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Form 29
November 2008
Revised March 2013
Revised October 2014
Revised Sept 2015
INFECTION PREVENTION AND CONTROL CANADA (IPAC CANADA)
Endorsement of Basic Education Courses for Infection Prevention & Control Practitioners
Application Form (version September 2015)
APPLICATION FEE: This application must be accompanied by a cheque payable to IPAC Canada in the
amount of $1,000 CAD plus 5% GST. Payment will also be accepted by credit card.
Card Number
Name on Card
____________________________________________
____________________________________________
Expiry Date __________________
Educational Institution:
Name and position of representative:
Mailing address:
Telephone:
Fax:
Email:
Date of application:
Name of course and course number (if applicable):
---------------------------------------------------------------------------------1.
Course description
Provide a brief course description that can be used on IPAC Canada’s web site. A
university/college calendar description is appropriate.
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2.
History of the course
Provide a brief summary of the history of the course—e.g., who developed it, when and why;
when it was last offered and when it will next be offered; usual enrollment; target group;
success rate of participants; and characteristics of students accepted.
3.
Course details
Provide, as a separate document, a detailed course outline. It must include the following
information but you may also provide other details you feel are important:
 Number of hours per class or topic
 Specific learning objectives per class or topic
 Teaching/learning methods used
 Assignments
 Required and recommended texts, readings and other learning resources (e.g., videos).
 Description of methods of evaluation of student learning outcomes, and their weights.
In addition to submitting the course outline, please complete the following table and identify 1)
where/when the topic is covered (e.g., what module or unit) and 2) the extent to which each topic
is covered, using the following legend:
0 = not covered
1 = defined, briefly introduced
2 = moderate coverage of the topic
3 = covered extensively in notes, exams and/or as a discussion topic
Content area (reflects IPAC
CANADA/APIC practice and
professional standards)
Reviews the APIC/IPAC CANADA
practice standards
Discusses professional accountability
Discusses ethical principles and
application to a variety of situations e.g.,
isolation, surveillance, reporting, pt care,
outbreaks
Covers basic epidemiology principles and
basic stats : risk, incidence and
prevalence, rates, OR, RR, interpreting p
values
Covers surveillance: methods, principles,
interpretation of results, reporting,
Where/
when
covered
Extent of
coverage
(see legend)
Comments
3
Content area (reflects IPAC
CANADA/APIC practice and
professional standards)
definitions, benchmarking
Covers outbreak detection, finding source
and management of outbreak
Covers screening: pros and cons,
methods, examples and interpretation of
findings
Covers basic microbiology: reading lab
reports, key diagnostic tests, key
microorganisms, normal flora vs.
pathogenic agents
Reviews important infections: infectious
agent, risk factors, transmission, S&S, dx,
and management
Covers pt care practices including RP and
AP components (including HH, PPE,
cough etiquette), asepsis, application to
clinical practice, and compliance issues
Covers cleaning and levels of disinfection
/ sterilization including reprocessing
issues
Introduces occupational health issues:
sharps safety, blood borne pathogens, post
exposure protocols, vaccination, and
healthy workplace policies
Reviews learning and education: adult
learning principles, lesson planning,
teaching methods, presentation basics, and
promoting behaviour change
Covers communication and
collaboration: written and oral
communication strategies, communicating
to different audiences, team/ relationship
building
Covers searching for resources: doing lit
and web searches, judging suitability of
web sites, finding Canadian resources
Research utilization: covers critical
appraisal of quality of evidence from
research articles and how/when to apply
Quality improvement: discusses how to
do a program evaluation and use of the
data to improve the program
Discusses pandemic planning/ emergency
Where/
when
covered
Extent of
coverage
(see legend)
Comments
4
Content area (reflects IPAC
CANADA/APIC practice and
professional standards)
preparedness/emerging issues
Discusses IP&C programs and roles:
roles of ICP, ICC, other committees ICPs
will be involved with, what goes into an
IP&C program, developing policies/
procedures, fiscal responsibility, produce
evaluation, legislative issues
AROs: discusses prevention and control of
key AROS including antibiotic
stewardship
Discusses adaption of IP&C to specific
settings or groups: e.g,, LTC, peds, psych,
ambulatory care, rural.
Covers facility planning/construction:
e.g., issues related to renovation
Discusses information technology for
searching for resources/literature, for
writing reports, and related to data base
management
Other (*list)
4.
Where/
when
covered
Extent of
coverage
(see legend)
Comments
Organizational support
Provide a list of the organizational resources available to support student learning and faculty
teaching: e.g., classroom or web facilities, library resources, technical support, support staff
for registration or administrative issues.
5.
Course Faculty
Provide the names and positions of the individuals who will be teaching in or have
responsibility for the course when it is next offered, including mentors. Specify the roles/
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responsibilities each will have; examples of roles include teaching content, leading discussion,
grading, or practice/project supervision. In addition to a brief summary in this application
form, submit, as separate documents, a CV for each individual.
Outline the criteria for selecting individuals.
6.
Pass level for the course
Identify the assigned level or mark required for a student to pass the course and explain the
rationale for that level.
7.
Course revisions and updating
Describe the methods used, or planned, to evaluate the course and faculty, and for revision or
updating the course. Provide examples of previous course and faculty evaluation and how
they were used.