Establishing an occupational health and infection control program in a large ambulatory care facility: Challenges and lessons learned

Introduction

Little has been documented regarding worker health and safety, knowledge, and models to deliver effective Infection Prevention and Control (IPC) and Occupational Health (OH) programs for outpatient settings, yet ambulatory care is becoming increasingly more complex. This study aimed to evaluate the determinants of a comprehensive OH/IPC program in ambulatory care that met the needs of three partners in a new ambulatory care facility in Vancouver, Canada, and to categorize gaps between needs and current level of service. 

Methods
Complementary qualitative and quantitative methods were employed. In addition to a literature review, environmental audits using Glo-Germ were conducted; workplace assessments were performed, and questionnaires were administered to staff to ascertain HCW knowledge and practice. A quasi-experimental design was used to assess the effectiveness of the education and training initiatives. 

Results
Workplace assessment findings highlighted several themes including; lack of signage, manuals and directives; physical plant issues; and equipment design, placement and/or procedural deficiencies. The survey of ambulatory care staff revealed inadequate knowledge with regard to IC and OH practices. Application of knowledge in practice was problematic, and there was an association between knowledge deficits and poor practice. There were significant differences between clinical and administrative staff in knowledge and practice. Glo-Germ Environmental audits highlighted significant gaps in cleaning processes in addition to a disconnect between what contracted cleaners felt they were responsible for and what nursing staff felt was their responsibility. 

Discussion
Gaps in knowledge and practice exist in ambulatory care; targeted training and educational initiatives are necessary for both clinical and administrative staff, with care taken to ensure that roles are responsibilities are clear. Strong managerial support and engagement by all public and private organizations represented in ambulatory care partnerships is required during all phases of program design and delivery to ensure both healthcare worker and patient safety.