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The Home Care and Community Health Support Pocketbook was created to bring awareness to several health and safety issues faced in home and community care.
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In long-term care it is increasingly apparent that who is on shift is just as important as how many staff are on shift. Quality care is difficult to achieve when we do not routinely engage with one another in a positive, or civil, manner.
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WorkSafeBC’s healthcare and social services planned inspection initiative focuses on high-risk activities in the workplace that lead to serious injuries and time-loss claims.
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WorkSafeBC is releasing a discussion paper with proposed amendments to the Current Rehabilitation Services and Claims Manual that guide wage rate decisions related to short-term and long-term disability compensation. Recommended amendments include: These changes may affect your claims costs. Click here to view the proposed changes and offer feedback to WorkSafeBC – The deadline is 4:30 p.m. on Friday, […]
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Hierarchy of Control

Infection Prevention—Long-Term Care

Reducing exposure to communicable disease involves considering the hierarchy of controls for infection prevention to eliminate or minimize exposure in the workplace.

The first step to reducing exposure in your care home is to identify and assess tasks that may result in exposure to communicable disease. Be sure to involve staff and your JOHS Committee in this process. Then, using the hierarchy of controls, implement control strategies starting from the most effective control measures. Applying multiple control strategies is the most effective.

Below, we outline general steps for reducing exposure in a long-term care home. These steps align with the hierarchy of controls for infection prevention that will safeguard the well-being of staff and residents.

Click each element to see examples of control measures.

Elimination
Remove the hazard.
Substitution
Replace the hazard.
Engineering Controls
Isolate people from the hazard.
Administrative Controls
Change the way people work.
PPE
Protect people with personal protective equipment.

Elimination

Remove the risk of exposure to communicable disease. The best way to eliminate communicable disease is to prevent it from entering the care home in the first place.
Examples:
  • Encourage staff and visitors not to come to the care home when they are ill or have symptoms of illness. Post signage in your workplace.
  • Actively screen visitors for symptoms of illness.
  • Encourage health care workers to self-monitor for signs and symptoms of illness prior to work.
  • Isolate symptomatic residents with suspected or diagnosed communicable disease when possible.
  • Eliminate the use of high-touch or shared items.
  • Follow BCCDC guidelines for visitors during an outbreak of COVID-19.
  • Offer remote communication options for residents and family members if in-person visits are not possible.

Substitution

Replace the hazard in the workplace with a safer alternative.
Examples:
  • Substitute less effective cleaning agents with cleaning and disinfecting agents that are suitable for the task.
  • Ensure disinfectants have a Health Canada drug identification number (DIN), or a Natural Product Number (NPN).
  • Replace items that are visibly broken, cracked, or cannot be properly cleaned or disinfected.
  • Substitute in-person meetings with virtual meetings where possible.
  • Substitute high touch or shared items with personal items or items that can be sanitized.

Engineering Controls

Isolate workers from exposure to communicable disease. These controls involve modifying the environment to reduce the risk of infection transmission.
Examples:
  • Use physical barriers to promote physical distancing such as plastic or plexiglass barriers.
  • Consider the use of drop curtains to isolate spaces or provide separation in shared rooms.
  • Use markers (i.e., tape on the floor) to remind individuals to maintain 2m distance when needing to space apart individuals. · Ensure indoor spaces are adequately ventilated with outside air.
  • Use air filtration systems to remove airborne pathogens
  • Provide well-stocked hand washing and alcohol-based hand rub stations throughout the home, including at entryways.
  • Ensure the use of safety engineered medical sharps or safety-engineered needles.

Administrative Controls

Change the workflow at your organization. Administrative controls involve policies, procedures, and guidelines to manage risk of infection.
Examples:
  • Develop and communicate infection control policies and procedures, such as exposure control plans.
  • Encourage respiratory hygiene/cough etiquette, and provide tissues and individual receptacles.
  • Provide staff training in hand hygiene, respiratory hygiene/cough etiquette and provide tissues and garbage receptacles. · Provide training in the use of PPE (donning and doffing).
  • Increase frequency of disinfecting surfaces and high-touch areas and shared equipment.
  • Limit the number of staff in shared spaces (break rooms, change rooms, etc.).
  • Assign specific units or cohorts to staff members to minimize movement throughout the home.
  • Cohort symptomatic residents when possible.
  • Dedicate the use of non-critical care equipment to a single resident where possible.
  • Disinfect equipment that is shared between residents.
  • Handle and dispose of sharps according to safe work procedures. Follow sharps handling procedures such as discarding any disposable, contaminated sharps in sharps disposal containers as soon as possible after use.

PPE

Give the worker something to wear to reduce exposure to communicable disease. PPE should be used when other control measures are not sufficient to reduce the risk.
Examples:
  • Direct staff to follow current provincial masking guidance.
  • Require staff to conduct a point of care risk assessment before any resident interactions to determine personal protective equipment required.
  • Ensure that workers who are required to wear a N95 respirator as indicated by a point of care assessment have been fit tested within the last year.
  • Ensure staff perform proper donning and doffing of PPE, and proper hand hygiene (link a huddle here).
  • Ensure face masks are replaced if soiled, damaged, or hard to breathe through.
  • Assign responsibility ensuring that PPE stock is available and suitable for use.
The above are examples of control measures that could be considered for each step in the hierarchy of controls, and act only as a guidance for possible controls measures that may be suitable for your organization. You are still required to minimize workplace hazards through an organization-specific risk assessment. The information in this document does not override the current provincial measures or guidance from your local health authority.
Infection Prevention—Long-Term Care

Additional Resources

Prevent the spread of infectious diseases such as COVID-19 and influenza by taking proper infection control measures in your workplace.
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More Hierarchy of Controls

Reducing exposure to communicable disease involves an approach that considers the hierarchy of controls for infection prevention to eliminate or minimize exposure in the workplace. The first step to reducing exposure is to identify and assess tasks that may result in exposure to communicable disease. Be sure to involve staff and your JOHS Committee or […]
View Hierarchy of Control
Reducing exposure to communicable disease involves considering the hierarchy of controls for infection prevention to eliminate or minimize exposure in the workplace. The first step to reducing exposure in your care home is to identify and assess tasks that may result in exposure to communicable disease. Be sure to involve staff and your JOHS Committee […]
View Hierarchy of Control
Safe resident handling involves an approach that considers the hierarchy of controls to eliminate or minimize the risk of injury in the workplace. The first step is to identify and assess tasks that may result in injury from resident handling. Be sure to involve staff and your JOHS Committee in this process. Then, using the […]
View Hierarchy of Control
Safe client handling involves an approach that considers the hierarchy of controls to eliminate or minimize the risk of injury in the workplace. The first step is to identify and assess tasks that may result in injury from client handling. Be sure to involve staff and your JOHS Committee in this process.  Then, using the […]
View Hierarchy of Control
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