Infection Prevention and Control in Personal Services Christian Lapensee B.A.Sc., C.P.H.I. (C) CIPHI (Guelph) June 22, 2010 Christian.Lapensee@ottawa.ca 613-580-6744 ext. 26308
Thank you CIPHI NCCEH MOHLTC OAHPP CPSO Elwood Table hosts (present and not) 2
Warning --------------------- Graphic Material 3
Adjustment For Ontario Original NCCEH premise for World Café based on Vancouver guidelines for P.S.E. Original questions not very applicable to Ontario Ontario guidelines very advanced & detailed Ontario guidelines constantly improving Ontario guidelines will be reviewed every two years (2011 target date) input from various stakeholders has been on going since 1998 Thank you to HU for input 4
HBV and HCV Diseases of Concern in PSS Mycobacteria involved in aesthetic, cosmetic, pedicure and injection related infections New species of mycobacteria named for personal services (Mycobacterium cosmeticum) HIV not directly associated with many infections Streptococcus, Staphylococcus, MRSA Pseudomonas, fungus, syphilis, tetanus, HPV, herpes, leprosy, lice 5
Hepatitis C Example Roughly 300 million cases worldwide Up to 70% show no symptoms (at least during acute phase) May remain asymptomatic for decades Cannot trace source of infection in 40% of cases Up to 35% not aware of their infection Virus can survive for long period of time PSW positive for HCV 6
What To Consider? Assume everyone is infected / Routine Practices Do not have to see blood on instruments, items, surfaces to contract infection Large % of unexplained infections have pointed to PSS as risk factor Scientific studies are limited Italian Study attributes 11.5% of HCV & - 15% of HBV cases due to beauty treatments 7
Best Methods to Protect Public in PSS? OPHS & IPCBPPSS = mandatory education of workers and clients IPAC should be part of curriculum for aesthetic schools, etc., and universities offering EH prgms Inspection and enforcement of guidelines Too many deficiencies to review today Licensing should be similar to restaurants Providing information to clients more effective compared to other public health programs 8
No Assurances From Statistics Unable to link infections due to incubation periods (unless large obvious clusters) Available statistics based on reported cases How many unreported cases? (tip of iceberg) Cannot base public health programs (and budgets) on statistics (or lack of) BB risk message is finally being updated (not just for sailors, bikers, IDU, MSM ) 9
What Services May be Considered Controlled Acts? (under RHPA) 10
Several Medical Devices - Skin Tag Removal for Example 11
Branding Torch Method 12
Strike Branding 13
Branding Cauterization Tool 14
Scarification / Cutting 15
Scarification / Cutting 16
Scarification / Skin Peels 17
Scarification and Skin Peels 18
Biomedical Waste 19
Dermal Punch Biopsy Tool Multiple Purposes for BM 20
Large Gauge Piercings 21
Implants Are Not Jewellery 22
Tissue Separators 23
Silicone Implants 24
Tongue Bifurcation 25
Ear Pointing 26
Anaesthetic, Botox Requires Analysis and Prescription 27
RHPA Health Professions Regulatory Advisory Council Under the legislation, HPRAC has a statutory mandate to advise the Health Minister on Suggested amendments to the RHPA and related Acts and their regulations Below the dermis & application of energy are the main applicable controlled acts for PSS The RHPA should only be applicable "in the course of providing health care services Colleges only have jurisdiction with respect to their members 28
If RHPA PHI cannot charge under the RHPA PHI can charge if a public health hazard (HPPA) A new act may be required RHPA always quoted word for word in every PSS situation regarding controlled acts? Botox / anaesthetic injections (PHI can only comment on IPAC procedures) Application would not work as not a health care service electrologists have tried HPRAC claims that it is up to colleges to enforce 29
CPSO Cannot consent to surgeries if the person conducting them is not licensed to do so All drugs / medication require a prescription It is illegal to provide medication to a PSW Although injections should only be performed by an RHP who has that controlled act in their scope of practice, physicians may delegate Physician-client relationship must be established after one visit it is official 30
CPSO Controlled acts listed in the RHPA allow members of RHP to perform them, but they also limit anyone else from doing them A breach of the regulations can be considered a criminal act Cosmetic and aesthetic procedures are considered health care A PSW would only be able to perform things listed in the exemptions as they would have no controlled acts in their scope of practice 31
Exemptions Apply to Public 32
Tattooing 33
Micropigmentation 34
Body Piercing (Aftercare) 35
Ear Lobe Piercing 36
Electrolysis 37
Acupuncture 38
Surface Piercing Now Common 39
Variations on Surface Piercing - Dermal Anchor Unstable 40
Variations on Surface Piercing Microdermal 41
Variations on Surface Piercing Microdermal 42
Variations on Surface Piercing Microdermal 43
Enforcement Section 13 is effective HPPA better deterrent than a small fine Profit margin for a body piercer (example) Guidelines easier to manipulate and update Regulations limit scope (rigid hard to change) PSS evolve guidelines must do the same Need grey area until all possible hazards have been identified if developing regulation Ensure guidelines are complete if regulation created 44
If A Criminal Act Police involvement is unlikely - Guelph where consent was highlighted All coverage does seem to highlight that services on minors would be an offence, so police may get involved Assault may be used for genital piercing Would push all services BACK underground Raiding spas and body piercing establishments? First conviction of a PSW will be interesting 45
Add BM Services to Guidelines Logical approach PHI is only source of information for operators Fear of endorsement by regulators Easy to add a statement at beginning of document that services listed are not endorsed as being safe or useful (as done in BC) We do not endorse piercing or tattooing, etc PSWs should be regulated, or at the very least licensed, but not through HPRAC 46
Education Of Operators, Clients Suppliers and Manufacturers 47
Keep an Eye Out for New Services 48
What Next?? 49
Thank You --------- Questions??? 50
Infection Prevention and Control in Personal Services Christian Lapensee B.A.Sc., C.P.H.I. (C) CHICA - May 31, 2010 Christian.Lapensee@ottawa.ca 613-580-6744 ext. 26308