COVID-19: Staging environment

No Results Found 0/0

Personal protective equipment (PPE)

The fundamental method of protecting workers is through the application of the hierarchy of hazard controls (NIOSH, January 13, 2015). Although PPE is the most visible of the hierarchy of controls, it is the last tier and should not be relied on as a standalone primary prevention program. The PPE tier refers to the availability, support and appropriate use of physical barriers between healthcare workers and an infectious agent/infected source to minimize exposure and prevent transmission (PHO, May 20, 2021).

An Organizational Risk Assessment should be performed in order to assess the efficacy of an organization’s hierarchy of controls, including the protocols for prioritizing and distributing PPE (PHO, May 20, 2021).

An Organizational Risk Assessment should be performed in order to assess the efficacy of an organization’s hierarchy of controls, including the protocols for prioritizing and distributing PPE (PHO, May 20, 2021).

What to wear, when

There are no changes to IPAC measures for COVID-19 variants of concern, as current evidence does not indicate that they are transmitted in different modes from other variants. However, due to the higher transmissibility of these variants, adherence to current IPAC measures remains especially important, with a lower margin of error (PHO, May 20, 2021).

Before every patient interaction, conduct a point-of-care risk assessment to determine the PPE required. See PHO’s advice on performing a risk assessment. At this time, vaccination status does not impact what PPE is required for HCWs or patients.

All patients (and those accompanying them) should wear a mask and perform hand hygiene while at the office/clinic, regardless of COVID-19 status. Patients who are symptomatic for COVID-19 or have a recent exposure MUST wear a surgical/procedure mask (MOH, July 28, 2021). A sample patient handout on wearing and disposing of masks is available on the OCFP’s Clinical Care – Office Readiness page.

For patients who screen negative for COVID-19: HCWs should wear a surgical/procedure mask for all interactions with and within 2 metres. If the patient is unmasked, eye protection (goggles or a face shield) is required. If the patient is masked for the entirety of the visit, eye protection may be used based on clinical discretion.

For patients who screen positive for COVID-19 (suspected or confirmed COVID-19 infection or contact): HCWs should follow Droplet and Contact Precautions for all interactions with and within 2 metres of patients this includes wearing the following PPE:

  • Surgical/procedure mask
  • Isolation gown
  • Gloves
  • Eye protection (goggles of face shield)

If HCWs are not able to follow droplet and contact precautions or are not knowledgeable on how to properly don and doff PPE, they should divert the care of the patient (e.g., to the emergency department, or to an assessment centre) as appropriate (MOH, July 28, 2021).

The circumstances in which airborne transmission is possible are not clearly established, however, it is recommended that airborne precautions be used when performing aerosol generating procedures (AGMPs) on patients with suspected or confirmed COVID-19 (OH, February 25, 2021). An N95 mask (not a medical/procedural mask) is used as part of airborne precautions, all other PPE is identical to droplet and contact precautions.

Scroll (left-right) for details

  • Surgical mask

    When to use

    • Use for all patient encounters that involve less than 6 feet of separation, regardless of COVID-19 status.

    When to discard

    • Extend use as long as possible.
    • Discard if wet, damaged, soiled, or removed (e.g. to eat or drink), or you exit the patient care area.
  • Eye protection (goggles or facemask)

    When to use

    • Use when providing care to a patient who has suspected or confirmed COVID-19.
    • Consider using for all patient encounters that involve less than 6 feet of separation, regardless of COVID-19 status.

    When to discard

    • Extend use as long as possible if caring for multiple patients using contact and droplet precautions.
    • Discard or sterilize according to manufacturer guidance after exiting patient room.
  • Isolation gown (disposable or cloth)

    When to use

    • Use when providing care to a patient who has suspected or confirmed COVID-19.

    When to discard

    • Discard after each patient encounter. Do not extend use of disposable isolation gowns between multiple patients with cofirmed COVID-19 infection unless gown supplies are limited.
    • Launder cloth gowns according to routine practices (CDC). Do not take PPE home to launder.
  • Latex or nitrile gloves

    When to use

    • Use when providing care to a patient who has suspected or confirmed COVID-19.

    When to discard

    • Discard after any of the following: immediately after the activity for which they were used; when moving from a contaminated body site to a clean body site for the same patient; after touching a contaminated environmental surface; or when integrity of glove is compromised.
  • N95 mask*

    * Not part of Droplet and Contact precautions (Medical/procedural masks suffice and should be used if available)

    When to use

    • Use when performing aerosol generating procedures (AGMPs) on a patient who has suspected or confirmed COVID-19

    When to discard

    • Discard after performing an AGMP on a patient who has suspected or confirmed COVID-19 (i.e. do not reuse for multiple AGMPs)
    • Discard if wet, damaged, soiled, or removed (e.g., to eat or drink), or you exit the patient care area.

PPE inventory and quality control

Accessing PPE

Ontario Health has implemented the Pandemic PPE Transitional Support (PPTS) program, which will temporarily allow free access to PPE for primary care providers who do not have established PPE supply chains or whose supply chains have failed. This allows providers to effectively skip Step 3 of the escalation process below. For more information, see Pandemic PPE Transitional Support (PPTS) FAQs (OH, August 4, 2020).

The following escalation process provides steps for you to access PPE for your practice/organization (OH, 2020):

Regional Leads – PPE and Critical Supplies
Toronto

Leads

  • Rob Burgess (Robert.Burgess@sunnybrook.ca)
  • Nancy Kraetschmer (Nancy.Kraetschmer@tc.lhins.on.ca)
Central

Leads

  • Susan Gibb (Susan.Gibb@lhins.on.ca)
North

Leads

  • Matthew Saj (sajm@tbh.net)
East

Leads

  • Paul McAuley (Paul.McAuley@3so.ca)
  • Shelley Moneta (Shelley.Moneta@lhins.on.ca)
West

Lead

  • Toby O’Hara (Toby.OHara@hmms.on.ca)

Inventory management initiatives

The MoH has issued an order for Mandatory Reporting of PPE Inventory, once per week, between Thursday and Monday. To report your PPE supply to the ministry, access the inventory reporting tool. The tool is open from 8 a.m. to 5 p.m. daily. Instructions for participation are published on the Ontario Health website.

Ontario Health has asked for healthcare providers to save and store used, unsoiled N95 unsoiled N95 respirators for decontamination using validated sterilization and disinfection methods. Store N95 respirators separately in labelled and dated storage containers.

To help extend the supply of PPE, Ontario Health suggests that providers switch to reusable PPE options wherever they can be safely implemented (OH, February 25, 2021).

Quality control

Health Canada is warning Canadians about counterfeit 3M N95 respirators in light of recent seizures of counterfeit products in Canada and at the United States border (Health Canada, April 15, 2021). Visit the 3M website for a hotline and published information on how to identify, prevent and report suspected fraud.

Health Canada is warning not to use masks labelled to contain graphene or biomass graphene, due to the potential for wearers to inhale graphene particles (Health Canada, April 2, 2021).

Confirm NIOSH approval # in the NIOSH database.

Ensure package and respirator have markings & details, as required by NIOSH.

Check for obvious signs of counterfeit (i.e. incorrect spelling).

Refer to the Government of Canada Specifications for COVID-19 Products site to confirm quality standards for other PPE.

Consult the PPE Supplier Validation Checklist (OMA, June 6, 2020) if you are purchasing PPE from a new supplier.

Donning and doffing PPE

The CDC recommends an additional handwashing step before putting on glovesFrequent handwashing with or without adjunct antiseptics is a vital component of infection control.

Incorrect doffing is very common and leads to contamination of the healthcare worker, their clothes or the environment.

Common doffing errors:

  • Doffing gown from the front.
  • Removing face shield of the mask.
  • Touching potentially contaminated surfaces and PPE during doffing.

Putting it into practice

Donning
Doffing
Donning and doffing tips
Click for details

Reducing discomfort associated with PPE use

Frequently asked questions (FAQs)
  • Maintain cool environment.
  • Topical moisturizers and petroleum jelly or baby napkin cream (only if use does not interfere with proper fit).
  • Use alternate mask type if one type is particularly irritating.
  • Take breaks from respirator use, with careful attention used when donning and doffing (especially when the respirator is being re-used).
  • Caps, headbands or fabric with buttons for straps of masks may reduce ear irritation but may increase pressure on front of face. This should only be done if it does not interfere with the proper fit of the PPE. These items must be integrated into proper donning/ doffing cycle and reprocessed or laundered appropriately with other PPE.
  • Use full face-shield.
  • Change to shorter, rotating shifts.
  • Lubricants to reduce friction between skin and goggles.
  • Avoid tight equipment.
  • Wet compression for severe skin indentations.
  • Avoid irritating agents when washing face.
  • For overheating: Avoid plastic gowns, maintain hydration, use shorter, rotating shifts and over-tight equipment.
  • For irritation: wear a barrier between body and PPE (unless overheating is issue) and avoid over-tight equipment.
  • Ensure hands are dry before donning gloves.
  • Choose non-irritating gloves (avoid latex).
  • Choose correct glove size.
  • Moisturize often, but avoid moisturizing immediately prior to donning gloves. Moisturizer is not sterile and can interfere with glove integrity.
  • Avoid hot water.
  • Rinse soap well.
  • Use hypoallergenic products (including at home).
  • Pat hands dry with paper towel instead of rubbing.
  • Moisturize often using a fragrance-free lotion or cream that contains humectants, fats and oils at least twice a day for prevention, and as often as feasible (including at work) for treatment.
  • Barrier cream efficacy unclear, such products are expensive, not removed by handwashing, and may = glove breakdown.
  • Avoid use of hand sanitizer immediately before or after handwashing.
  • Hand sanitizer is less likely to cause initial skin irritation than soap and water, but is more likely to cause acute pain once irritation occurs.
  • Ensure hands are dry before donning gloves.

Emerging evidence

PPE extended use, reuse and reprocessing

Extended use involves wearing the same PPE across multiple patient encounters WITHOUT taking it off. Extended use carries less risk of self-contamination and is therefore preferred to reuse.  
Reuse involves removal, storage, re-donning, and reuse of the same, potentially contaminated PPE items WITHOUT reprocessing in between. This is one of the principal sources of risk to health care workers (WHO, December 23, 2020). 
Reprocessing involves sterilizing equipment for reuse. In the context of PPE shortages, re-processing refers to sterilizing single-use equipment that was not designed to maintain integrity during cleaning or across multiple uses. If available and intact, expired stockpiles of single-use PPE are preferable to reprocessing single-use PPE. (PHO, April 4, 2020).

Please note that extended use of surgical/procedural masks and eye protection (e.g. goggles or face shields) is now recommended in Ontario.

  • Do not combine extended use and reuse practices.
  • Take extra care when removing PPE, as this is when self-contamination may occur. If you touch or adjust PPE, immediately perform hand hygiene with soap and water or sanitizer for 20 seconds.
  • During Crisis capacity, unused, expired PPE items that have been stored in accordance with manufacturers’ storage conditions may be used, following inspection and testing to ensure they are not damaged (OH, February 25, 2021).
Scroll (left-right) for details
  • Surgical mask

    Contingency capacity

    • Extend use of masks for repeated close encounters with several different patients without removing in between.
    • Restrict facemasks to use for HCP rather than for patients for source control.
    • When to discard: when the mask is wet, damaged, difficult to breathe through, soiled or removed.
    Click for Crisis capacity guidance
  • Eye protection

    The reuse of eye protection without appropriate reprocessing is strongly discouraged. See WHO Rational Use of PPE During COVID-19.

    Contingency capacity

    • Shift supply from disposable to reusable devices (i.e. goggles and reusable face shields).
    • Ensure appropriate cleaning and disinfection between users.
    • Extend use of disposable and reusable eye protection for repeated close encounters with several different patients without removing in between.
    • While the use of both disposable and reusable eye protection can be extended, only reusable eye protection should be sterilized and used again according to usual practice. At the end of a shift, disposable eye protection should be discarded.
    • When to remove: If it becomes visibly soiled or difficult to see through or if damaged (e.g. face shield can no longer fasten securely to the provider, if visibility is obscured and cleaning does not restore visibility).
    Click for Crisis capacity guidance
  • Isolation gown (disposable or cloth)

    The reuse of gowns without appropriate reprocessing is strongly discouraged. See: WHO Rational Use of PPE During COVID-19.

    Contingency capacity

    • Disposable gowns should be discarded, and cloth gowns laundered, after each patient encounter or after caring for multiple patients using contact and droplet precautions. Reusable (i.e. washable) gowns are typically made of polyester or polyester-cotton fabrics. Gowns made of these fabrics can be safely laundered according to routine procedures.
    • Consider the use of coveralls.
    • When to remove: Disposable gown should be discarded after each patient encounter. Cloth gowns should be laundered after each patient encounter. Do not take PPE home to launder.
    Click for Crisis capacity guidance
  • Latex or nitrile gloves

    Existing guidance advises against glove washing or reprocessing due to concerns over effectiveness of these practices due to potential loss of glove integrity (WHOPHOCPSBC).

  • N95 mask

    All PPE used for aerosol-generating medical procedures (AGMPs), including N95 masks, should not be used for multiple patients.

    Click for Crisis capacity guidance

Top resources

Delivering patient care in person New

The following section has been reviewed and endorsed by the Provincial Primary Care Advisory Table established by the Ministry of Health. For more information, including organizations and members involved, see the Acknowledgement and legal section.

Last reviewed: January 26, 2021
Last updated: October 6, 2020
Jump to:

Readiness assessment for delivering in-person care

The full spectrum of primary care services can be provided if safety protocols are implemented and capacity exists within the practice and local healthcare community. The CEP has developed this section to support primary care providers and their staff as they gradually increase the provision of in-person services during the COVID-19 pandemic. Adapted from the Ministry of Health’s COVID-19 Operational Requirements: Health Sector Restart (June 15, 2020), this section applies to all primary care settings.

While remote services should form the cornerstone of practice during the pandemic, clinics offering in-person visits should complete a risk assessment as per the Ministry of Health’s Directive #2.  This section provides clear guidance on how to perform and implement a risk assessment in primary care. It represents the first step of an iterative process that will evolve in response to feedback and as COVID-19 evidence and best practices evolve.

Step 1: Lay out a plan for mitigating COVID-19 transmission for in-person visits

COVID-19 hazards are:
  • Person-to-person transmission (patients, staff, and visitors)
  • Surface transmission
Identify

Under what circumstances can transmission happen?

  • Consider all aspects of the work conducted in a clinical setting – people, places, equipment, and supplies. Include non-routine activities such as deliveries, maintenance and repairs.
Anticipate

What are factors contributing to high-risk scenarios?

Consider:

  • Patients at particular risk for worse outcomes (patients with comorbidities, older adults).
  • Patients at risk for transmitting disease (children, essential workers).
  • Foreseeable risks (cleaning products running out, patient tests positive after visiting office).
  • Training, skill, and experience of healthcare workers.
Prioritize

How likely are the possible consequences to occur?

Consider:

  • Probability: the likelihood of the hazard or risk occurring.
  • Frequency: how many people will be exposed and how often.
  • Severity: the potential for the hazard to cause serious harm.
Assess controls

Is the risk controlled effectively, or is further action required?

  • If further action is required, see Step 2 to assess mitigation strategies.

Step 2: Assess possible mitigation strategies to determine feasibility for your practice setting

Clinics should assess strategies methodologically to determine what measures are feasible for each unique setting. Remember that where feasible, strategies should be adopted based on effectiveness and not ease of implementation.

Control strategies

Listed in order of effectiveness for risk reduction from most effective to least effective

Elimination

Can you physically remove the hazard?

Examples: reducing person-to-person transmission

  • Restrict patients from coming in person to the clinic. (See Step 3, balancing remote and in-person care)
  • Have staff self-monitor and not come to work if they develop symptoms. Consider using the provincial COVID-19 Self-Assessment.
  • Ensure there is space to isolate healthcare staff who develop symptoms.
  • Restrict extra visitors such as multiple family members, non-urgent services or deliveries, forms and paperwork pick up.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Substitution

Can you replace the hazard?

Examples: reducing person-to-person transmission

  • Offer remote (virtual/telephone) visits. (See Step 3, balancing remote and in-person care).
  • Have people wait outside instead of in the waiting room, and text/call when ready.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Engineering controls

Can you isolate people from the hazard?

Examples: reducing person-to-person transmission

  • Set certain days/times to see patients with acute respiratory/infectious illness. Send these patients directly to the exam room.
  • See populations at higher risk of COVID-19 complications at separate times (i.e. first thing in the morning).
  • Incorporate physical (plexiglass) barriers and spacing in the waiting area.
  • Screen all visitors for COVID-19 before entry into clinic and use signage to instruct patients about protocols.
  • Set specific times (when no patients are present) for non-clinical visitors (maintenance, repair, cleaning) to come to clinic.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Administrative controls

Can you change the way people work/move through the clinic?

Examples: reducing person-to-person transmission

  • Set certain days/times to see patients with acute respiratory/infectious illness. Send these patients directly to the exam room.
  • Have only certain staff see patients with acute respiratory/infectious illness, maintaining physical distancing where possible.
  • Perform POC Risk Assessment before each patient encounter.
  • Have all patients/visitors practice hand hygiene and wear masks for source control.
  • Space chairs to ensure physical distancing and mark out spaces for lineups on the floor.
  • If staff have recently traveled or been exposed to COVID-19, contact your local health unit for directive.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
PPE

Can you protect people with protective equipment?

Examples: reducing person-to-person transmission

Is this strategy feasible?

  • No: Refer patient to a setting equipped with required PPE.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.

Step 3: Find a balance between remote and in-person care

Efforts should be undertaken to reduce in-person visits, particularly when local disease burden is high. This does not require an “either/or” approach, but a thoughtful analysis of what aspects of patient care can be performed remotely in order reduce patient time in-clinic. It is recommended that remote visits be conducted first, followed by a curtailed in-person visit only as necessary. For detailed information on condition-specific information, see CEP’s COVID-19 Resource Centre.

Consider:
Patient access
  • Does the patient have access to the technology necessary to participate in remote visits? Telephone, internet/computer access?
  • Do they have the financial resources to use technology for a remote visit? (Some patients don’t have/can’t afford a data plan that would support a consultation.)
  • Does the patient have sufficient technological literacy to participate in remote visits? Download attachments, follow links, watch videos, send photos/videos?
  • Does the patient have access to a quiet and private place, where confidentiality can be maintained?
  • Are there language or other communication barriers that would make remote care difficult?
Clinical concerns
  • Is a physical exam necessary for diagnosis, treatment, or management?
  • See Determining when to schedule in-person vs remote visits for a guide on the problems that can be safely addressed and treated remotely.
  • Can a provider do a brief check in to monitor any deterioration in symptoms and can patients easily update providers on any changes?
  • Are there necessary measurements, scans, samples that can only be taken in-clinic? How often do these need to be taken?
  • Do remote consultation tools allow for appropriate level of assessment? Do photos/videos allow for high enough resolution? What are the targets for home measurements?
  • What is a reasonable amount of time for the patient to spend on the waitlist without negatively affecting health outcomes?
  • Are self-management tools and supports available to help the patient manage their condition at home? Apps, worksheets, videos, patient educators, helplines?
Community capacity
  • Would it be feasible to form a local network to “share” patients, as a way of expanding beyond the capacity of your individual setting?
  • Are community services available for coordinated care? (Assessment centres, community laboratories, pharmacies, specialists, rehabilitation)
  • How will community partners be impacted by an increase in services?
  • Are provincial services available to support care (ie. If patient is requesting a pap test, are these currently being processed provincially?)
Patient communications
  • Ensure patients know the clinic is open for services, as well as how to contact the clinic. Use physical signage, as well as outgoing voicemail and email signatures, and clinic website. Use physical signage for screening, hand hygiene, proper mask use, and respiratory etiquette. Signage should be accessible to all patients and visitors, reflecting the cultural context of the region and patient community. CMA has signage on high-level protections and symptoms available in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
  • Communications should be clear and timely for patients to ensure support across the full continuum of care. Set expectations about what to expect for in-person and remote (virtual and telephone) visits, how to provide information (consent documents, self-monitoring logs), how information will be shared (prescriptions, referrals, self-management resources), and the process for scheduling follow-ups.
  • Accept feedback and proactively request input. Identify patients/caregiver suggestions, expectations, and areas of concern.

Operational requirements for in-person care

Screening and testing

  • Patients and visitors should be screened over the phone before coming to the clinic.
  • Where patients present in-person without phone screening, patients and visitors should be screened upon arrival at the clinic.
  • If they screen positive, appointment should be deferred if possible and the individual referred for testing. If the appointment is urgent, refer the patient to the emergency room.
  • If a patient screens negative, appointment can be made. Remind the patient that if they develop symptoms between the time of the phone screening and the appointment, they should call the clinic for further instructions instead of coming in person.
  • Patients and visitors should be screened on-site before entering the clinic.
  • Patients and visitors should wear their own face covering. If they do not have one, provide one prior to entrance.
  • In-person screening must include staff protection as follows:
    • Best option: staff should be behind a plexiglass barrier.
    • Second option: If a barrier is not available, a 2-metre distance should be kept between screening staff and individuals being screened.
    • Last resort: if a barrier is not available and 2-metre distance is not possible, screening staff should wear PPE according to Droplet and Contact precautions.
  • If an individual screens positive, appointment should be deferred if it will not compromise patient safety, and the individual referred for testing.
  • Visitors who screen positive should not be permitted to accompany or visit the patient, pending test results. If the patient cannot attend the visit without the visitor, reschedule the visit for when an alternative visitor can accompany the patient.
  • Information about screening should be included on outgoing voicemail and email signatures, appointment confirmations, and clinic website, with links to the provincial online self-assessment tool where applicable.
  • Signage must be posted at the entrance to the clinic and in the reception area, requiring all patients and visitors to wear face coverings (if available and tolerated), perform hand hygiene, and report to reception to self-identify.
  • Signage should be accessible to all patients and visitors, reflecting the cultural context of the region and patient community. Download signage on MOH site, or see CMA’s resources in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
  • Before every patient interaction, healthcare workers must conduct a point-of-care risk assessment to determine the level of precautions required.
  • Healthcare providers may provide care to patients who screen positive for COVID-19 only if they have the PPE required to follow Droplet and Contact precautions ((Surgical/procedural mask, isolation gown, gloves, eye protection -goggles or face shield)and the sufficient knowledge to follow proper donning and doffing procedures. Practice donning and doffing with a buddy if staff are still being trained on procedures.
  • If your setting does not meet these requirements, divert the care of the patient:
    • to the emergency department if the medical reason for the appointment is urgent
    • to assessment centre for assessment and testing if the medical reason for the appointment is not urgent. In the instance where the assessment centre is only able to provide a swab, and not manage the clinical presentation, a follow up appt should be booked when swab result is negative to finish assessment and management
  • Patients who screen positive should be given a surgical mask and perform hand hygiene.
  • The patient should be isolated.
  • If an exam room is available, place the patient in the room with the door closed, avoiding contact with other patients if possible.
  • If an exam room is not available, instruct the patient to wait outside the clinic and call/text them when a room is available.
  • In the exam room, the patient should have access to tissues, hand sanitizer, and a touch-free/foot pedal-operated wastebasket.
  • Instruct patient to take their mask home with them (do not leave in waiting room) and provide information on doffing procedures.
  • Mask required and eye protection recommended for interactions with and within 2 meters of patients who screen negative.
  • No gown or gloves unless consistent with Routine Practices for specific patient symptoms.
  • Request all patients and visitors keep masks on.
  • All patients with at least one symptom should be tested.
    • Asymptomatic patients who are concerned they have been exposed to COVID-19 should be tested.
    • Asymptomatic patients who are at risk of exposure through their work (essential workers) should be tested.
  • If your setting is equipped, testing can happen on-site. All testing requires full droplet and contact PPE, even if the patient is asymptomatic.
  • If not equipped to offer testing, cases should be referred elsewhere (an assessment centre, Telehealth, etc.)

Risk assessment and mitigation

  • Have written measures for staff safety, including infection monitoring and control.
  • Ensure stable supply of essential supplies (drugs, PPE, hand hygiene and cleaning supplies).
  • Source and provide PPE through the regular supply chain, including regional leads or the provincial PPE Supplier Directory.
  • Ensure adequate staffing for services. Use information from Readiness assessment for primary care settings to ensure staffing needs are aligned with PPE availability. Consider preserving staff capacity where possible in preparation for future outbreaks.
  • Ensure service offerings align with related services such as laboratory diagnostics, rehabilitation, etc.
  • Work collaboratively with local region and other primary care providers where possible to ensure coordinated service offerings.
  • Ensure there is sufficient space to maintain 2-metre social distancing between people.
  • Redesign physical settings and interactions to minimize contact.
  • Provide face coverings where physical distancing is not possible.
  • Request all patients and visitors wear face coverings if they have them.
  • Provide tissues and lined garbage bins for patients and staff.
  • Ensure sufficient supplies for proper hand hygiene: hand washing stations and 70% alcohol hand sanitizer.
  • Post signage about symptom screening, hand hygiene, proper mask use, and respiratory etiquette. CMA has signage on high-level protections and symptoms available in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
  • Employers and healthcare workers should determine which visitors are essential, and restrict all other visitors from entering the clinic.
  • Where possible, schedule symptomatic patients for end-of-day visits.
  • Minimize the time patients spend in the waiting room. If possible for patient, have them wait outside or in the car – otherwise, stagger appointments so that social distancing can be maintained.
  • Minimize staff in the healthcare setting. Consider which roles can be performed remotely, or develop shifts to meet the necessary number of on-site staff while ensuring social distancing.
  • Ensure healthcare workers, staff, and patients use proper PPE across clinic settings and have adequate observed training in donning and doffing.
  • Healthcare providers should preserve the use of PPE by applying other mitigation strategies identified through the Readiness assessment for primary care settings.
  • If a patient comes into the setting and later tests positive, contact local health unit for advice and guidance about the risk of possible exposure for healthcare workers.
  • Staff should self-monitor for symptoms and not come to work if they develop symptoms. Consider using a daily screening form, log or app for staff as a prompt for this.
  • Ensure there is space to isolate healthcare staff who develop symptoms.
  • If a healthcare worker develops symptoms at work, they should put on a mask if not already wearing one, isolate, and they should be sent home as soon as possible.
  • If they are critical to operations, healthcare workers who have returned from travel within the last 14 days (outside of Canada or from a COVID infected area within Canada) or had a confirmed exposure to a COVID-19-positive patient must self-monitor for symptoms but may continue to work with specific precautions.
  • After every patient visit (symptomatic or asymptomatic), sanitize treatment areas, horizontal surfaces and equipment before another patient is brought in. Remember to include administrative equipment – mouse, keyboard, printer, etc.
  • All common areas should be regularly cleaned, at least twice daily.
  • Plexiglass barriers should be integrated into cleaning schedule and cleaned daily.
  • Non-essential items should be removed from patient care areas to avoid contamination.

Resources for implementation

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

Functional overview New

Text with Icon block

We use the “text with icon” field to quickly orient the user with the type of information/content to expect in the inline copy by using common and easy to understand visual cues/icons.

Used when providing guidance/best practice/recommendations re delivering care/permission to do something. 

For example:

Used when providing external links to recommendations/further information. 

For example:

Used when conveying REALLY important information that applies to the whole population, high risks, red flags, gov’t requirements, etc.  The point of use is to make the user STOP and read.  So we tended to use it sparingly otherwise the impact of the icon will be diluted.

For example:

  • Any persons experiencing one of the following should be told to self-isolate and tested as soon as possible:
    • Fever (temperature of 37.8°C or greater)
    • New/worsening cough
    • Shortness of breath (dyspnea)
    • Sore throat
    • Difficulty swallowing
    • New olfactory or taste disorder(s)
    • Nausea/vomiting, diarrhea, abdominal pain
    • Runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.)
  • There is only low-quality evidence available on COVID-19, as it is an emerging virus. Many studies being released have not been peer-reviewed. Among those that have been peer-reviewed, many are small, retrospective observational studies and thus have serious limitations and risks of bias. While the findings of emerging COVID-19 studies can be useful in helping to broaden our understanding about how the virus might operate, the results of COVID-19 studies should not be considered validated.
  • As reports of children experiencing a multi-system inflammatory syndrome multiply, the Canadian Paediatric Surveillance Program issued a Public Health Alert (CPSP, May 12, 2020) encouraging those providing paediatric care to familiarize themselves with the presentations of this emerging syndrome. It has now been included in the case definition and is reportable to public health.

Generally used when conveying information that applies to the part of the population, things that are “strongly recommended” but maybe not yet mandated, cautions, etc. Similar criteria as the (!) icon, but with a content that isn’t quite as MUST READ. The point of use is to make the user PAUSE and read.  Used more frequently.

For example:

  • OCFP and CFPC suggest strongly considering PPE use for all patient encounters that involve less than 6 feet of separation due to the possibility of asymptomatic and pre-symptomatic transmission. For more information on PPE, see Infection prevention and control: PPE, HCW infection control, cleaning.
  • While rare, clinicians should be aware of this potential syndrome and maintain a high index of suspicion to identify cases. Some patients have deteriorated quickly and have required intensive care unit admission for vasopressors and mechanical ventilation.
  • Caution should be taken when using NSAIDs in the context of acute respiratory infections (ARI) and patients with the following conditions.

Commonly used and understood icon that conveys “geolocate”. Used when linking out to regional/local resources.  

For example:

Used for when we provide talking tips.

For example:

  • Responding to questions about unproven therapies for COVID-19: “Though research is underway, there are currently no medications recommended for preventing or treating COVID-19 because there is not enough evidence to make any conclusions yet” (CMAJ, 2020).
  • “This is your home and we will make every effort to make you comfortable in your new room with all of your belongings.”
  • “In-room dining is important for you and other residents so that we can protect everyone, including yourself.”
Table block options
Table

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

  • Mostly commonly used “table”. “cleanest” in look and feel.  Allows for a maximum of 3 columns, infinite rows.
  • For example, used consistently throughout the tool in a section’s “Top resources”.
  • Inner border can be grey or blue.
Table with Icon

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

FAQ/info block

Answer 1

Answer 2

Answer 3

Another “click to reveal” block. commonly used for FAQs, chronic diseasae mgmt, special pops, etc. For example:

Please note the content contained within the answer is NOT searchable using the search function.

Stack of papers. Multiple Choice
Option 1
can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Option 2
can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Takes up a lot of page “real estate”. We tend to NOT use unless there are multiple Y/N questions/use of block consistently. For example, see: COVID-19: Social Care Guidance. Please note the content contained within the answer is NOT searchable using the search function.

Card block

We use this block when displaying similar information that has consistent headings/categories. It was originally developed to contain rx info. Allows us to use horizontal real estate and not overload the vertical/infinite scroll issue. Also gives provides opportunity to add additional information with each card that pops out for more details. Mobile friendly. Searchable in search function. For example:

Pop-out block

Designed for talking tips, etc. Generally used to contain information that is not necessarily immediately relevant for all users. But, for those that are interested, they can click to “opt-in” to view the content. Content is NOT searchable using the search function. For example:

Image block

Used for images of diagrams, static flow charts, evidence tables that go beyond three columns, etc. Please note, if we can we try NOT to use images for evidence tables are they do not render well in mobile. Where possible, consider how the content can be summarized differently/more succiently before going down the image route. For example:

Red Flags

adfafdasf

adsfasfa

["Fingerprint"]
["Fingerprint"]
['50122450']
['50122450']
["Fingerprint"]
["Fingerprint"]
['50122294']
['50122294']
['50122293']
['50122293']
["Fingerprint"]
["Fingerprint"]
['50119648']
['50119648']
["Fingerprint"]
["Fingerprint"]
['50119648']
['50119648']
["Fingerprint"]
["Fingerprint"]
['50119488']
['50119488']
["Fingerprint"]
["Fingerprint"]
['50074699']
['50074699']
["Fingerprint"]
["Fingerprint"]
['50103995']
['50103995']
["Fingerprint"]
["Fingerprint"]
['50103610']
['50103610']
['50103608']
['50103608']
["Fingerprint"]
["Fingerprint"]
['50103598']
['50103598']
["Fingerprint"]
["Fingerprint"]
['50096438']
['50096438']
["Fingerprint"]
["Fingerprint"]
['50074699']
['50074699']
['50074653']
['50074653']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']