These
precautions apply to blood, semen, vaginal secretions, and saliva for hepatitis B and C and HIV—if
contaminated with blood. Saliva can be contaminated with hepatitis B even though blood is not present.
Body substances such as feces, nasal secretions, sputum, tears, urine and vomitus are not implicated in
the transmission of HIV, hepatitis B and C unless visibly contaminated with blood.
Risks of exposure to infection can be greatly reduced if the following interventions are in place:

Keep immunization up-to-date—immunizations reduce the chances of becoming infected with
certain diseases;

Wash your hands—hand washing is the single most important measure for preventing infection;

Use disposable gloves when in contact with blood, body fluids, secretions and excretions, and nonintact skin and mucous membranes;

Wash hands after removing gloves—gloves do not replace hand washing;

Wear masks and protective eyewear when there is a risk of contamination to mucous membranes
from splashing or spraying (eyes, nose, mouth);

Encourage clients to wash hands regularly;

Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in a situation/
environment where there is potential for exposure;

Comply with guidelines on cleaning and disinfection;

Ensure used needles are disposed of in a biohazard container.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
College of Nurses of Ontario (2000). Infection Control Guidelines. Toronto, ON, College of Nurses of Ontario, 3-10.
(The) College of Physicians and Surgeons of Ontario (1999). Infection Control in the Physicians’ Office.
Toronto, ON. the College of Physicians and Surgeons of Ontario, 1-41.
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13
ROUTINE PRACTICES
HAND WASHING
Disease-causing microorganisms can frequently be isolated from the hands. Hand carriage of bacteria
is an important route of transmission of infection between clients or from the health care worker to
the client. Guidelines from national and international infection prevention and control organizations
have repeatedly acknowledged that, hand washing is the single most important procedure for
preventing infections.
Hand washing with plain soap (detergents) is effective in removing most transient microbial flora.
The components of good hand washing include using an adequate amount of soap, rubbing the
hands together to create some friction, and rinsing under running water. This technique
decreases the number of germs on your hands.
RECOMMENDATIONS ON HAND WASHING
1) Hands must be washed:

between direct contact with individual clients;

before performing invasive procedures;

before preparing, handling, serving or eating food, and before feeding a client;

when hands are visibly soiled;

after situations or procedures in which microbial or blood contamination of hands is
likely;

after removing gloves; and

after personal body functions, such as using the toilet or blowing one’s nose.
2) Hand washing is encouraged whenever a health care provider is in doubt about the
necessity for doing so. As well as between client contacts, hand washing may be indicated
more than once in the care of one person, for example, after touching excretions or
secretions, and before going on to another care activity for the same person.
3) Hand washing facilities should be conveniently located throughout the health care setting.
They should be available in or adjacent to rooms where health care procedures are
performed. If a large room is used for several individuals, more than one sink may be
necessary. Sinks for hand washing should be used only for hand washing and not for any
other purpose, e.g., as a utility sink. There should be access to adequate supplies and proper
functioning soap and towel dispensers or hand dryers.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
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ROUTINE PRACTICES
HAND WASHING
RECOMMENDATIONS ON HAND WASHING
4) To avoid recontaminating hands, faucets with foot- wrist- or knee-operated handles should be
installed wherever possible. If automated faucets are not available, single-use towels should be
supplied for the user to turn off faucets.
5) Hands should be dried thoroughly with either a single-use towel or electric air dryer.
6) Hand lotion may be used to prevent skin damage from frequent hand washing. Lotion should be
supplied in disposable bags in wall containers by sinks or in small, non-refillable containers to
avoid product contamination.
7) Liquid hand wash products should be stored in closed containers and dispensed from either
disposable containers or containers that are washed and dried thoroughly before refilling.
8) Hand washing with plain soap is indicated in routine health care and for washing hands soiled
with dirt, blood or other organic material. Plain soap and water will remove many transient
organisms.
9) Hand washing with an antiseptic agent is indicated prior to performing invasive procedures or
when caring for individuals with antibiotic-resistant organisms.
10) Hand washing with waterless/alcohol-based agents should be made available where access to
water is limited — agents are not effective if hands are soiled with dirt or heavily contaminated
with blood, or other organic material. Follow manufacturer’s instruction for use.
11) Clients in settings where hygiene is poor should have their hands washed. Clients should be
helped to wash their hands before meals, after going to the bathroom, and before leaving their
room.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
15
ROUTINE PRACTICES
HAND WASHING
TABLE 2. SOAPS AND ANTISEPTIC AGENTS FOR HAND WASHING
Product
Indications
Special Considerations
Plain soap, bar soap,
liquid*, granules



May contain very low concentrations of
antimicrobial agents to prevent microbial
contamination growth in the product.
Waterless alcohol
hand-hygiene
solutions:

For routine care of clients.
For washing hands soiled
with dirt, blood or other
organic material.
Demonstrated alternative
to conventional agents.
For use where hand
washing facilities are
inadequate, impractical or
inaccessible.
For situations in which the
water supply is
interrupted.

May be chosen for hand
scrubs prior to
performance of invasive
procedures.
When caring for severely
immunocompromised
individuals.
Based on risk of
transmission (e.g., specific
microorganisms).
When caring for
individuals with
antimicrobial resistant
organisms.

Not effective if hands are soiled with dirt or
heavily contaminated with blood or other
organic material.
Follow manufacturer’s recommendations
for use.
Efficacy affected by concentration of
alcohol in product. Use at least a 60%
alcohol product.
Hand creams should be readily available to
protect skin integrity; or use alcohol hand
wash with emollients.
Antiseptic agents may be chosen if it is felt
important to reduce the number of client
flora or when the level of microbial
contamination is high.
Antiseptic agents should be chosen when
persistent antimicrobial activity on the
hands is desired.
They are usually available in liquid
formulations*.
Antiseptic agents differ in activity and
characteristics.
Routine use of hexachlorophene is not
recommended because of neurotoxicity and
potential absorption through the skin.
Alcohol containers should be stored in
areas approved for flammable materials.


Antiseptic agents












* Disposable containers are preferred for liquid products. Reusable containers should be thoroughly washed and
dried before refilling, and routine maintenance schedules should be followed and documented. Liquid products
should be stored in closed containers and should not be topped-up.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
(Adapted for use by shelters August, 2001).
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
16
ROUTINE PRACTICES
Originally produced by the Peel Health Department
1. Wet Hands
2.
Soap
3. Lather
4. Rinse
Towel Dry
Shaping our futuretogether
www.city.ottawa.on.ca
722-2200
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
17
ROUTINE PRACTICES
Produit à l’origine par le Service de la santé de Peel
1.
2.
3. Mousser
4. Rincer
Sécher
Ensemble, formons notreavenir
www.ville.ottawa.on.ca
722-2200
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
18
ROUTINE PRACTICES
HAND WASHING
TABLE 3: HOW TO WASH HANDS
Procedure
Rationale
Remove jewelry before hand-wash
procedure.
Rinse hands under warm running water.

Lather with soap and, using friction,
cover all surfaces of the hands and
fingers.
Rinse under warm, running water.
Dry hands thoroughly with single-use
towel or forced-air dryer.
Turn off faucet using a paper towel.
Do not use fingernail polish or artificial
nails.








This allows for suspension and washing away of the
loosened microorganisms.
The minimum duration for this step is 10 seconds;
more time may be required if hands are visibly soiled.
For antiseptic agents — 3-5 ml are required.
Frequently missed areas are the thumbs, under
fingernails, backs of fingers and hands.
To wash off microorganisms and residual handwashing
agent.
Drying achieves a further reduction in number of
microorganisms.
Reusable towels are avoided because of the potential
for microbial contamination.
To avoid recontaminating hands.
Artificial nails or chipped nail polish may increase
bacterial load and prevent visualization of soil under
fingernails.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
19
ROUTINE PRACTICES
GLOVES
GLOVES ARE WORN TO:

Provide an additional protective barrier between health care providers’ hands and blood, body
fluids, secretions, excretions and mucous membranes; and

Reduce the potential transfer of microorganisms from infected clients to health care providers,
and from client-to-client via health care providers’ hands.
Glove use should be an adjunct to, not a substitution for, hand washing. If all personnel perform hand
washing carefully and appropriately, gloves are not necessary to prevent transient colonization of health
care providers’ hands and subsequent transmission to others.
RECOMMENDATIONS ON GLOVE USE
1) Gloves should be used as an additional measure, not as a substitute for hand washing.
2) Gloves are not required for routine client care activities if contact is limited to a client’s intact
skin, e.g., when transporting clients.
3) Clean, non-sterile gloves should be worn:

if exposure is anticipated to blood and body fluids capable of transmitting bloodborne
infection, e.g., hepatitis B, hepatitis C, and HIV;

if exposure is anticipated to potentially infectious body substances such as pus, feces,
respiratory secretions or exudate of skin lesions;and

when the health service provider has non-intact skin on his/her hands.
4) Gloves should be changed:

between client contacts;

if a leak is suspected or the glove tears; and

between care activities and procedures on the same client, after contact with materials
that may contain high concentrations of microorganisms.
5) Hands must be washed after gloves are removed.
6) Potentially contaminated gloves should be removed prior to touching clean environmental
surfaces (e.g., lamps, blood pressure cuffs).
7) Single-use disposable gloves should not be washed or reused.
8) Non-latex gloves should be available for individuals with latex sensitivity.
9) For housekeeping activities, instrument cleaning and decontamination procedures, general
purpose reusable household gloves (e.g., neoprene, rubber, butyl) are recommended. Medical
gloves are not durable enough for these activities.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
20
ROUTINE PRACTICES
GOWNS

The routine use of gowns is not recommended.

Gowns should be used to protect uncovered skin and prevent soiling of clothing during procedures
and client-care activities that are likely to generate splashes or sprays of blood, body fluids,
secretions, or excretions, or where soiling of clothing is anticipated.
WHEN USING GOWNS, THE FOLLOWING POINTS SHOULD BE OBSERVED:

gowns should be located conveniently;

hands must be washed before gowning;

the gown must be long enough to cover the clothes, and the sleeves must be no shorter than just
above the wrist;

the gown is put on with the opening at the back, with edges overlapping, thus covering as much
clothing as possible;

the gown is tied at the waist and neck;

the neck and waist ties are undone and the gown removed without touching the clothing, then turned
inside on itself, rolled up and placed in laundry hamper;

hands are washed;

gowns are preferably used only once. For routine client care, if a gown is used more than once, it
should be used for a single client only, and discarded if wet, soiled, or at the end of the health care
worker’s shift; and

wet gowns must be removed immediately to prevent a wicking action that facilitates the passage of
microorganisms through the fabric.
If clothing is soiled with body fluids:

change clothing;

shower if necessary;

bag soiled clothing; and

launder with hot water and soap.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
21
ROUTINE PRACTICES
MASKS AND EYE PROTECTION

Masks and eye protection or face shields should be worn where appropriate to protect the mucous
membranes of the eyes, nose and mouth during procedures and client care activities likely to generate
splashes or sprays of blood, body fluids, secretions or excretions.

N.B.: Each service provider should carry a pocket resuscitation mask—in a case or on a belt.
Use a pocket mask for CPR but DO NOT delay CPR.

Masks should be used only once and changed if wet (because masks become ineffective when moist);

Masks should cover both the nose and the mouth;

Avoid touching the mask while it is being worn;

Discard all masks into an appropriate receptacle;

Masks must not be allowed to dangle around the neck; and

Wash hands after removing the mask.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
22
ROUTINE PRACTICES
CLEANING, DISINFECTING CLIENT CARE EQUIPMENT
Appropriate cleaning and disinfecting of client-care equipment is important in limiting the transmission
of organisms. Cleaning is always essential prior to disinfection. An item that has not been cleaned cannot
be assuredly disinfected. The manufacturer of the chemical product provides instructions for proper use
of the product.
Cleaning and disinfecting of medical equipment is divided into these three categories based on the
potential risk of infection involved in their use:
1) Non-Critical: items that either touch only intact skin but not mucous membranes, or do not
directly touch the client, involves cleaning and low-level disinfection.
2) Semi-Critical: items that come in contact with mucous membranes but do not penetrate them,
requires cleaning followed by high-level disinfection. Intermediate-level disinfection maybe
acceptable. (See Table 4)
3) Critical: items such as instruments or devices that enter sterile tissue must be cleaned, followed
by sterilization.
Sterilization: there is no sterilization available for equipment onsite at the shelters. Therefore, it is
the responsibility of the individual health care worker to ensure equipment is sterilized.
RECOMMENDATIONS FOR CLIENT CARE EQUIPMENT:
1) Where possible, client-care equipment should not be shared.
2) Reusable equipment that has been in direct contact with the client should be cleaned before use
in the care of another client. Items that are routinely shared should be cleaned between clients.
A routine cleaning schedule should be established and monitored for items that are in contact
only with intact skin, if cleaning between clients is not feasible.
3) Equipment that is visibly soiled should be cleaned.
4) Commodes, like toilets, should be cleaned regularly, and when soiled. Bedpans should be
reserved for use by a single client and labeled appropriately.
5) Procedures should be established for assigning responsibility and accountability for routine
cleaning of all client-care equipment.
6) Soiled health care equipment, e.g. bedpans, should be handled in a manner that prevents
exposures to skin and mucous membranes and contamination of clothing and the environment.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
23
ROUTINE PRACTICES
CLEANING, DISINFECTING CLIENT CARE EQUIPMENT
PRODUCT LABELING (CHEMICAL DISINFECTANTS)

The product label must have a Drug Identification Number (DIN). The presence of a DIN indicates
that, upon review, it has been established that the product is safe and effective for its intended use.

The product label must be read carefully for instructions on use. Failure to do so often leads to
inappropriate use, storage or disposal of the product and may expose the client as well as the health
care worker to an increased risk of infections or toxic chemical effects. Inappropriate storage of
chemical disinfectants may reduce their shelf life, and if they become contaminated, may also lead to
bacterial growth.

The product label should include mixing instructions, including concentrations for dilution, and
length of disinfection time.

The product label needs to be read for factors that may influence the activity of the disinfectant, such
as temperature, ph, relative humidity and water hardness.
TABLE 4: CLEANING AND DISINFECTING COMMONLY-USED EQUIPMENT
Manufacturers’ Recommendations for Concentration and Exposure Time Must be followed.
Process
Equipment
Examples of Items*
Products or Methods
Cleaning some
items may
require low
level
disinfection‡
 All
reusable
equipment
Cleaning
followed by
intermediate
level
disinfection‡
 Some
semicritical
items
 Physical removal of soil, dust or
foreign material
 Chemical, thermal or mechanical
aids may be used
 Cleaning usually involves soap and
water, detergents or enzymatic
agents
 Quaternary ammonium compounds
 Phenolics
 Some iodophors
 3% hydrogen peroxide
 Alcohols
 Hypochlorite solutions
 Iodophors
 Phenolics
Cleaning
followed by
high level
disinfection‡
 Semicritical
items
 All reusable equipment,
since such equipment
requires cleaning after
use and before further
disinfection processes are
initiated
 Bedpans, urinals,
commodes
 Stethoscopes
 Blood pressure cuffs
 Ear specula
 After large environmental
blood spills
 Glass thermometers
 Electronic thermometers
 Hydrotherapy tanks /
bathtubs used for client
whose skin is not intact‡
 Respiratory therapy
equipment‡
 Nebulizer cups‡
 Ear syringe nozzles




2% glutaraldehyde
6% hydrogen peroxide
Peracetic acid
Chlorine or chlorine compounds
*
For products that appear in two categories, manufacturers’ directions differ for length of exposure time and concentration.
‡ For guidelines regarding disinfection, refer to comprehensive discussion of disinfection issues.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
(adapted for use by shelters June 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
24
ROUTINE PRACTICES
CLEANING, DISINFECTING CLIENT CARE EQUIPMENT
TABLE 5: MAJOR CLASSES OF CHEMICAL DISINFECTANTS AND THEIR RELATIVE
ADVANTAGES AND DISADVANTAGES
Manufacturers’ recommendations for concentration and exposure time must be followed.
Disinfectant
Uses
Advantages
Disadvantages
Alcohols
 Intermediate level disinfectant
 Disinfect thermometers, external
surfaces of some equipment
(e.g., stethoscopes)
 Equipment used for home health
care
 Used as a skin antiseptic
 Fast acting
 No residue
 Non staining
Chlorines
 Intermediate level disinfectant
 Disinfect hydrotherapy tanks,
bathtubs, environmental surfaces
 Effective disinfectant following
blood spills
 Equipment used for home health
care
 See Table 6 for uses and dilution
of chlorines
 Low cost
 Fast acting
 Readily
available in
non-hospital
settings
Hydrogen
peroxide
 3% solution (low-level
disinfectant)
 Equipment used for home health
care
 Cleans floors, walls and
furnishings
 BP cuffs & stethoscopes, bedpans,
urinals, commodes, ear specula
 Strong oxidant
 Fast acting
 Breaks down
into water and
oxygen
 Volatile
 Evaporation may diminish
concentration.
 Inactivated by organic
material
 May harden rubber or
cause deterioration of
glues
 Corrosive to metals
 Inactivated by organic
material
 Irritant to skin and
mucous membranes
 The length of time bleach
solutions can be used:
 dilution of bleach
1:10 prepared fresh
and used within
24-hours;
 dilution of bleach
1:50 prepared fresh
and used within
1-30 days—this
solution must be
kept in an enclosed
brown, opaque
bottle.
 Use in well-ventilated
areas
 Can be corrosive to
aluminum, copper, brass
or zinc
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
25
ROUTINE PRACTICES
TABLE 5: MAJOR CLASSES OF CHEMICAL DISINFECTANTS AND THEIR RELATIVE
ADVANTAGES AND DISADVANTAGES
Manufacturers’ recommendations for concentration and exposure time must be followed.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58. (adapted for use by shelters June 2001)
Rutala, William A (1996). APIC (Association for Professional in Infection Control and Epidemiology) Guidelines for Selection and Use of Disinfectants.
AJIC Am J Infect Control 24:313-42.
Disinfectant
Uses
Advantages
Disadvantages
Iodophors

Intermediate level
disinfectant for some
equipment (hydrotherapy
tanks, thermometers)
Low level disinfectant for
hard surfaces and
equipment that does not
touch mucous membranes
(e.g., IV poles,
wheelchairs, beds,
thermometers, BP cuffs
& stethoscopes, bedpans,
urinals, commodes, ear
specula)
Low/intermediate level
disinfectants
Clean floors, walls and
furnishings
Clean hard surfaces and
equipment that does not
touch mucous membranes
(e.g., IV poles,
wheelchairs, beds)



Low level disinfectant
Cleans floors, walls and
furnishings
Clean blood spills, BP
cuffs & stethoscopes,
bedpans, urinals,
commodes, ear specula


Phenolics



Quaternary
ammonium
compounds



Rapid action
Relatively free of
toxicity and
irritancy







Leaves residual
film on
environmental
surfaces
Commercially
available with
added detergents to
provide one-step
cleaning and
disinfecting
Generally nonirritating to hands
Usually have
detergent
properties






Note: Antiseptic
iodophors are NOT
suitable for use as
hard surface
disinfectant
Corrosive to metal
unless combined with
inhibitors
Disinfectant may
burn tissue
Inactivated by
organic materials
May stain fabrics and
synthetic materials
Not recommended
for use on food
contact surfaces
May be absorbed
through skin or by
rubber
Some synthetic
flooring may become
sticky with repetitive
use
DO NOT use to
disinfect instruments
Non-corrosive
Limited use as
disinfectant because
of narrow
microbicidal
spectrum
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
(adapted for use by shelters June 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
26
ROUTINE PRACTICES
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
27
ROUTINE PRACTICES
TABLE 6: DIRECTIONS FOR HOUSEHOLD BLEACH PREPARATION
Product
Household Bleach
(5% sodium hypochlorite
solution with 50,000 ppm*
available chlorine)
NaDCC (Sodium
dichloroisocyanurate)
powder with 60% available
chlorine
Chloramine-T powder with
25% available chlorine
*
Parts per million
†
Intended Use
Recommended Dilution

Cleanup of blood
spills


To add to laundry 
water


Surface cleaning
Soaking of
glassware or
plastic items
Cleanup of blood
spills

One part (one 8-ounce cup/250ml) of
bleach to be mixed with 500 parts (28
gallons†) of tap water
One part (one 8-ounce cup/250ml) to be
mixed with 50 parts (2.8 gallons†/12.6
litres) of tap water

Dissolve 8.5g in one litre of tap water
Cleanup of blood
spills

Dissolve 20 g in one litre of tap water


Use concentrations of 1 part bleach
(e.g. 8-ounce cup/250ml to be mixed with
9 cups of tap water—1:10)
Imperial gallon (4.5 litres)
The length of time bleach solutions can be used:
— dilution of bleach 1:10 prepared fresh and used within 24 hours; and
— dilution of bleach 1:50 prepared fresh and used within 1-30 days—this solution must be kept in an
enclosed brown, opaque bottle.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58. (adapted for use by shelters June 2001)
Rutala, William A (1996). APIC (Association for Professional in Infection Control and Epidemiology)
Guidelines for Selection and Use of Disinfectants. AJIC Am J Infect Control 24:313-42.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
28
ROUTINE PRACTICES
HOUSEKEEPING
The aim of cleaning is to achieve a clean environment with regular and conscientious general
housekeeping. Visible dust and dirt should be removed routinely with water and detergent and/or
vacuuming. The environment should be kept free of clutter to facilitate housekeeping.
RECOMMENDATIONS FOR ROUTINE HOUSEKEEPING
1) Housekeeping protocols should include careful cleaning of wet surfaces and equipment to
prevent the build-up of biofilms. Environmental water reservoirs have been associated with
numerous infections and outbreaks. Examples include faucet aerators, showerheads, sinks,
drains, ice machines, water carafes and bathtubs.
2) Facilities should determine a schedule for cleaning and maintaining ducts, fans, and air
conditioning systems.
3) During wet cleaning, cleaning solutions and the tools with which they are applied soon become
contaminated. Therefore, a routine should be adopted that does not redistribute microorganisms.
Cleaning less heavily contaminated areas first, and changing cleaning solutions and cloths/mops
frequently, may accomplish this.
4) Wet mopping is most commonly done with a double-bucket technique, which extends the life of
the solution because fewer changes are required. When a single bucket is used, the solution must
be changed more frequently because of increased bioload.
5) Tools used for cleaning and disinfecting must be cleaned and dried between uses.
6) Mop heads should be laundered daily in areas of great activity and at a set interval for areas of
lesser contamination. All washed mop heads must be dried thoroughly before storage.
7) Facilities should develop policies for cleaning schedules and methods, which should include the
name of the person who is responsible for housekeeping.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
29
ROUTINE PRACTICES
HOUSEKEEPING
TABLE 7: CLEANING PROCEDURES FOR COMMON ITEMS
Surface /
Object
Procedure / Frequency
Horizontal
surfaces such as
over-head
tables, work
counters, beds,
mattresses,
bedrails
Walls, blinds,
curtains



Thorough cleaning
Cleaning when soiled
Cleaning between clients
and after discharge

Floors


Should be cleaned
regularly with a detergent
and as splashes/visible soil
occur
Thorough regular cleaning
Cleaning between clients
and after discharge
Damp-mopping preferered
Should be vacuumed
regularly and shampooed
as necessary
Thorough cleaning
Cleaning when soiled
Cleaning between clients
and after discharge
Carpets /
Upholstery
Toilets and
Commodes





Special Considerations


Detergent is adequate in most areas.
Blood/body fluid spills should be cleaned up
with disposable cloths, followed by disinfection

These may be the source of enteric pathogens
such as hepatitis A, salmonella, and E. Coli
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
(adapted for use by shelters June 2001)
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
30
ROUTINE PRACTICES
TABLE 7: CLEANING PROCEDURES FOR COMMON ITEMS
Surface /
Object
Procedure / Frequency
Special Considerations
Toys


Should be regularly
cleaned, disinfected with a
low-level disinfectant,
thoroughly rinsed, and airdried


Toys should be constructed of smooth,
nonporous (i.e., not plush) materials to facilitate
cleaning and decontamination:
1. Clean to remove visible dirt. Use detergent and
hot water;
2. Sanitize by soaking in a 1/100 bleach in water
solution (10 ml bleach in 1 L water) for 30
seconds and then allow to air-dry. Sanitizing
solution should be made at the time of use;
3. Mouthing toys should be avoided as it is
impractical to clean and disinfect after each use;
4. All toys that have not been mouthed can be
cleaned and sanitized once a week as follows:

Small toys: clean and sanitize as indicated
above;

Soft washable, cuddly toys should be
avoided. When they are essential, they
should be machine-washed in hot water with
normal detergent and dried on the hottest
cycle of your dryer on a weekly basis;

Non machine-washable or large toys, (e.g.
books, puzzles, activity centres, riding toys):
wipe with a clean cloth soaked in hot water
with detergent, then wipe with a clean cloth
soaked in a sanitizing solution of 1/50 bleach
in water solution, (20 ml bleach in 1L water)
and let air dry. 1/50 bleach in water is used
here for items which cannot be soaked in
sanitizing solution.
Consider the use of gloves when disinfecting to
prevent skin irritation. Wash hands after
disinfecting toys.
Do not use phenolics
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
(adapted for use by shelters June 2001)
City of Ottawa, Public Health and Long Term Care Branch (November, 2000). Communicable Disease Report. Ottawa, ON: City of Ottawa.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
31
ROUTINE PRACTICES
CLEANING BLOOD SPILLS
RECOMMENDATIONS FOR CLEANING BLOOD SPILLS
1) Appropriate personal protective equipment should be worn for cleaning up a blood spill.
Gloves should be worn during the cleaning and disinfecting procedures. If the possibility of
splashing exists, the worker should wear a facemask and gown. Personal protective equipment
should be changed if torn or soiled and always removed before leaving the location of the spill,
and hands washed.
2) The blood spill area must be cleaned of obvious organic material before applying a disinfectant,
as hypochlorites and other disinfectants are substantially inactivated by blood and other materials
3) Excess blood and fluid capable of transmitting infection should be removed with disposable
towels. Discard the towels in a plastic-lined waste receptacle.
4) After cleaning, the area should be disinfected with a low - intermediate chemical disinfectant
such as quaternary ammonium compounds or household bleach. Concentration of household
bleach—1:10 dilution: mix 1 part bleach to 9 parts water—i.e., 1 cup bleach to 9 cups water.
See Table 6 for directions on the preparation and use of chlorine-based disinfectants.
5) Household bleach or chemical germicide should be left on the surface for 10 minutes.
6) The treated area should then be wiped with paper towels soaked in tap water. Allow the area to
dry.
7) The towels should be discarded in a plastic lined waste receptacle.
8) Care must be taken to avoid splashing or generating aerosols during the clean up.
9) Hands must be thoroughly washed after gloves are removed.
10) For carpet or upholstered surfaces, a common supermarket disinfectant may be used.
11) Counter tops and surfaces that have been contaminated with blood or body fluids should be
cleaned with disposable toweling, using an appropriate cleaning agent and water as necessary,
(e.g., after each procedure, after treatment of each client, at the completion of daily work
activities, and after any spill). Surfaces should then be disinfected with a low-level chemical
disinfectant or sodium hypochlorite (household bleach dilution).
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
32
ROUTINE PRACTICES
LAUNDRY
All linen that is soiled with blood, body fluids, secretions or excretions, or contaminated with lice or
scabies, should be handled using the following list of recommendations—regardless of source, or care
setting:
RECOMMENDATIONS FOR HANDLING LAUNDRY
1) Collection and Handling

Linen should be handled with a minimum of agitation and shaking.

Heavily soiled linen should be rolled or folded to contain the heaviest soil in the center of the
bundle. Large amounts of solid soil, feces or blood clots should be removed from linen with
a gloved hand and toilet tissue and placed into a bedpan or toilet for flushing. Excrement
should not be removed by spraying with water (e.g., from clothing, reusable incontinence
pads).
2) Bagging and Containment

Soiled linen should be bagged at the site of collection.

To prevent contamination or soaking through, a single, leakproof bag or a single cloth bag
can be used.

Laundry carts or hampers should be used to collect or transport soiled linen and need not be
covered. The practice of placing lids on soiled linen carts is not necessary from an infection
control perspective.

Linen bags should be washed after each use and can be washed in the same cycle as the linen
contained in them.
3) Washing and Drying

Microbial counts on soiled linens are significantly reduced during the mechanical action and
dilution of washing and rinsing. With the high cost of energy and use of cold water
detergents (which do not require heat to catalyze their actions) hot water washes (>71.1º C
for 25 minutes) may not be necessary. Several studies show that low temperature laundering
will effectively eliminate residual bacteria to a level comparable with high temperature
laundering. When low temperature washes are combined with the addition of bleach (with a
total available residual chlorine of 50-150 ppm), residual bacteria on laundry are reduced to
below levels found on laundry washed at high temperatures. See Table 6 for directions on
preparing and using chlorine-based disinfectants. Machine drying of linen contributes to a
further reduction of residual bacteria.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
33
ROUTINE PRACTICES
4) Protection of Laundry Workers

Reusable gloves should be washed after use, allowed to hang dry, and discarded if punctured
or torn.

Hand washing facilities should be readily available.

Personnel should wash their hands whenever gloves are changed or removed.

Staff in care areas, need to be aware of sharps when placing soiled linen in bags. Workers are
at risk from contaminated sharps, instruments or broken glass that may be contained with
linen in the laundry bags.

All care givers and laundry workers should be trained in procedures for handling of soiled
linen.

Laundry workers, should be offered immunization against hepatitis B—needles may be
occasionally found in soiled linen.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
34
ROUTINE PRACTICES
MANAGING UNTREATED WASTE
RECOMMENDATIONS FOR MANAGING UNTREATED WASTE
1)
Blood and body fluid waste, drainage-collection units, and suction containers with blood—
should be sealed in impervious containers and disposed of in the sanitary sewer if permitted
by local regulatory authorities, or incinerated.
2)
Waste such as gloves, dressings, or materials soaked with blood or secretions—should be
put in leak-proof garbage bags and disposed of in normal landfill sites.
3)
Sharps such as needles, blood syringes, lancets, or clinical glass—should be disposed of
in a biohazard container and disposed using Medical Waste Management Inc., telephone:
(905) 789-6660, or Med-Tech Environmental Ltd., (877) 791-3545. Sharps must not be put
in regular garbage collection and compaction to become a risk to solid waste workers.
“What To Do With Used Needles” (City Of Ottawa, February 19, 2001):

Call the City of Ottawa, 580-2400 (this applies to households and institutions.)
Agencies should use a licensed disposal company.

See pamphlet in the Additional Resources section of this resource.
“Be Careful With Needles!” (City Of Ottawa, March, 2001):

see fact sheet in the Additional Resources section of this resource.
SAFE HANDLING OF SHARP OBJECTS
How to minimize the risk of sharps injuries and reduce the potential for transmission of
infection:

do not recap, bend, or break used needles;

do not remove used, uncapped needles from syringes;

do not leave unattended used sharps;

immediately after use, place in an approved, biohazard container all used disposable syringes,
needles and other sharp items;

place biohazard container as close to area of use as possible;

fill sharps container only 2/3 full;

follow safe procedures when performing needle exchange; and

postpone certain procedures if possible i.e., if the client’s behavior is inappropriate.
College of Nurses of Ontario (2000). Infection Control Guidelines. Toronto, ON, College of Nurses of Ontario, 3-10.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-83.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
35
A HEALTH EDUCATION RESOURCE FOR INFECTION CONTROL
IN SHELTERS AND DROP-IN CENTRES
Guidelines
for
Communicable Disease
and
Other Health Issues
in Shelters
and
Drop-In Centres
——
36
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)…WHAT IS IT?
Staphylococcus aureus (S. aureus), is a bacteria commonly found on people and in the environment.
MRSA is a type of S. aureus that has become resistant to the antibiotic methicillin, and other
antibiotics.
MRSA COLONIZATION

Colonization occurs when the bacteria live on or in the body with no sign or symptom of illness.
Twenty-five percent of people carry the more common S. aureus on the skin and in the nose, and do
not get sick with it. Colonization must be present for infection to occur.
MRSA INFECTION

Infection occurs when the bacteria gets past the person’s normal defenses and the person becomes
ill—e.g., respiratory infection, blood infection, or open-sore infection.
HOW IS MRSA TRANSMITTED?

MRSA is spread from person-to-person, when a person’s contaminated unwashed hands or gloves
come into contact with the eyes, nose, mouth or open sores of another person. MRSA is more
commonly spread in health care settings by workers who do not wash their hands between clients, or
by unclean, shared equipment.
WHO IS AT INCREASED RISK OF COLONIZATION OR INFECTION OF MRSA?

People with a severely weakened immune system with underlying chronic disease—
e.g., alcoholism, malnutrition, diabetes, peripheral vascular disease, cancer (receiving
chemotherapy), and AIDS;

People undergoing invasive medical procedures with the presence of invasive devices;

People with ongoing multiple antibiotic therapy; and

People who have multiple hospital admissions or prolonged hospitalization.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Methicillin Resistant Staphylococcus Aureus in Long Term Care Facilities. Toronto, ON:
Queens Printer for Ontario, 1-22.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
37
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH MRSA
Accommodation

Single rooms may reduce opportunities for direct and indirect contact, and droplet transmission when
the source client has poor hygiene, contaminates the environment, or cannot be expected to comply
with infection-control measures because of age or altered mental status.
Handwashing

Handwashing is the main method of prevention;

All staff should wash their hands before and after every client contact. Regular soap and water
should be used with friction for 10 seconds;

Alcohol handwash should be used if washing stations are not readily available; and

Hands must be washed after glove use, and after all skin-to-skin contact.
Barriers

Non-sterile gloves are required when providing all personal care within the client’s room—including
toileting and bathing;

Change gloves after having contact with infective material that may contain high concentrations of
microorganisms (i.e. wound drainage). Remove gloves before leaving client’s room. Handwashing
after wearing gloves is essential;

Gowns are only required during care if gross contamination or soiling of clothing is likely (i.e. bed
bath). Gowns are not necessary for walking into the client’s room to deliver items or to check on the
client; and

The use of masks is not required, even with clients with MRSA pneumonia (there is little evidence
that MRSA can be spread by droplet transmission from a person with MRSA pneumonia).
Equipment

A supply of care items/equipment (e.g., gowns, gloves) should be kept in the client’s room; and

Skin care items (e.g., soaps, solutions, creams) should not be shared with other clients and they
should be kept in the client’s room.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Methicillin Resistant Staphylococcus Aureus in Long Term Care Facilities. Toronto, ON:
Queens Printer for Ontario, 1-22.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
38
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH MRSA
Housekeeping

As contaminated environmental surfaces are not a significant reservoir for MRSA, special
housekeeping practices are not warranted. (reminder: all hydrotherapy equipment should be cleaned
and disinfected following facility and manufacturer’s protocol after each client’s use, regardless of
MRSA culture status.):
 daily cleaning of all horizontal surfaces and frequently touched surfaces/items is the minimal
requirement, e.g., bedrails, bedside tables, commodes and bathroom, door handles, faucet handles,
light switches, call bell, telephone, etc. Any other surfaces or items that are visibly soiled must be
cleaned;
 terminal cleaning should also include disinfection of less frequently touched surfaces, e.g., wash
wall areas likely to be touched, change bedside curtain, etc. all supplies and patient care
equipment must be thoroughly cleaned, e.g., blood pressure cuff, IV pole, IV pump, respiratory
equipment, etc. items which cannot be cleaned must be discarded, e.g., dressings;
 a process should be in place to ensure that compliance to these cleaning procedures is maintained,
e.g. signed checklist; and
 refer to Routine Practices—Cleaning, disinfecting client-care equipment, Table 4 (pg. 24);

It is unnecessary to label or take special precautions with garbage (e.g., double-bagging is not
needed). Secure the garbage bag before it leaves the room.
Laundry

Normal wash and dry cycles for clothing and gowns are sufficient to destroy the MRSA;

Soiled linens should be bagged in each client’s room; and

Laundry staff do not need to take special precautions.
Dietary

Use of disposable dishes is not required. Regular dishwashing cycles will clean dishes sufficiently.
Client Activities

There is no need to restrict the client’s participation in facility activities;

Cover open wounds; and

Assist client with handwashing technique. If the resident cannot reliably follow basic hygienic
measures, be sure client is supervised during toileting and handwashing activities.
Notification / Transfer of Client

Before transferring client, notify all receiving facilities of client’s MRSA status.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Methicillin Resistant Staphylococcus Aureus in Long Term Care Facilities. Toronto, ON:
Queens Printer for Ontario, 1-22.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
39
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH MRSA
Visitors

There is no need to restrict visitors;

Visitors do not need to wear gowns or gloves; and

Teach visitors good handwashing technique.
Criteria for Discontinuing MRSA Precautions

The client must remain on precautions until three sets of negative colonization and site specific
swabs, taken one week apart, have been obtained;

Once the client has been removed from precautions, he/she will be monitored once per month for
three months, by obtaining swabs of nose, axilla, groin/perineum, dry skin lesions and/or any
cultured exit sites; and

Should the client become positive again after negative cultures are obtained, this protocol must be
followed again.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Methicillin Resistant Staphylococcus Aureus in Long Term Care Facilities. Toronto, ON:
Queens Printer for Ontario, 1-22.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
40
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRE)… WHAT IS IT?
Enterococcus is a bacteria that usually lives in people’s bowels; however, it can also live on skin or
in the environment. VRE is a type of enterococcus (a bacteria), that has become resistant to the
antibiotic vancomycin, and other antibiotics.
VRE COLONIZATION

Colonization occurs when the bacteria lives on or in the body with no sign or symptom of illness.
VRE behaves the same way as all other enterecocci bacteria.
VRE INFECTION

Infection occurs when the bacteria get past the person’s normal defenses and the person becomes
ill— e.g., blood infection, gastrointestinal infection or open-sore infection.
HOW IS VRE TRANSMITTED?

VRE is spread from person-to-person when one person’s contaminated, unwashed hands or gloves
come into contact with the eyes, nose, mouth or open sores of another person. VRE is spread more
commonly in health care settings by workers who do not wash their hands between clients, or by
unclean, shared equipment.
WHO IS AT INCREASED RISK OF COLONIZATION OR INFECTION OF VRE?

People with a severely weakened immune system with underlying chronic disease—e.g., alcoholism,
malnutrition, diabetes, peripheral vascular disease, cancer (receiving chemotherapy), and AIDS;

People undergoing invasive medical procedures with the presence of invasive devices;

People with ongoing multiple antibiotic therapy/or vancomycin therapy; and

People who have multiple hospital admissions or prolonged hospitalization.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin Resistant Enterococci in Long Term Care Facilities. Toronto,
ON: Queens Printer for Ontario, 1-23.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
41
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH VRE
Accommodation

The optimal placement is a private room. If this is not possible, avoid placing the client who has
VRE in a room with clients who have poor personal hygiene, open skin lesions, invasive devices, or
who require frequent hospital admissions.
Handwashing

Handwashing is the main method of prevention;

Before and after every contact with the VRE-positive client or his/her environment, all staff must
wash their hands using an antibacterial soap;

Upon leaving the client’s room, all persons (staff, clients, visitors) must wash their hands with an
antibacterial soap or alcohol handwash; and

After removing gloves hands must be washed.
Barriers

Wear gloves when providing all personal care or cleaning the environment. Change gloves after
contact with sites/bodily fluids soiled with stool or after toileting. Use non-sterile gloves;

Wear a clean gown when providing all personal care. Discard gown after each use;

As VRE is not spread through the air, masks are not required.
Procedures For All Service Providers Before Leaving Client’s Room

Remove gloves and place in the garbage receptacle for general waste;

Remove gown, making sure to turn contaminated side inwards, and place in laundry if washable, or
in garbage receptacle if disposable;

Using sink in client’s room or bathroom, wash hands with antibacterial soap. Dry hands with paper
towels and use paper towels to turn off taps. Dispose of paper towel in garbage container;

Use alcohol handwash while in client’s room if handwashing sinks are not available. Ideally, staff
should carry their own supply of alcohol handwash on their person; and

Once gown and gloves are removed, ensure that clothing and hands do not come in contact with
environmental surfaces (e.g. curtains, door handles, light switches). Use new paper towels to handle
these objects.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000). A Health Education Resource
for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin Resistant Enterococci in Long Term Care Facilities. Toronto,
ON: Queens Printer for Ontario, 1-23.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
42
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH VRE
Supplies and Equipment

The following supplies are required:
 Gowns and gloves;
 Bags for linens;
 Plastic bags for heavily soiled linen and for garbage containers;
 Extra bedpans and urinals; and
 Garbage container, lined with plastic bag for general waste, which is to be placed inside the
client’s room. Dispose of all contaminated garbage and linen inside room.

Dedicate equipment (e.g. stethoscope, BP cuff, dressing supplies, creams/lotions etc.) to the VREcolonized client. Label and use only one wheelchair or walker for the client, and keep the equipment
in the client’s room until no longer needed. Place a sign on the door to remind visiting physicians to
not take their own equipment into the room. Clean all equipment removed from the client’s room
with an approved disinfectant and bleach.

Clean the client’s wheelchair daily with an approved disinfectant while the wheelchair is in the
client’s room. Put gloves on the handles and brakes after the cleaning. When the wheelchair leaves
the room, remove the gloves. It is recommended that wheelchairs with foam grips not be used
because the grips are very difficult to keep clean. The wheelchair should stay in the client’s room
when not in use. The wheelchair should be treated as being clean.

Any equipment shared between clients (e.g. shower chair, bathtub, non-disposable therapy
equipment), must be cleaned after each use. Cleaning includes the use of approved disinfectant, then
bleach at a 1:10 concentration.
Client’s Use of Toileting Facilities

The options for toileting are listed in order from the most preferable to least preferable:
 Client has own private washroom.
 Client has designated toilet/stall that no other client uses (service providers could use tape on the
toilet seat or stall door to discourage other clients from accessing).
 Client-shared toilets must be cleaned after each use; or client has own dedicated commode, which
is cleaned daily. Transmission of VRE from toilets being used by more than the VRE-client is an
issue. Each client with VRE will need to be assessed to determine the best approach to toileting
and subsequent cleaning.
 Clean the toilet surfaces (seat, grab bar, toilet paper dispenser, flusher handle) after each use if
client shares washroom. Cleaning includes the use of an approved disinfectant, then bleach at a
1:10 concentration. Management will need to plan for this to ensure staff’s compliance with the
cleaning requirements.

City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000).
A Health Education Resource for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin Resistant Enterococci in Long Term Care Facilities.
Toronto, ON: Queens Printer for Ontario, 1-23.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
43
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH VRE
Day-to-Day Cleaning of a Client’s Room

Gloves should be worn while cleaning the client’s room or washroom. Discard gloves after each use.
 Daily cleaning of all horizontal surfaces and frequently touched surfaces/items is the minimal
requirement, e.g., bedrails, bedside tables, commodes and bathroom, door handles, faucet handles,
light switches, call bell, telephone, etc. Any other surfaces or items that are visibly soiled must be
cleaned.
 A process should be in place to ensure that compliance to these cleaning procedures is
maintained, e.g. signed checklist.
 Terminal cleaning should also include disinfection of less frequently touched surfaces, e.g., wash
wall areas likely to be touched, change bedside curtain, etc. all supplies and patient care
equipment must be thoroughly cleaned, e.g., blood pressure cuff, IV pole, IV pump, respiratory
equipment, etc. items which cannot be cleaned must be discarded, e.g., dressings.
Laundry

Deposit bed linen and clothing in the regular laundry hamper, kept in the client’s room. If heavily
soiled or very wet, place the items in a plastic bag before depositing in the laundry hamper; and

Use normal procedures for handling and cleaning laundry of the VRE-affected client.
Allow a Client who is still positive for VRE out of their room if:

Continent of bowel and bladder; or

Incontinent but wearing a leak proof brief; or

If VRE is colonizing a wound or stoma which is covered with a dressing with no risk of drainage
soaking through the dressing; or

Client’s personal hygiene is adequate and contamination of the environment is unlikely;

Client washes hands well prior to leaving the room; and/or

For clients who are confused, a system of regular assisted hand washing may need to be
implemented.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000).
A Health Education Resource for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin Resistant Enterococci in Long Term Care Facilities.
Toronto, ON: Queens Printer for Ontario, 1-23.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
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44
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
PRECAUTIONS TO TAKE FOR CLIENTS WITH COLONIZED OR INFECTED WITH VRE
Meals

Client must wash hands before going to dining area. Have client sit in the same place using the same
seat at each meal;

Use regular dishes and cutlery. Use of disposable dishes is not required. Regular dishwashing cycles
will clean dishes sufficiently;

Clean the table and chair after each meal;

If the client has very poor personal hygiene, or requires extensive personal contact during feeding,
tray service to the client’s room may be considered.
Visitors

Visitors should wear gloves if the are visiting the client within his/her room;

Visitors should wash their hands when leaving the client’s room;

Visitors should wear a gown if they are going to have direct contact with the client (i.e., assistance
with personal care).
Notification / Transfer of Client

Prepare the client for transfer by washing their hands and cleaning their wheelchair/assistive devices
if they are being transferred with the device(s);

Notify the transferring ambulance and the receiving facility of the VRE status before the transfer
occurs (i.e., emergency department or admission unit and infection control practitioner).
Criteria for Discontinuing VRE Precautions

VRE-infected or colonized clients may be removed from precautions when VRE-negative results
have been obtained on at least three consecutive cultures, one or more weeks apart. Appropriate
specimens for VRE culture include stool or rectal swab;

Once the client has been removed from precautions, he/she should be monitored, by obtaining a
rectal swab/stool specimen once per month, for four months.
Client attending Medical appointments

Physicians should visit the client within the facility whenever possible. If this is not possible, the
client may attend medical appointments if necessary. Inform the physician’s office ahead of time of
the required precautions.
Follow-up/Evaluation

After 3 weeks, rescreen the clients within the geographic area of the client(s) carrying VRE to check
for further transmission of VRE. Consideration should be given to rescreening when all residents
have become negative or a resident remains colonized after two months.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable Disease Program (2000).
A Health Education Resource for Designated Officers of Emergency Services. (2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin Resistant Enterococci in Long Term Care Facilities.
Toronto, ON: Queens Printer for Ontario, 1-23.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada
(November 1999). Infection Prevention and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms (MDRO).Ottawa, ON,
the Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the Community and Hospital Infection Control Association-Canada.
A Health Education Resource for Infection Control in Shelters & Drop-In Centres
45
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
These guidelines are intended to provide service providers and other professionals with
guidance on communicable disease control in shelters and drop-in centres.
City of Ottawa, Public Health and Long Term Care Branch
Health Protection Division
COMMUNICABLE DISEASE PROGRAM
(613) 724-4224
February 2002
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46
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Amebiasis
Cause/Symptoms
Parasite.
Fecal-oral route.
Abdominal distention and cramps, diarrhea
or constipation, and rarely fever or chills.
Food and water
contaminated by
infected food handler or
sewage.
May be symptom free.
Beaver Fever
Bite
(Animal)
Bite
(Human)
Transmission
Incubation
Period of
Communicability
Reporting of
Individual Cases
Few days to
several months,
commonly 2 to 4
weeks.
Until treated.
Report within one
working day to
724-4224.
Depends on the
cause.
Depends on the
cause.
Report immediately
to 722-2200
See Giardia.
There is risk of rabies from the bites of bats,
cats, dogs, ferrets, groundhogs, muskrats,
racoons, skunks and other wild mammals.
Bites of gerbils, hamsters, mice, moles,
rabbits and squirrels do not have to be
reported unless the animal’s behaviour was
very abnormal. Feeding squirrels is a form
of provocation.
Animal saliva
introduced by a bite or
scratch.
If the skin is broken, there is a risk of
transmission of hepatitis B, hepatitis C, and
HIV from an infected person.
Contact of contaminated
blood with a break in
the skin or blood inside
of the mouth.
(580-2400 after
hours) in order to
begin rabies
immunization if
needed and/or
quarantine the
biting animal if
available.
Depends on the
cause.
Depends on the
cause.
Report immediately
to 724-4224 if a bite
breaks the skin
(580-2400after
hours).
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Campylobacter
Cause/Symptoms
Transmission
Diarrhea, abdominal pain, fever, nausea and
vomiting. Stools may contain blood.
Fecal-oral route. Food
and water contaminated
by infected food handler
or sewage.
Undercooked meats (all
kinds).
Bacteria.
Incubation
Period of
Communicability
Reporting of
Individual Cases
1 to 10 days.
Up to several weeks
after beginning of
symptoms, or until
treated.
Report within one
working day to
724-4224.
Variable, 2-5
days for thrush
in infants.
White lesions are
present.
Not needed.
2 to 3 weeks;
commonly 13 to
17 days.
1-4 days before to 5
days after onset of
rash.
Report number of
cases and age of
client, by mail or fax
to 724-4130 on a
weekly basis. See
form.
Unpasteurized milk.
Contact with animals
(often kittens and
puppies).
Candidiasis
(Thrush, Diaper
Rash)
Fungus.
Thrush: Thin white layer on tongue and
inside of cheeks. May cause difficulty in
feeding, or may be symptom-free.
Diaper rash or other skin rash: Well
demarcated, beefy red rash with white flaky
border, usually in skin folds. Painful when
comes in contact with urine.
Person-to-person by
direct contact.
Candida organism
normally present on
skin, so can be autoinfected.
Chickenpox
Virus.
Person-to-person by:
(Varicella)
Fever. Blister-like rash occurs in successive
crops. Scabs form after the blister stage.
"Spots" usually appear first on the body, face
and scalp, then later spread to the arms and
legs.
a) respiratory secretions,
or
b) direct skin contact
with fluid from blisters
or objects and surfaces
contaminated by the
fluid from the blisters.
Low infectiousness
after 1 or 2 days of
rash.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Cold Sores
(Herpes)
Cause/Symptoms
Virus.
Small blisters appear and then burst to form a
crust. Sores are usually around the mouth
but can be around the nose and eyes area.
With the first infection, sores may be
accompanied by fever, flu-like illness, and
painful irritation.
ConjunctivitisBacterial
(Pink Eye)
Purulent conjunctivitis (bacterial): Pink or
red conjunctiva (the white of the eye) with
thick or crusty white or yellow discharge
(pus), occasionally accompanied by fever.
Transmission
Person-to-person by
saliva.
Incubation
Reporting of
Individual Cases
2 to 12 days.
While sores are
apparent. Virus may
be transmitted even
when no visible
lesions are present.
Not needed.
24 to 72 hours.
For duration of
infection or until 24
hours of antibiotic
treatment.
Not needed.
12 hours to 12
days.
For duration of
infection.
Not needed.
Hand washing is
important in
preventing
transmission.
Person-to-person: by
direct or indirect contact
with eye secretions.
Period of
Communicability
Hand washing is
important in
preventing
transmission.
ConjunctivitisViral
(Pink Eye)
Non-purulent conjunctivitis (viral or
allergic): Pink conjunctiva (the white of the
eye) with a clear, watery eye discharge often
accompanied by a cold.
Person-to-person: by
direct or indirect contact
with eye secretions.
Hand washing is
important in
preventing
transmission.
Cough
See Influenza, Pertussis, Respiratory
Syncytial Virus, or Tuberculosis.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Coxsackie
Virus
(Hand, Foot and
Mouth Disease)
Cause/Symptoms
Sudden onset of fever, sore throat.
Rash on the palms of the hands, the fingers,
and on the soles of the feet, and sores inside
the mouth
Acute self-limited viral infection. Usually in
children, particularly in the summer months.
Crabs
(Genital lice)
Diarrhea
Small grey-brown insects and white eggs
(nits) attached to pubic hairs. May spread to
other areas where there are hairs: head,
eyebrows, underarms, etc. Cause intense
itching and skin redness.
Transmission
Person-to-person by
respiratory secretions
and fecal-oral route.
Incubation
Usually 3 to 6
days.
During the acute
stage of the illness.
Reporting of
Individual Cases
Not needed
Transmission via
stools persists for
several weeks.
Lesions themselves do
not spread infection.
Person-to-person by
direct skin-to-skin
contact (sexually) or
indirect contact through
bedding, clothing, and
towels.
Period of
Communicability
6 to 10 days.
As long as lice or
eggs remain alive on
hair (until treatment).
See Gastroenteritis.
Not needed.
Not needed unless
part of an outbreak,
call 724-4224
(580-2400 after
hours).
Eschericha coli
0.157:H7
Eye infection
Bacteria.
Fecal-oral route.
Severe abdominal cramps, watery, possibly
bloody diarrhea, and fever.
Contaminated food and
water: undercooked
meat, unpasteurised
milk, vegetables.
1 to 8 days
3 weeks in a third of
children.
Report immediately
to 724-4224
1 week or less in
adults.
(580-2400 after
hours).
See Conjunctivitis.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Cause/Symptoms
Fever
If accompanied by diarrhea or vomiting, see
Gastroenteritis, Hepatitis, Meningitis.
Transmission
Incubation
Period of
Communicability
Reporting of
Individual Cases
If accompanied by rash, see Chickenpox,
Coxsackie, Impetigo, Measles, Parvovirus,
Roseola, Rubella, or Streptococcal Infection.
If accompanied by cough, sore throat or
runny nose, see Influenza, Mononucleosis,
Pertussis, Strep throat, or Tuberculosis.
Fifth Disease
See Parvovirus B19
Gastroenteritis:
Bacteria, viruses or parasites.
Outbreaks at
shelters & dropin centres
See Amebiasis, Campylobacter, E. Coli,
Giardiasis, Salmonella, Shigella, Yersinia
Vomiting, diarrhea, abdominal pain,
headache, fever.
Depends on cause.
Usually fecal-oral route
or through food and
water contaminated with
causing germs.
Depends on
cause.
Depends on cause.
Early recognition of
an outbreak is
important
For shelters & drop-in
centres— an outbreak
will be defined as 3 or
more cases within 48
hours of each other
Report immediately
to 724-4224 or
(580-2400 after
hours)
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Gastroenteritis
Cause/Symptoms
Transmission
Depends on cause.
See Amebiasis, Campylobacter, Eschericha
coli, Giardiasis, Salmonella, Shigella, or
Yersinia.
Usually fecal-oral route
or through food and
water contaminated with
causing germs.
Period of
Communicability
Reporting of
Individual Cases
Depends on
cause.
Depends on cause.
Not needed unless
part of an outbreak
(see above).
Sexually (skin-to-skin).
2 to 12 days.
Usually while sores
are apparent but
virus may be
transmitted even
when no visible
lesions are present.
Not required.
Parasite.
Fecal-oral route.
(Beaver Fever)
Diarrhea, abdominal cramps, bloating,
weight loss. May be symptom free.
Water and food
contaminated by
infected food handler or
sewage. Lake and river
water.
3 to 28 days or
longer, usually 7
to 10 days.
Entire period of
infection, often
months, or until
treated.
Report within one
working day to
724-4224.
Hand Foot and
Mouth Disease
See Coxsackie Virus.
(single case)
Bacteria, viruses or parasites.
Incubation
Vomiting, diarrhea, abdominal pain,
headache, fever.
Genital herpes
Virus.
Painful sores on the skin around genitalia.
With the first infection, sores may be
accompanied by fever, flu-like symptoms and
painful irritation.
German
Measles
Giardiasis
See Rubella.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Head lice
(Pediculosis)
Cause/Symptoms
Itching of the scalp
Transmission
Incubation
Direct head-to-head
contact
The egg to egg
cycle coverage
about 3 weeks.
Nits found attached to the hair
Lice seen in the hair
Virus.
Fever, tiredness, nausea, jaundice,
(yellowing of skin), abdominal discomfort,
dark urine, clay coloured stools.
Reporting of
Individual Cases
As long as lice or
eggs remain alive on
the infested person or
until treated
Not needed
1-2 weeks prior to
symptoms to 1 week
after the onset of
symptoms.
Report immediately
to 724-4224
From weeks before
onset of symptoms to
months or years after
end of symptoms.
Some become
carriers and remain
contagious for life.
Report to
The louse life
cycle extends
over 18 days.
(see fact sheet in the “additional resources”
section at the back of this manual)
Hepatitis A
Period of
Communicability
Fecal-oral route. Food
and water contaminated
by infected food handler
or sewage.
15 to 50 days,
average 28-30
days.
Through contact with
blood and bloody fluids,
semen, vaginal fluid and
saliva with non-intact
skin or mucous
membrane (eyes, nose
and mouth).
45 to 180 days,
average 2-4
months.
(580-2400 after
hours).
May be symptom free.
Hepatitis B
Virus.
Same symptoms as hepatitis A.
(see fact sheet in the “additional resources”
section at the back of this manual)
560-6099 within one
working day.
For example:
unprotected sexual
intercourse, sharing of
needles in injection drug
use, bites that break the
skin.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Hepatitis C
Cause/Symptoms
Virus.
Same symptoms as hepatitis A and B.
(see fact sheet in the “additional resources”
section at the back of this manual)
Transmission
Through contact with
blood (bites that break
the skin, needle sharing
in injection drug users,
unsterile tattooing or
body piercing, sharing
contaminated razors or
toothbrushes, receiving
blood products prior to
1990.
Incubation
Period of
Communicability
Reporting of
Individual Cases
2 weeks - 6
months, most
common 6-9
weeks.
From one or more
weeks before onset
of first symptoms to
the end of symptoms;
persists indefinitely
in carriers (90% of
those infected).
Report to 560-6099
within one working
day.
Generally 4-12
weeks until HIV
blood test is
positive.
Generally begins
early after onset of
infection and extends
throughout life.
Report to 560-6099
within one working
day.
There is no evidence of
transmission through
sharing of eating and
drinking utensils or
through blood touching
intact skin.
HIV (Human
Immunodeficie
ncy Virus) /
AIDS
Many will develop a short-term flu-like
illness several weeks to months after
infection; after several years, damage to the
immune and other systems lead to severe
infections and death.
(see HIV fact sheet in the “additional
resources” section at the back of this manual)
Through contact with
blood (needle sharing in
injection drug users,
unsterile tattooing or
body piercing),
unprotected sexual
intercourse, or from
mother to fetus.
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54
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Cause/Symptoms
Transmission
Impetigo
Infection of the skin caused by Streptococcus
or Staphylococcus bacteria. It often follows
a scrape or insect bite. It usually appears on
the face or exposed skin as a rash with a
cluster of red bumps or blisters, which may
ooze or be covered by a honey-coloured
crust.
Person-to-person by
direct contact with sores
or from asymptomatic
carriers.
It is very contagious and should be treated
at once.
Influenza
Lice
Infection of the airways caused by the
viruses influenza, A, B, or C leading to fever
headache, muscle soreness, runny nose, sore
throat, and cough.
Incubation
Variable.
Commonly 1-10
days.
Hand washing is
important in
preventing
transmission.
Period of
Communicability
Reporting of
Individual Cases
From onset of rash
until 24 hours of
treatment with oral
or topical antibiotics
if lesions are few and
small.
Not needed.
Person to person by
respiratory secretions or
direct contact with
secretions.
1-5 days.
From onset of
symptoms up to 7
days.
Not required unless
part of an outbreak.
If = 15% of adults
ill, report within one
working day to
724-4224.
Person-to-person by
respiratory secretions or
direct contact with
secretions.
10 days (range of
7-18) for fever
and 14 for rash.
2 days before the
fever and cough until
4 days after
beginning of rash.
Report immediately
to 724-4224
See head lice.
(Pediculosis)
Measles
(Rubeola)
Virus.
Fever (=38.3°C), cough, pink eyes sensitive
to light, runny nose (symptoms of a cold),
dusky-red blotchy rash on 3rd to 4th day
after onset of symptoms spreading
downwards from face, and sometimes white
spots in mouth.
(580-2400 after
hours).
Very contagious.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Cause/Symptoms
Meningitis
Bacteria or virus.
(any kind)
Young children may show a cluster of
symptoms such as irritability, poor feeding,
vomiting, fever and excessive high-pitched
crying. Older children and adults may
experience severe persistent headache,
vomiting and neck rigidity.
Molluscum
contagiosum
(Non-plantar
warts)
Virus.
Skin infection with small flesh-coloured or
translucent bumps with sunken centre, most
often on face, trunk, or limbs of children.
Can be found on genitalia. Usually
symptom-free, but may cause itchiness.
Transmission
Varies depending on
cause of meningitis.
Often is person-toperson by respiratory
secretions.
Person-to-person
through direct skin-toskin contact or indirect
contact (by sharing
clothes or at swimming
pools), or sexually.
Incubation
Period of
Communicability
Reporting of
Individual Cases
Varies
depending on
cause of
meningitis.
Varies depending on
cause of meningitis.
Report immediately
to 724-4224
1-7 weeks, but
can be as long as
6 months.
Unknown, but
probably as long as
lesions persist.
Not needed.
4-6 weeks.
Up to 1 year or more.
Not needed.
(580-2400 after
hours).
Handwashing is
important to prevent
transmission.
Mononucleosis
Virus.
Person-to-person by
respiratory secretions.
Fever, sore throat, swelling of glands around
neck area, fatigue.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Mumps
Cause/Symptoms
Virus.
Fever, swelling and tenderness of salivary
glands slightly above the angle of the jaw.
Nausea
Outbreaks
(any kind,
except for
gastroenteritis
or diarrhea)
Transmission
Incubation
Period of
Communicability
Reporting of
Individual Cases
Person-to-person by
respiratory secretions or
contact with saliva.
12-25 days;
usually 18 days.
7 days before, to 9
days after swelling;
most contagious 48
hours before onset of
illness.
Report within one
working day to
724-4224.
If more than 1 case,
report immediately
to 724-4224
(580-2400 after
hours).
See Gastroenteritis.
15% or more people sick with similar
symptoms or absent at the same time.
Varies.
Varies.
Varies.
Report immediately
to 724-4224
(580-2400 after
hours).
Person-to-person by
respiratory secretions
and mother-to-fetus
4-14 days (can
be as long as 21
days)
One week before
onset of rash until
onset of rash.
Children with
chronic anemia
maybe contagious for
up to one week after
onset of rash.
Report immediately if
 2 cases (diagnosed
by a physician)
For gastroenteritis or diarrhea: 3 or more
cases, within 48 hours of each other in the
same shelter or drop-in centre.
For mumps, measles, parvovirus,
pertussis, and rubella: see specific
reporting criteria.
Parvovirus B19
Virus
Mild fever and distinctive “slapped cheeks”
facial rash. After 1-4 days, a red, lace-like
rash appears on the arms and body and can
last 1-3 weeks. May be symptom-free.
Pediculosis
Call 724-4224 or
560-2400 after hours
See head lice.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Pertussis
(Whooping
cough)
Cause/Symptoms
Bacteria.
Transmission
Person-to-person by
respiratory secretions.
Incubation
7 to 10 days, up
to 20 days.
Repeated bouts of violent coughs which may
end with a crowing or high pitched whoop
and vomiting. Last 6 - 10 weeks.
Period of
Communicability
From the onset of the
cough until:
See Conjunctivitis.
Pinworms
Worm.
Itching around the anal area. Irritability.
Poison Ivy
Plant toxin.
If part of an
outbreak,
b) 5 days after
starting proper
antibiotic treatment.
(more than 1 case)
call immediately to
724-4224.
Pinworm eggs transmit
to others by fecal-oral
route or contaminated
bedding, food or
clothing.
2 to 8 weeks.
During incubation
period, until
treatment is initiated.
Not needed.
Direct skin contact with
any part of the plant.
Symptoms
appear after a
few minutes to
several days.
Washing the
exposed area
immediately
decreases the
severity of
symptoms.
Not contagious after
the toxin has been
washed off from the
skin or clothing. The
blister liquid is not
contagious.
Not needed.
Not contagious.
Redness and blisters in linear pattern, where
skin was exposed. Very itchy.
Report within one
working day to
724-4224.
a) 3 weeks after
onset of paroxysms
or whooping; or
Occurs mainly in pre-school children.
Pink Eye
Reporting of
Individual Cases
Washing any exposed
skin and clothing to
remove toxin ensures
that no one else comes
into contact with the
toxin.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Rash
Respiratory
Syncytial Virus
Ringworm
(Tinea)
Cause/Symptoms
Transmission
Incubation
Period of
Communicability
Reporting of
Individual Cases
See Candidiasis, Chickenpox, Coxsackie,
Impetigo, Measles, Parvovirus, Poison Ivy,
Ringworm, Roseola, Rubella, Scabies, or
Streptococcal Infection.
Virus.
2 to 8 days.
From a few days
before the
appearance of
symptoms for up to 4
weeks.
Not needed.
Can cause colds, bronchiolitis, bronchitis,
croup, pneumonia, and ear infections. Most
common in 0-2 years old.
Person-to-person
through respiratory
droplets or contact with
secretions. Can be
spread by contaminated
toys and other surfaces.
Fungus. Flat, well demarcated, red, circular
patches with scaly or crusted border on the
skin or scalp. The patches are often itchy.
Person-to-person by
direct contact: skin-toskin.
4 to 10 days.
For duration of
illness or until
treatment is initiated.
Not needed
10 days.
Unknown.
Not needed.
Indirect spread by
contaminated hands,
objects and surfaces.
Roseola
Virus.
Person-to-person. Not
well understood.
Sudden onset of fever lasting 3-5 days.
Following break of fever, fine, pink rash
appears on trunk and body.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Cause/Symptoms
Rubella
Virus.
(German
measles)
Mild fever, runny nose, enlarged tender neck
nodes, fine pale red rash spreading from
behind the ears to the face, then downward.
May have tender joints. Often difficult to
diagnose.
Salmonella
Transmission
Person-to-person by
respiratory secretions.
Incubation
Period of
Communicability
From 14 to 23
days, usually 1618 days.
For about 1 week
before until 7 days
after the onset of the
rash.
Very contagious.
Reporting of
Individual Cases
Report by next
working day to
724-4224.
If part of an
outbreak, (more
than 1 case) call
immediately to
724-4224
(580-2400 after
hours).
Bacteria.
Fecal-oral route.
Diarrhea, nausea, vomiting, headache,
abdominal pain, fever, lack of appetite. May
be symptom-free.
Food and water
contaminated by
infected food handler or
sewage.
6-72 hours,
usually 12-36
hours.
Several weeks to
months after
beginning of
symptoms.
Report within one
working day at
724-4224.
Undercooked meats
(any kind).
Undercooked eggs.
Unpasteurized milk.
Animal contact, e.g.,
turtles, chicks.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Scabies
Cause/Symptoms
Caused by a mite burrowing under the skin.
Rash appears as bumps, patches or tiny red
lines, usually between fingers and toes and in
skin folds.
Transmission
Incubation
Person-to-person by
direct skin-to-skin
contact or indirectly by
sharing of clothes or
towels.
2 to 6 weeks.
Food and water
contaminated by
infected food handler or
sewage.
1 to 7 days,
usually 1-3 days.
1-4 days in
persons
previously
infested.
Period of
Communicability
Reporting of
Individual Cases
From beginning of
the incubation period
until treated.
Intense itching, especially at night.
See fact sheet in “additional resources”
section at the back of this manual
Scarlet Fever
Shigella
See Streptococcal Infection.
Bacteria.
Watery diarrhea which may contain blood,
fever, nausea, vomiting, abdominal cramps.
May be symptom free.
As long as present in
the stool: 1 week if
treated, up to 4
weeks if not.
Report within one
working day to
724-4224.
Fecal-oral route.
Stomach Ache
See Gastroenteritis or Hepatitis.
"Strep Throat"
See Streptococcal Infection.
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Streptococcal
Infection
(Strep Throat)
(Scarlet Fever)
Cause/Symptoms
Bacteria.
Transmission
Person-to-person by
respiratory secretions.
Incubation
1 to 5 days.
Strep Throat:
Very sore and red throat, fever.
Scarlet Fever:
High fever, vomiting, "sandpaper" skin rash,
"strawberry tongue", red cheeks and
whiteness around mouth.
Period of
Communicability
From onset of
symptoms until 24
hours after beginning
of treatment.
Up to 10-21 days if
untreated.
During convalescence, skin on hands and
feet may peel.
Streptococcal
Infection
(Invasive Group
A Strep)
Necrotizing fasciitis:
Fever, localised redness, swelling, blister
formation, and intense pain. Redness
spreads very quickly (up to 3 cm/hour). Can
arise from infected chickenpox lesions.
Person-to-person by
respiratory secretions,
through direct and
indirect contact.
Up to 10 days.
Unknown.
Reporting of
Individual Cases
Not needed.
If in an outbreak
situation (refer to
"outbreak")
report, report
immediately to
724-4224
(580-2400 after
hours).
Report immediately
to 724-4224
(580-2400 after
hours).
Toxic Shock Syndrome:
Sudden onset of high fever, vomiting,
diarrhea, rash, muscle pains, and shock. Can
be fatal.
Tinea
See Ringworm
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GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Tuberculosis
Cause/Symptoms
Mycobacterium.
In the lungs or airways (pharynx, larynx):


Cough producing sputum, lasting
over 2 weeks.
Loss of weight, fever, night sweats,
tiredness.
Outside of the lungs or airways:
It varies depending on where the disease is
located (lymph nodes, larynx, bones, kidneys
meningitis).
See fact sheet in “additional resources”
section at the back of this manual
Typhoid fever
See Salmonella.
Varicella
See Chickenpox.
Vomiting
See Gastroenteritis.
Whooping
Cough
See Pertussis.
Transmission
Incubation
Period of
Communicability
In the lungs or airways:
Person-to-person by
respiratory secretions.
2 to 12 weeks for
the Mantoux
skin test to show
exposure to the
tuberculosis.
Tuberculosis can be
contagious only if it
is in the lungs or
airways.
Outside of the lungs or
airways:
If tuberculosis is
anywhere else in the
body, it is not
contagious.
Several weeks to
years for
someone to show
symptoms of
illness.
Reporting of
Individual Cases
Report within one
working day to
724-4224.
Laboratory tests are
needed to identify if
or how contagious
someone is.
In children 18
years of age and
under, the
incubation
period tends to
be shortest and
the
complications
greatest.
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63
GUIDELINES FOR COMMUNICABLE DISEASE & OTHER
HEALTH ISSUES IN SHELTERS AND DROP-IN CENTRES
Disease
Yersinia
Cause/Symptoms
Bacteria.
Watery diarrhea, fever, headache.
Transmission
Incubation
Period of
Communicability
Raw pork and beef.
Food and water
contaminated by
infected food handler or
sewage. Contact with
infected pets, e.g.: dogs,
cats, rodents, birds.
3 to 7 days,
usually under 10
days.
For 2 to 3 months or
until treated with
antibiotics.
Reporting of
Individual Cases
Report within one
working day
724-4224.
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CITY OF OTTAWA PUBLIC HEALTH AND LONG TERM CARE BRANCH
REPORT OF DESIGNATED COMMUNICABLE DISEASES
TO THE MEDICAL OFFICER OF HEALTH (MOH)
Under the Ontario Health Protection and Promotion Act, physicians, hospital operators, laboratory operators, school principals and child
care facilities must report to the local MOH any person who, in his or her opinion, is or may be infected with an agent of one of the
communicable diseases listed below. Your co-operation in reporting will help to ensure prompt and complete follow-up of cases.
Please report according to the schedule outlined below.
Category 1: Diseases requiring IMMEDIATE public health follow up: Report immediately by telephone at 724-4224 during
office hours. During evenings and week-ends report to the MOH on call at 580-2400.
Category 2: Diseases requiring prompt follow-up. Please ensure delivery by mail the next working day or telephone 724-4224.
Any known or suspected outbreaks should be reported immediately as per category 1.
Category 3: Sexually Transmitted Diseases. These diseases should be reported to the SEXUAL HEALTH CENTRE on the next working
day at 560-6099.
Category 4: No immediate action - may be delivered weekly by mail, in batches. Schools, day cares and nurseries may also report by
calling 724-4224. Specific forms are available for chickenpox reporting and these may be sent in on a monthly basis.
CAT. DISEASE
3- AIDS
2- Amebiasis
1- Anthrax
1- Bites of dogs, cats & suspected rabid animals
1 - Botulism
4 - Brucellosis
2 - Campylobacter enteritis
3 - Chancroid
4 - Chickenpox (Varicella)
3 - Chlamydia trachomatis infections
1 - Cholera
2 - Cryptosporidiosis
4 - Cytomegalovirus infection, congenital
1 - Diphtheria
4 - Encephalitis, including:
i. Primary, viral
ii. Post-infectious
iii. Vaccine-related
iv. Subacute sclerosing panencephalitis
v. Unspecified
1 - Food poisoning, all causes
1 - Gastroenteritis, institutional outbreaks
2 - Giardiasis, except asymptomatic cases
3 - Gonorrhoea
1 - Group A Streptococcal infections, invasive
4 - Group B Streptococcal infections, neonatal
1 - Haemophilus influenzae b, invasive
1 - Hemorrhagic fevers, including:
I. Ebola virus disease
ii. Marburg virus disease
iii. Other viral causes
1 - Hepatitis A
3 - Hepatitis B
3 - Hepatitis C
4 - Hepatitis D (Delta hepatitis)
3 - Herpes, neonatal
3 - HIV infection
CAT. DISEASE
4 - Influenza, Types A, B, & C
1 - Lassa Fever
4 - Legionellosis
4 - Leprosy
2 - Listeriosis
4 - Lyme Disease
4 - Malaria
1 - Measles
1 - Meningitis, bacterial
4 - Meningitis, viral
1 - Meningococcal disease, invasive
2 - Mumps
3 - Ophthalmia neonatorum
1 - Paratyphoid Fever
2 - Pertussis (Whooping Cough)
1 - Plague
1 - Poliomyelitis, acute
2 - Psittacosis/Ornithosis
2 - Q Fever
1 - Rabies
2 - Rubella
4 - Rubella, congenital syndrome
2 - Salmonellosis
1 - Shigellosis
3 - Syphilis
4 - Tetanus
2 - Trichinosis
2 - Tuberculosis
2 - Tularemia
1 - Typhoid Fever
1 - Verotoxin-producing E. coli infections and
indicator conditions including
Hemolytic Uremic Syndrome (HUS)
1 - Yellow Fever
2 - Yersiniosis
65

66
REPORTING FORM
Please complete all applicable areas and return form to:
Medical Officer of Health
City of Ottawa
Public Health and Long Care Branch
Communicable Disease
495 Richmond Road
Ottawa, Ontario, K2A 4A4
FAX: (613) 724-4130
Personal information on this form is
collected under the authority of the
Health
Protection
and
Promotion
Act,
Sections 22 and 24, and will be used for
Public Health follow-up.
Any questions
should be directed to the Communicable
Diseases Manager at 722-2328.
REPORTING AGENCY:
PATIENT INFORMATION:
SURNAME:
FIRST NAME:
DATE OF BIRTH:
AGE:
SEX:
ADDRESS:
CITY:
POSTAL CODE:
HOME PHONE:
WORK PHONE:
OCCUPATION:
NAME OF SCHOOL/DAYCARE:
DISEASE INFORMATION:
DISEASE:
ORGANISM/SITE:
ONSET DATE:
SPECIMEN TYPE:
TREATMENT HISTORY:
TREATMENT:
HOSPITALIZED?:
TREATMENT DATE:
YES
NO
ADMISSION DATE:
HOSPITAL NAME:
DISCHARGE DATE:
COMMENTS:
PHYSICIAN INFORMATION:
NAME:
SPECIALTY:
ADDRESS:
CITY:
POSTAL CODE:
PHONE:
DATE OF NOTIFICATION:
SIGNATURE OF PERSON REPORTING:
67
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Additional Information
——
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A HEALTH EDUCATION RESOURCE FOR INFECTION CONTROL
IN SHELTERS AND DROP-IN CENTRES
Resources

Hepatitis B, Hepatitis C

HIV

Head Lice

Scabies

Tuberculosis Health Facts

Positive Skin Test

TB Booklet – What I Need to Know

What to Do With Used Needles

Be Careful With Needles!
——
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Appendices
Appendix I
Table 6:
Transmission Characteristics and Empiric Precautions by Clinical Presentations:
Recommendations for Acute Care Centres.
Appendix II
Table 7:
Transmission Characteristics and Precautions by Specific Etiology: Recommendations for
Acute Care Centres
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care.
Canadian Communicable Disease Report. Ottawa, ON: Health Canada
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Glossary of Terms
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GLOSSARY OF TERMS
Antimicrobial Agent: A product that kills or suppresses the growth of microorganisms.
Antimicrobial-Resistant Organism: A microorganism that has developed resistance to the action of several
antimicrobial agents and that is of special clinical or epidemiologic significance. Organisms included in this group are
MRSA, VRE, penicillin-resistant pneumococcus, certain Gram negative bacilli resistant to all penicillins and
cephalosporins, and multi-drug resistant Mycobacterium tuberculosis. Other microorganisms may be added to this list if
antibiotic resistance is judged to be significant in a specific health care facility or patient population, at the discretion of
the infection control program or local, regional or national authorities.
Antiseptics: chemicals that kill microorganisms on living skin or mucous membranes. Antiseptics should not be used in
housekeeping.
Barrier Techniques: Use of single rooms, gloves, masks, or gowns in health care settings to prevent transmission of
microorganisms.
Carrier: An individual who is found to be persistently colonized (culture-positive) for a particular organism, at one or
more body sites, but has no signs or symptoms of infection.
Cleaning: the physical removal of foreign material, e.g., dust, soil, organic material such as blood, secretions, excretions
and microorganisms. Cleaning physically removes rather than kills microorganisms. It is accomplished with water,
detergents and mechanical action. The terms “decontamination” and “sanitation” may be used for this process in certain
settings, e.g., central service or dietetics. Cleaning reduces or eliminates the reservoirs of potential pathogenic organisms.
Cleaning agents are the most common chemicals used in housekeeping activity.
Colonization: Presence of microorganisms in or on a host with growth and multiplication but without tissue invasion or
cellular injury.
Communicable: Capable of being transmitted from one person to another; synonymous with “infectious” and
“contagious”.
Contagious: Capable of being transmitted from one person to another; synonymous with “infectious” and
“communicable”.
Contamination: The presence of microorganisms on inanimate objects (e.g. clothing, surgical instruments) or
microorganisms transported transiently on body surfaces such as hands, or in substances (e.g. water, food, milk).
Critical items: instruments and devices that enter sterile tissues, including the vascular system. Critical items present a
high risk of infection if the item is contaminated with any microorganisms, including bacterial spores. Reprocessing
critical items involves meticulous cleaning followed by sterilization.
Disease: Clinical expression of infection; signs and/or symptoms are produced.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care. Canadian
Communicable Disease Report. Ottawa, ON: Health Canada
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GLOSSARY OF TERMS
Disinfection: the inactivation of disease-producing microorganisms. Disinfection does not destroy bacterial spores.
Disinfectants are used on inanimate objects; antiseptics are used on living tissue. Disinfection usually involves chemicals,
heat or ultraviolet light. Levels of chemical disinfection vary with the type of product used.
Fomites: those objects in the inanimate environment that may become contaminated with microorganisms and serve as a
vehicle of transmission.
Germicide: an agent that destroys microorganisms, especially pathogenic organisms.
Hand antisepsis: a process for the removal or destruction of resident and transient microorganisms on hands.
Hand wash(ing): a process for the removal of soil and transient microorganisms from the hands.
Heavy microbial soiling: the presence of infection or high levels of contamination with organic material, e.g., infected
wounds, feces.
High level disinfection: level of disinfection required when processing semicritical items. High level disinfection
processes destroy vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non enveloped (non lipid) viruses,
but not necessarily bacterial spores. High level disinfectant chemicals (also called chemisterilants) must be capable of
sterilization when contact time is extended. Items must be thoroughly cleaned prior to high level disinfection.
Immunocompromised: Increased susceptibility to infection. In this document the term refers to patients with congenital
or acquired immunodeficiency or immunodeficiency due to chemotherapeutic agents or hematologic malignancies.
Infection: The entry and multiplication of an infectious agent in the tissues of the host
a) Inapparent (asymptomatic, subclinical) infection: an infectious process running a course similar to that of clinical
disease but below the threshold of clinical symptoms
b) Apparent (symptomatic, clinical) infection: one resulting in clinical signs and symptoms (disease).
Infectious: Caused by infection or capable of being transmitted.
Infectious tuberculosis: Factors related to the patient that enhance transmission and determine the patient’s level of
infectivity include:
• disease involving the lungs, airways or larynx
• presence of acid-fast bacilli on microscopic direct smear examination of the sputum
• presence of cavitation, extensive disease, or pneumonic infiltrates on x-ray
• undergoing a procedure that can induce coughing or cause aerosolization of tubercle bacilli
• presence of cough, sneeze or other forceful expiratory procedure in a patient with pulmonary TB.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care. Canadian
Communicable Disease Report. Ottawa, ON: Health Canada
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GLOSSARY OF TERMS
Infectious waste: that portion of biomedical waste that is capable of producing infectious disease (219)
Intermediate level disinfection: level of disinfection required for some semicritical items. Intermediate level
disinfectants kill vegetative bacteria, most viruses and most fungi but not resistant bacterial spores.
Isolation The physical separation of infected individuals from those uninfected for the period of communicability of a
particular disease.
Low level disinfection: level of disinfection required when processing noncritical items or some environmental surfaces.
Low level disinfectants kill most vegetative bacteria and some fungi as well as enveloped (lipid) viruses (e.g., hepatitis B,
C, Hantavirus, and HIV). Low level disinfectants do not kill mycobacteria or bacterial spores. Low level disinfectantsdetergents are used to clean environmental surfaces.
Noncritical items: those that either touch only intact skin but not mucous membranes or do not directly touch the patient.
Reprocessing of noncritical items involves cleaning and/or low level disinfection.
Outbreak: An excess over the expected incidence of disease within a geographic area during a specified time period,
synonymous with epidemic.
Plain or nonantimicrobial soap: detergent-based cleansers in any form (bar, liquid, leaflet, or powder) used for the
primary purpose of physical removal of soil and contaminating microorganisms. Such soaps work principally by
mechanical action and have weak or no bactericidal activity. Although some soaps contain low concentrations of
antimicrobial ingredients, these are used as preservatives and have minimal effect on colonizing flora.
Precautions: Interventions implemented to reduce the risk of transmission of microorganisms from patient to patient,
patient to health care worker, and health care worker to patient.
Sanitation: a process that reduces microorganisms on an inanimate object to a safe level (e.g., dishes and eating utensils
are sanitized).
Semicritical items: devices that come in contact with nonintact skin or mucous membranes but ordinarily do not
penetrate them. Reprocessing semicritical items involves meticulous cleaning followed preferably by high-level
disinfection (level of disinfection required is dependent on the item, see Table 5). Depending on the type of item and its
intended use, intermediate level disinfection may be acceptable (see Table 5 for examples).
Sharps: needles, syringes, blades, laboratory glass or other objects capable of causing punctures or cuts.
Sterilization: the destruction of all forms of microbial life including bacteria, viruses, spores and fungi. Items must be
cleaned thoroughly before effective sterilization can take place.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care. Canadian
Communicable Disease Report. Ottawa, ON: Health Canada
(adapted for use by shelters June 2001
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References
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REFERENCES
Block, Seymour S (1991). Disinfection, Sterilizaton, and Preservation. (4th Edition). Philadelphia:
Lea & Febiger.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable
Disease Program (1997). Tuberculosis Screening and Contact Management: Recommendations and
Notes. Ottawa, ON, City of Ottawa, Communicable Disease Program.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable
Disease Program (2000). A Health Education Resource for Designated Officers of Emergency Services.
(2nd Edition). Ottawa, ON: City of Ottawa, Communicable Disease Program.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Communicable
Disease Program (2001). Policy for Tuberculosis Screening in Shelters and Drop-In Centres. Ottawa,
ON: City of Ottawa, Communicable Disease Program.
City of Ottawa, Public Health and Long Term Care Branch. Health Protection Division, Communicable
Disease Program (2001). Guidelines for Communicable Disease and Other Health Issues in Shelters and
Drop-In Centres. Ottawa, ON: City of Ottawa, Communicable Disease Program.
City of Ottawa. Public Health and Long Term Care Branch. Health Protection Division. Communicable
Disease Program (2001). Needlestick Injury/Accidental Exposure Protocol Chart for use in Shelters and
Drop-In Centres. Ottawa, ON: City of Ottawa, Communicable Disease Program.
City of Ottawa, Public Health and Long Term Care Branch (November, 2000). Communicable Disease
Report. Ottawa, ON: City of Ottawa
City of Ottawa, Public Health and Long Term Care Branch. Health Protection Division. Environmental
Health Program (Date Unknown). Correct Handwashing Procedures: Fact Sheet. Ottawa, ON: City of
Ottawa, Environmental Health Program.
City of Ottawa, Public Health and Long Term Care Branch, Health Protection Division, Environmental
Health Program (2001). What to Do With Used Needles. Ottawa, ON: City of Ottawa, Environmental
Health Program
City of Ottawa, Public Health and Long Term Care Branch. Sexual Health Centre (2001).
Be Careful With Needles! Ottawa, ON: City of Ottawa, Sexual Health Centre.
City of Ottawa, Public Health and Long Term Care Branch. Sexual Health Centre (2000).
Hepatitis B: Fact sheet. Ottawa, ON: City of Ottawa, Sexual Health Centre.
City of Ottawa, Public Health and Long Term Care Branch, Sexual Health Centre. (2000).
Hepatitis C: Fact sheet. Ottawa, ON: City of Ottawa, Sexual Health Centre.
City of Ottawa, Public Health and Long Term Care Branch, Sexual Health Centre. (2000).
HIV: Fact sheet. Ottawa, ON: City of Ottawa, Sexual Health Centre.
City of Toronto Public Health and Lung Association (Date Unknown). Positive Skin Test. Toronto, ON,
City of Toronto, Public Health Department.
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REFERENCES
College of Nurses of Ontario (2000). Infection Control Guidelines. Toronto, ON, College of Nurses of
Ontario, 3-10.
(The) College of Physicians and Surgeons of Ontario (1999). Infection Control in the Physicians’ Office.
Toronto, ON. the College of Physicians and Surgeons of Ontario, 1-41.
Health Canada (1998). Canadian Immunization Guide. (5th Edition). Ottawa, ON: Canadian Medical
Association, 54-57.
Health Canada (1998). Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and
Sterilization in Health Care. Canadian Communicable Disease Report. Ottawa, ON: Health Canada, 1-58.
Health Canada (1997). Infection Control Guidelines: Preventing the Transmission of Bloodborne
Pathogens in Health Care and Public Services Settings. Canada Communicable Disease Report 23S3.
Ottawa, ON: Health Canada, 1-42.
Health Canada (1999). Infection Control Guidelines: Routine Practices and Additional Precautions for
Preventing the Transmission of Infection in Health Care. Canadian Communicable Disease Report.
Ottawa, ON: Health Canada, 1-83.
Ontario Ministry of Health (1998). Tuberculosis Control Protocol, Ministry of Health, Public Health
Branch, Mandatory Health Programs Service Guidelines. Toronto, ON: Queens Printer for Ontario.
Ontario Ministry of Health (1996). Guidelines for the Management of Methicillin Resistant
Staphylococcus Aureus in Long Term Care Facilities. Toronto, ON: Queens Printer for Ontario, 1-22.
Ontario Ministry of Health (1996). Guidelines for the Management of Residents With Vancomycin
Resistant Enterococci in Long Term Care Facilities. Toronto, ON: Queens Printer for Ontario, 1-23.
Ontario Ministry of Health (1995). Health Facts TB Infection /TB Disease. 100M/12/95 CAT# 4129492,
Toronto, ON: Queens Printer for Ontario.
Ontario Ministry of Health (1993). Communicable Disease Control Outbreak Control: A Guide to the
Control of Enteric Disease Outbreaks in Health Care Facilities. Toronto, ON: Queens Printer for Ontario.
(The) Ottawa Organization for Practitioners in Infection Prevention and Control. A Chapter of the
Community and Hospital Infection Control Association-Canada (November 1999). Infection Prevention
and Control Guidelines for Housekeeping Practices Related to Multi-Drug Resistant Organisms
(MDRO).Ottawa, ON, the Ottawa Organization for Practitioners in Infection Prevention and Control.
A Chapter of the Community and Hospital Infection Control Association-Canada.
Rutala, William A (1996). APIC (Association for Professional in Infection Control and Epidemiology)
Guidelines for Selection and Use of Disinfectants. AJIC Am J Infect Control 24:313-42
Rutala, William A. (1998). Stability and Bactericidal Activity of Chlorine Solutions.
Infection Control and Hospital Epidemiology vol. 19: No 5 323-610
81