Infection Control in CanadaAuthor(s): Beverly CampbellSource: Infection Control and Hospital Epidemiology, Vol. 10, No. 3 (Mar., 1989), pp. 121-122Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/30105112 .

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Readers Forum

Infection Control in Canada Beverly Campbell, RN, BScN, CIC

The Canadian health care system serves a popula- tion of approximately 25 million people spread out over a very large geographic area (9,960,000 km2). Canada is a federal state consisting of ten provinces and two territories. It was formally created in 1867 when the British North America Act (BNA Act) was passed by the British Parliament, uniting several of the British North American colonies.

The BNA Act grants the provincial governments primary jurisdiction over most health services. The federal government has jurisdiction over quarantine, the establishment and maintenance of marine hospi- tals, and the quality of food and drugs, and until recently provided health care services to the territo- ries. The federal government also helps to finance provincial health care services and, therefore, the provincial governments have been persuaded to establish hospital and medical care insurance pro- grams. The shared-cost federal programs require each province to meet certain conditions in order to obtain federal funding. This division of powers has resulted in ten distinct, although related, health sys- tems.'

Health services are not free. Although most Cana- dians do not pay directly for physician or hospital services, they do pay for these services through taxes, payroll and employee deductions, or other such mechanisms, depending on their particular provin- cial medical insurance plan. Everyone, however, has equal access to quality health care.2

FEDERAL ROLE IN INFECTION CONTROL In 1980, the Laboratory Centre for Disease Control

(LCDC) of the Health Protection Branch of National Health and Welfare allocated funds to establish the Bureau of Infection Control, in response to a growing need for an infection control resource at the national level. In a reorganization of LCDC in 1986, this bureau became the Division of Infection Control within the Bureau of Communicable Disease Epi-

From the Division of Infection Control, Bureau of Communicable Dis- ease Epidemiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa, Ontario.

Address reprint requests to Beverly Campbell, Division of Infection Control, Bureau of Communicable Disease Epidemiology, Laboratory Cen- tre for Disease Control, Ottawa, Ontario KlA OL2.

demiology. The Division of Infection Control has no legislative authority and acts primarily as a resource to those working in this field.

To date, this division has established a number of programs to assist infection control personnel. A series of infection control guidelines are available on a number of subjects ranging from the long-term care setting to the most recent, perinatal guidelines for infection control. Some of these guidelines were adapted directly from the Centers for Disease Control (CDC) guidelines, but new guidelines and revisions have become more distinctly Canadian.

A one-week intensive course developed and co- sponsored by the Community and Hospital Infection Control Association (CHICA-Canada) and the Divi- sion of Infection Control is available to assist new infection control practitioners. This course has been held each fall by the Division of Infection Control in Ottawa for the past six years and has been held in several other provinces as need has dictated.

In June 1984, the then Bureau of Infection Control initiated the Canadian Nosocomial Infection Sur- veillance Program (CNISP) with nine participating hospitals. The objectives of this program included determining nosocomial infection rates, determining pathogens responsible for the infections, monitoring the pathogens for changes in resistance profiles, and determining characteristics of the patients that acquire infections to assist in developing profiles of those at risk. A summary of the results from June 1984 to May 1985 has been published.3 Results of CNISP to date are similar to other multicenter sur- veillance programs.

Some of the participating CNISP hospitals expressed a desire to manipulate their own sur- veillance data, and in 1987 the Division of Biometrics and the Division of Infection Control developed a software program called "Surveillance Analysis Sys- tem for Infections" (SASI). There are now fifteen hos- pitals in the pilot software program. Three other hos- pitals are continuing to use the manual CNISP system and still submit surveillance data on a regular monthly basis.

The Division of Infection Control also provides consultation and pertinent reference material to those who request assistance.

INFECT CONTROL HOSP EPIDEMIOL 1989/Vol. 10, No. 3 121

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NATIONAL ORGANIZATIONS It is noteworthy that several Canadians were actively

involved in the formation of the Association of Practi- tioners in Infection Control (APIC) and that APIC's first annual conference was held in Toronto in 1972. The Canadian Hospital Infection Control Associa- tion was founded in 1976 and in 1985 changed its name to the Community and Hospital Infection Con- trol Association-Canada (CHICA-Canada) to reflect the importance of a multidisciplinary approach to infection control.

CHICA-Canada has 600 members and 13 regional chapters. The major goal of the organization is to provide a national, professional, bilingual organiza- tion for all persons directly involved or associated with infection control. During the past year CHICA- Canada's public relations committee has established a national infection control week to coincide with the American infection control week. A planning guide to assist persons planning an infection control week has been prepared and mailed to all members as well as numerous institutions and agencies to promote the importance of infection control.

Conferences are held biannually with regional sym- posia held during alternate years. CHICA-Canada publications include a newsletter and journal that are mailed to all members four times yearly.

ACCREDITATION OF HEALTH CARE FACILITIES

A Canadian Council on Hospital Accreditation was chartered by the federal government in 1958 author- izing the development of national standards. Before 1958 Canadian hospitals could participate in the American hospital accreditation program. Accredita- tion is a voluntary process and the surveyors are health professionals selected from a pool of interested individuals. Accreditation standards require that effective measures for the control of infection shall be established, instituted, directed, reviewed, and modi- fied as appropriate.4 Approximately 600 facilities were surveyed in 1988 (personal communication, Canadian Council on Health Facilities Accreditation, July 1988).

INFECTION CONTROL PROGRAMS AND PERSONNEL

In 1981, the Bureau of Infection Control surveyed all Canadian hospitals (N=1,239) to gather baseline information on infection control programs and prac- tices in Canadian hospitals.5,6 At that time 63% of these hospitals indicated that they had an infection control program of some kind, and accredited hospi- tals appeared more likely to have some sort of pro- gram in place (81%). Infection control committees were reported in 61.8% of responding hospitals, and the membership of these committees was multi- disciplinary. Membership of the committee also var- ied considerably depending on the type of hospital.

Of hospitals with infection control programs, 82.3% had written guidelines available and 93.2%

carried out some type of surveillance. Total or tradi- tional surveillance was not extensively practiced, par- ticularly by infection control practitioners whose positions were part-time. Laboratory reports were the most common triggering mechanisms for sur- veillance (84.3%), and infection control reports were also frequently used (75.3%).

The first infection control practitioner positions were established between 1950 and 1955; however, the majority of positions (80.6%) were established after 1971. In 1981, only 18.6% of infection control practi- tioner (ICP) positions in Canadian hospitals were full-time, and most positions were held by nurses (92%). In 1984, a survey of ICPs in hospitals larger than 200 beds supported the findings of the 1981 study.? That is, 12% of hospitals over 200 beds did not have an ICP, and the ratio of ICPs to bed size was low in Canadian hospitals.

In the 1984 survey only 26% of responding ICPs held department manager supervisory positions. Although ICPs generally reported to the laboratory, administration, or nursing departments, a wide vari- ety of other reporting relationships were indicated. Currently there is no certification program for Cana- dian ICPs; however, many Canadian ICPs have success- fully completed the American certification program.

In 1987, a survey of 1,358 Canadian long-term care facilities was undertaken to determine the scope of infection control programs and personnel in these types of facilities (unpublished data, Division of Infec- tion Control, LCDC). Written infection control guide- lines were available in 53.6% of responding facilities and infection control committees in 41.2%. Less than half (44.2%) indicated that there was one individual responsible for infection control. It was also found that, on average, 4.7 hours per week were spent on infection control in these facilities.

SUMMARY The information presented here reflects the

activities of those organizations and agencies with the most impact on infection control in Canada. There are, however, numerous other organizations both on a national and provincial level that also play important roles in infection control. Although great strides have been made in infection control in Canada, we still have much to do to raise the profile of this important activity. REFERENCES 1. Soderstrom L: The Canadian Health Care System. London, Croom Helm

Ltd, 1978, pp 14-19. 2. Begin M: Medicare Canada's Right to Health. Montreal, Optimum Publish-

ing International Inc, 1987, pp 46-58. 3. Canada Diseases Weekly Report: Canadian Nosocomial Infection Sur-

veillance Program. Annual Summary June 1984-May 1985. Health and Welfare Canada, October 1986, Vol 12S1.

4. Canadian Council on Hospital Accreditation: Guide to Accreditation of Canadian Health Care Facilities. Ottawa 1986, CCHA.

5. Losos J, Trotman M: Infection control practices in Canadian hospitals. Am J Infect Control 1984; 12:289-292.

6. Losos J, Trotman M, Campbell B: Profile of infection control practitioners in Canadian hospitals. Am J Infect Control 1984; 12:325-328.

7. Campbell BA, McCunn SM, Trotman M, et al: The infection control practitioner in Canadian hospitals with more than 200 beds. Am J Infect Control 1986; 14:224-228.

122 Readers' Forum/Campbell

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