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Exposure of Emergency
Service Workers to
Infectious Diseases
August 17th, 2012
GLOSSARY
AIDS
Acquired Immunodeficiency Syndrome
Antibodies
Acting as the body’s army, antibodies are proteins generally found in the blood that detect
and destroy invaders, like bacteria and viruses.
Antigen
A substance that when introduced in the body stimulates the production of an antibody
(e.g. bacteria).
Antiseptic
A substance that kills or prevents the growth of bacteria. It is applied to living tissue/skin
to prevent an infection. (e.g., Polysporin)
Applicant
Baseline
Person who submits an application to the Medical Officer of Health (health unit) for an
order
Baseline testing is performed in order to have results to compare to.
Blood-borne pathogens
A disease that can be spread by contamination with blood.
Bodily fluids
Any fluid that originates from the body. (e.g., blood, semen, vaginal secretions, saliva, etc.)
DO
Designated Officer
ESW
Emergency Service Worker
HBV
Hepatitis B
HCV
Hepatitis C
HIV
Human Immunodeficiency Virus
Mucous membranes
A lining that is involved in absorption and secretion. They line cavities that are exposed to
the external environment and internal organs. (e.g. nostrils and mouth)
Pathogen
A bacteria, virus or other microorganism that can cause disease.
Percutaneous injury
An injury that penetrates the skin (e.g., needlestick, cut with a sharp object)
PEP
Post-exposure prophylaxis – refers to medication that can be given after an exposure to
certain types of infectious diseases. (e.g. HIV, HBV)
PPE
Personal Protective Equipment (e.g. , gloves, N95 masks, goggles)
Respondent
Person who has been identified by an applicant as a person whose bodily substances may
have come into contact with the applicant.
Routine practices
Refers to the infection prevention and control practices to be used with all clients. (e.g.,
wear gloves, wash hands)
Source person
Refers to the person whose blood came into contact with the exposed person.
Window period
The window period for HIV infection refers to the period between the time a person
becomes infected with HIV and the time he or she develops antibodies to HIV that are
detectable with current tests.
Table of Contents
Contact information
Reportable disease list
Exposure of ESW to ID protocol .............................................................................................................. 1
Introduction ............................................................................................................................... 1
Roles and responsibilities ........................................................................................................... 2
Emergency Service Agency ............................................................................................. 2
Emergency Service Worker (ESW)................................................................................... 2
Designated Officer (DO) .................................................................................................. 2
Public Health .................................................................................................................. 2
Method of notification ............................................................................................................... 4
Initiated by ESW ............................................................................................................. 4
Initiated by DO ............................................................................................................... 4
Initiated by Public Health................................................................................................ 4
Assessing exposures and actions ............................................................................................................ 6
Blood-borne .................................................................................................................................... 6
Immediate steps – First Aid ........................................................................................................ 7
Post-Exposure Testing ................................................................................................................ 7
Mandatory Blood Testing Act 2006 ............................................................................................ 8
Post-Exposure Prophylaxis (PEP) ................................................................................................ 9
Airborne .......................................................................................................................................... 9
Droplet/Contact............................................................................................................................. 10
Prevention of infectious diseases ......................................................................................................... 12
Chain of transmission .................................................................................................................... 13
Modes of transmission .................................................................................................................. 14
Routine practices and additional precautions ................................................................................ 15
Fact sheets
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Influenza
Pertussis
Group A streptococcus infections
Hepatitis B
Hepatitis C
HIV/AIDS
Tuberculosis
Contact Information
Infectious Disease Program
705-267-1181
After hours emergency number:
1-800-461-1818
Regular office hours
Monday – Friday
8:30 a.m. – 12:00 noon & 1:00 p.m. – 4:30 p.m.
Summer office hours
Monday – Friday
8:00 a.m. – 12:00 noon & 1:00 p.m. – 4:00 p.m.
Answering service available 24hrs/7 days a week
REPORTABLE DISEASES
The following specified Reportable Disease, (Ontario Regulation 559/91 and amendments under the Health
Protection and Promotion Act, 1990) are to be reported to the Local Medical Officer of Health.
Acquired Immunodeficiency Syndrome (AIDS)
►Hantavirus Pulmonary Syndrome
Pneumococcal Disease, invasive
Acute Flaccid Paralysis
►Hemorrhagic fevers, including:
►Poliomyelitis, acute
Amebiasis
►1. Ebola virus disease
Psittacosis/Ornithosis
►Anthrax
►2. Marburg virus disease
►Q Fever
►Botulism
►3. Other viral causes
►Rabies
►Brucellosis
►Hepatitis A
►Respiratory infection, institutional outbreaks
Campylobacter enteritis
Hepatitis B
Rubella
Chancroid
Hepatitis C
Rubella, congenital syndrome
Chickenpox (Varicella)
Influenza
Salmonellosis
Chlamydia trachomatis infections
►Lassa Fever
►Severe Acute Respiratory Syndrome (SARS)
Cholera
►Legionellosis
►Shigellosis
►Cryptosporidiosis
Leprosy
►Smallpox
►Cyclosporiasis
►Listeriosis
Syphilis
►Diphtheria
Lyme Disease
Tetanus
Malaria
Transmissible Spongiform Encephalopathy:
►Encephalitis, including:
1. Primary, viral (including WNV)
►Measles
1.Creutzfeldt-Jakob Disease, all types
2. Post-infectious
►Meningitis, acute
Trichinosis
3. Vaccine-related
► 1. bacterial
Tuberculosis
2. viral
►Tularemia
3. other
Typhoid Fever
4. Subacute sclerosing panencephalitis
5. Unspecified
►Food poisoning, all causes
►Meningococcal disease, invasive
►Verotoxin-producing E. coli infection indicator
►Gastroenteritis, institutional outbreaks
Mumps
conditions including Hemolytic Uremic Syndrome(HUS)
►Giardiasis
Ophthalmia Neonatorum
►West Nile virus Illnesses:
Gonorrhea
►Group A Streptococcal Disease, invasive (iGAS)
Group B Streptococcal Disease, neonatal
►Paralytic Shellfish Poisoning
Paratyphoid fever
Pertussis (Whooping Cough)
1.West Nile virus Fever
2.West Nile virus Neurological Manifestations
►Yellow Fever
►Haemophilus influenza b disease, invasive
►Plague
Yersiniosis
Note: Disease marked ►and all respiratory infection outbreaks in institutions should be reported immediately by
telephone, to the Medical Officer of Health. Other diseases are to be reported the next working day.
To report a disease or for more information,
please contact the Porcupine Health Unit at:
(705) 267-1181, toll-free 1-800-461-1818
or by confidential fax at (705) 360-7324
www.porcupinehu.on.ca
Ontario Regulation 559/91 under the Health Protection and Promotion Act amended on December 2013.
Exposure of Emergency
Service Workers to
Infectious Diseases
August 17th, 2012
INTRODUCTION
The Exposure of Emergency Service Workers to Infectious Disease protocol was established in 2008. It
replaces the Notification of Emergency Service Workers protocol which had been established in 1994 by
the Ontario Ministry of Health and Long Term Care.
The purpose of this protocol is to ensure that:
1. Emergency service workers (ESWs) are notified by the Porcupine Health Unit in the event
that he/she may have been exposed to an infectious disease of public health importance so
that appropriate actions can be taken. A list of the reportable diseases is accessible on the
Porcupine Health Unit website.
2. Designated officers (DOs) are able to obtain advice from the Porcupine Health Unit
regarding possible exposure(s) of ESWs to infectious diseases of public health importance.
This document was created to identify the roles and responsibility for each individual, including the
Emergency Service Agency, ESWs, DOs and Public Health. It will also provide a process that will facilitate
communication between Public Health and Emergency Service Agencies in our community.
There is a section on assessing exposures and recommended actions. This section will also include an
overview of the Mandatory Blood Testing Act 2006. Additional tools and resources will be highlighted
throughout the document.
A copy of the protocol is available on our website and in appendix at the end of this document.
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ROLES AND RESPONSIBILITIES
To ensure the protocol is effective, everyone must understand their role. This will ensure the workers
receive the best possible care if they are exposed to an infectious disease.
Emergency Service Agency
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Appoint Designated Officer (DO).
Advise the Porcupine Health Unit (PHU) of any new DOs.
Assess the risks of occupational exposure.
Set standards of practice; provide training and appropriate personal protective equipment.
Inform all staff who the DO and/or alternate is for the agency.
Emergency Service Worker (ESW)
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Be aware of the risks of exposure to the specified infectious diseases and understand how to
prevent or minimize the risk of exposure.
Prevent exposures by using routine practice and appropriate procedures and/or personal
protective equipment.
Comply with workplace health and safety policies.
Report any possible exposure immediately to the DO or alternate.
Designated Officers (DO)
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Receive and document reports of exposure from ESW.
Assess the situation and determine if an exposure could have occurred.
Refer to DO’s Manual regarding assessment for post-exposure and recommendations for action.
Contact Porcupine Health Unit and provide details of the incident if assistance is needed.
Relay recommendations for post exposure follow-up to any exposed workers.
Porcupine Health Unit may advise that a worker has been exposed to an infectious disease; it is
the responsibility of the DO to notify the worker.
Public Health
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Keep an up-to-date list of DOs in our area (e.g., police, firefighters, ambulance) in order to
facilitate the exposure notification process.
Receive reports of infectious diseases specified on the reportable disease list on a 24/7 basis and
respond as soon as possible, no later than 48 hours (depending on situation and/or disease).
Provide DOs and the Emergency Service with up-to-date information on infectious diseases.
Provide consultations at the request of the DO following an assessment of a suspected exposure
to help determine if a significant exposure has occurred.
Contact the DO for ESWs on duty who are contacts of an infectious disease.
Follow up on reportable infectious diseases when they are received.
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DO NOT expect Porcupine Health Unit to:
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Gather information from the ESW (role of the DO).
Provide specific treatment advice (role of the ESW’s physician).
Provide information on the diagnosis of a patient (confidential).
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METHOD OF NOTIFICATION
Method 1
Notification initiated by an Emergency Service Worker (ESW)
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An ESW who believes that he/she may have been exposed to one of the specified infectious
diseases should immediately report the incident to the DO or alternate.
The ESW should provide detailed information of the situation, and any other information the DO
may need.
Agency-specified forms should be filled out by the ESW
The DO then refers to the resource manual, agency policies and may consult the Porcupine
Health Unit’s Infectious Disease intake nurse or inspector for recommended actions.
Method 2
Notification initiated by Porcupine Health Unit
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In the course of routine case management for infectious disease, the Porcupine Health Unit may
receive a report of an infectious disease where there is a concern that ESWs could have been
exposed. This notification of possible exposure may come to the Porcupine Health Unit from
several different sources (e.g., physicians, hospitals or other health units)
The Porcupine Health Unit shall notify the appropriate Emergency Service Agency’s DO (police,
fire, EMS) of possible exposure.
Notification will include recommendations for action. Specific criteria may have to be met for
the ESW to be considered a contact (e.g., shared confined space for more than 1 hour).
Notification will NOT include disclosure of any information concerning the source of the
possible infection in order to maintain confidentiality.
Proper documentation of the exposure is the responsibility of the DO, and should be done on
agency-specific forms. There is no requirement to forward these forms to the Porcupine Health
Unit.
If the ESW is confirmed as having had exposure to an infectious disease, Porcupine Health Unit
will notify them of recommended actions or prophylactic medications (e.g., antibiotics), if
necessary. All contact information will be kept confidential.
Method 3
Notification initiated by Designated Officer
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If an ESW has expressed his/her concern about a possible or known exposure to one of the
specified infectious diseases while offering emergency services, the DO should inform the ESW
to complete the appropriate forms (agency-specified forms).
The DO will assess the exposure based on the information provided by the ESW.
The DO should refer to the appropriate section of this manual for information on assessment of
exposures. The information is available on the Porcupine Health Unit website.
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The DO should determine whether the ESW could have been exposed to a specified infectious
disease.
If the DO determines that an exposure could have occurred, he/she will provide the ESW with
post-exposure recommendations based on agency policies and information in the Designated
Officer’s Resource Manual.
If the DO is not sure of the appropriate recommendations for post exposure, the DO should
contact the Porcupine Health Unit. The Porcupine Health Unit will respond as soon as possible
after receiving a call, no later than 48 hours (depending on situation and/or disease).
The DO communicates recommendations made by the Porcupine Health Unit to the ESW.
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Assessing
Exposures
August 17th, 2012
ASSESSING EXPOSURES
1. Diseases Spread by Blood-Borne Route
In the course of their duties, an ESW may accidentally be exposed to body fluids. This section is to
prevent the transmission of blood-borne pathogens such as HIV, Hepatitis B (HBV) and Hepatitis C
(HCV) and to establish a system for managing potential exposures in a timely manner.
The type of body fluid and the type of incident must be investigated to determine if the exposure of the
emergency service worker to a blood-borne pathogen is significant. A combination of one type of body
fluid and one incident listed below constitutes a significant exposure.
a. Type of Body Fluids
Body fluids capable of transmitting HBV, HCV and HIV from an infected individual include:
 Blood, serum, plasma and all biologic fluids visibly contaminated with blood;
 Vaginal secretions and semen (unlikely to transmit HCV);
 Saliva (for HBV only, unless contaminated with blood).
Feces, nasal secretions, sputum, tears, urine and vomit are not implicated in the
transmission of HBV, HCV and HIV unless visibly contaminated with blood.
b. Types of Incident
Incidents in which body fluids listed above, comes into contact with the person’s:
 Tissue under the skin
 Non-intact skin (e.g., cut, chapped or abraded skin);
 Mucous membrane (e.g., eyes, nose or mouth).
An exposure to these viruses can occur as a result of:
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A needle stick injury, with a used needle
An injury with a sharp object that has been in contact with body fluids
Damaged skin (rash, or open wound), that has come in contact with body fluid
Splashing of blood or body fluids into the mouth or eye
Splashing of mouth, eye, or open wound with another body fluid (e.g., vomit) that has blood in
it.
A bite that breaks the skin
An exposure to these viruses does NOT occur as a result of:
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A needle stick, where the needle has not been used
Blood or body fluids coming in contact with hands covered by intact gloves
Blood or body fluids coming in contact with intact skin
Blood or body fluids coming in contact with protective clothing
Splashing of blood or body fluids into the face where a mask and goggles were worn
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Managing Occupational Exposures to Blood-borne Pathogens
I. Immediate Steps & First Aid
 For percutaneous injuries, allow wound to bleed freely and then wash it gently but thoroughly
with soap and water. Apply an antiseptic to the wound if applicable.
 Flush mucous membranes exposed to bodily fluids with water.
 Remove contaminated clothes.
 Inform the supervisor or designated officer immediately. They will help the ESW decide if it is a
significant exposure and will contact the Porcupine Health Unit if guidance is needed. They may
also require additional forms to be completed such as a WSIB report.
 Complete an incident report according to your workplace policies. Please note that a sample
incident report is available in this package and on our website.
 If the exposure is significant, the exposed worker should seek medical attention from a physician
as soon as possible.
II. Post-Exposure Testing of the Exposed Person
The DO or supervisor should strongly encourage the exposed ESW to get tested for HIV, HBV and HIV.
Without baseline data, any future claims for compensation may be jeopardized. Baseline testing is done
by the physician.
HIV baseline: within one week of the incident then at 2-4 weeks and 3 months. For individuals
who have a severely impaired immune system or have taken PEP, testing should also be
repeated at 6 months.
HBV baseline: Depends on the immunization history/documentation of protective antibody
level. If the exposed person has a documented immunity to HBV, no testing is required. If
immunity is unknown, the person should be tested as soon as possible after exposure and if
negative, again at 3 months and 6 months.
HCV baseline: The exposed person should be tested as soon as possible after exposure and if
negative, again at 3 months and 6 months.
III. Testing of the Source Person
If the source person is known, testing is recommended when their HIV, HBV and HCV status is unknown
or uncertain. The source should also be assessed for current risk factors because he/she may be in a
window period when testing occurs.
The most efficient way to obtain source testing is by voluntary consent. The exposed person or a
designated officer/supervisor should directly ask the source to agree to be tested for blood-borne
diseases. Consent should be obtained from the source to release the results to the exposed person’s
physician.
If voluntary consent is not achieved, the exposed person may choose to initiate the Mandatory Blood
Testing process in accordance to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07.
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IV. Mandatory Blood Testing Act 2006
A person may apply for an order for taking a blood sample under the Mandatory Blood Testing Act 2006
if he/she has come into contact with a bodily substance of another person:
1. As a result of being a victim of a crime;
2. While providing emergency health care services or emergency first aid to the person, if the
person was ill, injured or unconscious as a result of an accident or other emergency;
3. In the course of his or her duties, if the person belongs to a prescribed class, including:
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Persons who are employed in a correctional institution, place of open custody or place of
secure custody
Police officers, employees of a police force who are not police officers, First Nations
Constables and auxiliary members of a police force
Firefighters, including volunteers
Paramedics and emergency medical attendants
Members of the College of Nurses of Ontario
Members of the College of Physicians and Surgeons of Ontario
Paramedic students engaged in field training
4. While being involved in a prescribed circumstance or while carrying out a prescribed activity
This act allows for faster access to the source person’s HIV, HBV and HCV status which can reduce
anxiety and the time that the exposed person needs to take PEP. Please note that it is the responsibility
of the ESW to ensure all required forms are completed. Forms are available at the Porcupine Health
Unit and may also be found on the Ministry of Community Safety and Correctional Services website.
Please see link below. Lab requisitions are exclusively provided by the health unit and Public Health Lab.
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/MinistryResults?Openform&SRT=T&MAX
=5&ENV=WWE&STR=1&TAB=PROFILE&MIN=008&BRN=10&PRG=
Specific requirements must be met for the Porcupine Health Unit to be able to proceed with the act.
Review the following checklist:
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Application must be received within 7 days of the occurrence, includes applicant report and
physician report.
The Identification of Respondent section of the applicant report must be completed.
If the applicant was a victim of a crime, a police report must be made.
Applicant must consent to the release of personal health information
Applicant must consent to the release of information on police report
Applicant must consent to examination by a physician
Applicant must consent to counseling
Applicant must consent to baseline testing
Applicant must consider recommended PEP
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V. Post-Exposure Prophylaxis (PEP)
1. HIV: The need for HIV anti-viral medications must be quickly assessed by a physician based on
the nature of the exposure and the risk of / knowledge that the source is HIV positive.
According to the CDC, PEP regimens should include a basic regiment of Zidovudine 300mg BID
and lamivudine (3TC) 150mg BID. They may be given in a combined form as Combivir for 4
weeks. A protease inhibitor, (e.g. Kaletra) can be added to the basic regimen for high-risk
exposures.
These medications are preferably started within an hour of the exposure but can be given up to
72 hours after. They are very expensive and can cause side effects such as nausea, fatigue and
diarrhea. There is no guarantee that PEP will prevent HIV infection.
2. HBV: When the source person is HBV positive or their immune status is unknown, steps to be
taken by the exposed person depend on their vaccination and antibody status.
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If the exposed person has documented evidence of immunity, there is no need for postexposure prophylaxis.
If the immune status is unavailable within 48 hours, the person could receive Hepatitis B
immune-globulin (HBIG). It should be administered as soon as possible after the
incident. It is believed to be somewhat effective up to 7 days after the exposure;
however, efficacy decreases substantially when it is given more than 48 hours after
exposure.
If the person is not showing immunity or has not completed their vaccine series, they
need to be assessed by a physician to see if they require an additional dose.
3. HCV: There is no vaccine or PEP available for Hepatitis C.
2. Diseases Spread By Airborne Route
Small bacteria and viruses such as tuberculosis, measles and chickenpox can be spread over long
distances by air current. These microorganisms are so small that they can float in the air and can be
spread through coughing, sneezing, laughing, talking and singing. Wearing a fit-tested N95 respirator is
the only type of personal protective equipment (PPE) that will prevent the transmission of these
diseases.
An exposure to these diseases could occur when:
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Enclosed in a confined space (e.g., ambulance, car) over a long period of time with an individual
who is coughing vigorously
Giving mouth-to-mouth resuscitation without barrier protection
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An exposure to these diseases is unlikely to occur when:
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ESW is confined in an enclosed area with a coughing individual, when either or both are wearing
an N-95 mask that covers mouth and nose
Mouth-to-mouth resuscitation was performed using barrier protection or bag valve
Assessing exposure
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How often and for how long was the ESW in contact with the individual?
How close was the ESW to the individual?
Did the ESW perform any procedures that put him/her in face-to-face contact with the
individual?
Was the ESW in a confined space with the patient? Was there any air circulation?
Did the ESW use appropriate PPE?
Actions:
1. ESW should notify DO immediately.
2. ESW should see family physician for assessment of exposure to TB. Alternately, the ESW may
attend Porcupine Health Unit for a TB skin test.
Note: Recommendation for TB skin testing may differ depending on timing of exposure.
3. Testing for TB usually includes skin testing done after exposure and again at 8 weeks. The test
must be read 48-72 hours later by a doctor or nurse. If the skin test is positive, a chest x-ray is
performed to assess for active TB disease. If the ESW has a positive skin test or other tests
indicative of infection, medication may be recommended.
3. Diseases Spread by Droplet and/or Direct Contact
Meningococcal Disease (meningitis), Invasive Group A Streptococcus (IGAS) and Influenza are examples
of disease that are spread by droplet and direct contact. They are spread through respiratory secretions
by contact with the mucous membranes of the eye, nose and mouth, when providing care within 2
metres of the patient. These secretions can contaminate objects and persons. Depending on the
situation, gloves, gowns, masks and goggles may be required.
An exposure to these infections could occur when:
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Giving mouth-to-mouth resuscitation without barrier protection or bag valve
Someone with one of these infections coughs or sneezes directly in the face of an ESW
without proper PPE (mask and eyewear)
Suctioning or intubation without proper PPE (mask and eyewear) where nasal or oral
secretions come in contact with mucous membranes.
Contact with fluid from a wound without proper PPE
An exposure to these infections does NOT occur when:
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Barrier protection or bag valve is used for mouth to mouth resuscitation
Uncovered intact skin comes in contact with the saliva, nasal secretions or fluid from a wound
of someone with these infections
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Routine practices are followed
Being in an enclosed space with someone who has one of these infections
Assessing exposure:
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Did the ESW perform any procedures that put him/her in direct contact with oral/nasal
secretions?
Did the ESW wear appropriate PPE?
Did the ESW have any broken areas on their skin?
Actions:
1. The ESW should notify the DO immediately. The DO should notify the Porcupine Health Unit of
contact for recommendations regarding preventative antibiotics or vaccines.
2. The ESW should seek assessment from a physician as soon as possible. Prophylactic medication
may be recommended for ESWs in direct contact with oral/nasal secretions or direct contact
with lesions with inappropriate PPE.
3. Prophylactic medication is not routinely indicated for ESWs unless there is a confirmed
exposure.
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Incident Report for Exposures
Reported/Received by:
Date:
Telephone number:
Date and Time of Incident:
TYPE OF INCIDENT
Bite (skin is broken)
Needle stick/sharps injury
Blood / bodily fluid exposure (e.g., splash in eye, nose or mouth)
Other (specify infectious disease):
Details of Incident (what happened?): ______________________________________________________________
_____________________________________________________________________________________________
_________________________________________________________________________
*For infectious diseases, contact the Porcupine Health Unit for disease specific recommended actions.
PERSON EXPOSED
Name:
DOB (yr/mo/day):
Address:
City:
Postal Code:
Telephone:
Physician:
Physician Telephone:
CURRENT IMMUNIZATION STATUS AND TST HISTORY (if applicable)
Tetanus: Primary series  Yes
 No
Date of last booster (yr/mo/day):
Hepatitis B Vaccine: Series complete?  Yes
 No
 Yes
 No
Previous positive TST?
Anti-HBs titre:
IU/L
FOR BLOOD / BODILY FLUID EXPOSURE COMPLETE THE FOLLOWING
Was first aid administered?  Yes
Baseline Testing
 No
 Yes
Was baseline testing done?
Date
 No
Results
□ Hepatitis B
□ Hepatitis C
□ HIV
* Please note that the exposed person needs to be seen by a physician to have baseline testing done.
SOURCE PERSON
Is source person known?
 Yes
 No
Name:
DOB (yr/mo/day):
Address:
City:
Postal Code:
Telephone:
Physician:
Physician Telephone:
If the status of the source person with respect to blood-borne pathogens is unknown, recommend voluntary
testing for the source person as soon as possible. If the source person does not comply with voluntary testing,
refer to the Designated Officer Resource Manual or visit the Porcupine Health Unit website for information on the
Mandatory Blood Testing Act 2006.
Prevention of
Infectious Diseases
August 17th, 2012
PREVENTION OF INFECTIOUS DISEASE
The Body’s Immune System
When the immune system is functioning effectively, it protects the body from most infectious
organisms. The immune system does this both directly by cell attack, and indirectly by releasing
chemicals and protective antibodies.
The body’s first line of defence against the invasion of disease-causing microorganisms is the skin and
mucous membranes. As long as the skin is unbroken, it provides a physical barrier to most
microorganisms. Intact mucous membranes provide similar mechanical barriers within the body. The
mucous membranes also secrete chemicals to kill pathogens. For example, the stomach mucosa
secretes acid that kills bacteria.
The body uses cells, mostly white blood cells, and chemicals released from cells, to directly attack and
kill the pathogens and help repair tissues. This is seen in the inflammatory response surrounding an
infected cut. This is the body’s second line of defence that is triggered whenever body tissues are
injured.
The body’s third line of defence is the immune response. The immune response provides protection
that is targeted against specific disease-causing organism (antigens) and has memory. After initial
exposure to the antigen, the body recognizes the antigen and reacts more vigorously at later meetings
to destroy it anywhere in the body. The body produces “antibodies” against the disease and provides
immunity.
Immunity to a disease is acquired either actively or passively. Active immunity is either naturally
acquired after having the disease, or artificially acquired after receiving the vaccine for that disease.
Vaccines are beneficial in that they provide the immunity without having to suffer the sometimes severe
symptoms of disease. Vaccines stimulate antibody production and promote immunological memory.
Passive immunity is immunity that is obtained from an outside source. Passive immunity is passed from
mother to fetus through the placenta into the fetal circulation. This protects the infant from diseases the
mother has immunity to, for several months after birth. Passive immunity can also be acquired
artificially when a person receives and injection of immune globulin. This medication is derived from
donated blood serum from a person who has the antibodies to that disease. The donated antibodies
provide immediate protection but it only lasts a short period of time. This type of passive immunity
(immune globulin) may be given to a person without immunity, for example, after exposure to Hepatitis
B. Hepatitis B vaccine is also administered so that the person can produce his/her own antibodies to
provide long-term protection.
12
The infection process can be described as a chain of infection. Understanding the chain must precede
the breaking of the links, which leads to prevention of infection. Each component of this chain is
connected to another link in the chain of infection.
Infectious Agent – The infectious agent is a biological, physical or chemical entity capable of causing
disease. (e.g., virus, bacteria, parasite, fungus, vectorborne)
Reservoir – The reservoir is the place where the infectious agent can survive but may or may not
multiply. Human reservoirs usually have the disease, they can be acute or carriers of the disease. A
carrier is a person who is capable of spreading the disease, but has no identifiable signs or symptoms of
the disease.
Portal of Exit – The portal of exit is the path by which the infectious agent leaves the reservoir (e.g.,
respiratory tract, genitourinary tract, gastrointestinal tract, skin, mucous membranes, placental [mother
to fetus], blood).
Mode of transmission – Mode of transmission is the method by which the organism reaches a
susceptible host. (e.g., direct contact, indirect contact, airborne, vehicle [food and water], vectorborne)
Portal of Entry – Portal of entry is the means the infectious agent enters the body; they are the same as
portal of exits.
Susceptible Host – The susceptible host may have characteristics that influence the susceptibility and
severity of disease.
The control of infectious disease involves breaking this chain of infection by altering the host, the
environment or the agent. (e.g., hand washing or wearing PPE)
13
Modes of Transmission
Microorganisms are transmitted in by several routes, and the same microorganism may be transmitted
by more than one route. There are five main routes of transmission: contact, droplet, airborne, common
vehicle and vectorborne.
1. Contact transmission, the most important and frequent mode of transmission of health care
associated infections (HAI), is divided into direct and indirect contact transmission.
 Direct contact transmission involves a direct body surface-to-body surface contact
and physical transfer of microorganisms between an infected or colonized person.
 Indirect contact transmission involves contact between a susceptible host and
usually a contaminated inanimate object, such as equipment instruments, and
environmental surfaces. This is often the result of contaminated hands that are not
washed which contaminate the object or environment.
2. Droplet transmission, theoretically, is a form of contact transmission. However, the
mechanism of transfer of the pathogen to the host is quite distinct from either direct or
indirect contact transmission. Droplets are generated from the source person primarily
during coughing, sneezing, talking and during the performance of certain procedures such as
suctioning and administering nebulized medications. Transmission occurs when droplets
containing microorganisms generated from the infected person are propelled a short
distance through the air (usually less than one metre) and deposited on the host’s
conjunctivae, nasal mucosa, or mouth. Because droplets do not remain suspended in the air,
special air handling and ventilation are not required to prevent droplet transmission.
Droplets can also contaminate the surrounding environment and lead to indirect contact
transmission.
3. Airborne transmission occurs by dissemination of either airborne droplet nuclei (small
particle residue (5 mm or smaller in size) of evaporated droplets containing microorganisms
or dust particles containing the infectious agent (e.g., dust created by rotary powered foot
care tools). Microorganisms carried in this manner remain suspended in the air for long
periods of time and can be dispersed widely by air currents. These may become inhaled by a
susceptible host within the same room or over a longer distance from the source client
depending on environmental factors. Environmental controls are important: special air
handling and ventilation help reduce airborne transmission. Microorganisms transmitted by
airborne transmission include Mycobacterium tuberculosis, Measles, Varicella (Chickenpox).
4. Common vehicle transmission applies to microorganisms transmitted by contaminated
items such as food, water and medications to multiple hosts and can cause explosive
outbreaks. Control is through using appropriate standards for handling food and water and
preparing medications.
14
5. Vectorborne transmission occurs when vectors such as mosquitoes, flies, rats, and other
vermin transmit microorganisms; this route of transmission is of less significance in health
care facilities in Canada than in other settings.
Routine Practices and Additional Precautions
Routine practices and additional precautions are a set of infection control precautions that should be
used for the care of all individuals, regardless of their diagnosis or presumed infection status. Routine
practices apply to:



Blood
All bodily fluids, secretions and excretions regardless of whether they contain visible blood
Non-intact skin and mucous membranes
Personal Protective Equipment (PPE)
To protect yourself, it is essential to have a barrier between you and the potentially infectious material.
These barriers include gloves, gowns, masks, eye shields and mouth guards.




Always wear appropriate PPE in exposure situations.
The necessary PPE should be readily available in the work area.
Remove any PPE that is torn or punctured, or has lost its ability to function as a barrier to bloodborne pathogens.
Remove PPE before leaving the work area and place in appropriately labelled bags to be
disposed of or decontaminated. Refer to the order of putting on and taking off personal
protective equipment fact sheets that follow.
Clean Your Hands
Cleaning your hands is one of the most important, and easiest, practices used to prevent transmission of
many infectious diseases, including blood borne pathogens.






Wash hands, or exposed skin, as soon as possible (e.g., after an exposure incident, removal of
gloves or other PPE)
Familiarize yourself with location of the nearest handwashing facilities.
An alcohol-based hand rub (ABHR) may be used until soap and running water are available.
The use of an ABHR is the preferred method of decontamination of hands that are visibly clean.
Note: Alcohol-based hand rub should contain at least 70% of ethyl or isopropyl alcohol
In the event hands are visibly soiled but a handwashing sink is not accessible along with soap
and water, carry out the following steps:
a. Use a wet wipe to remove as much visible soil/organic material as possible from hands
b. Allow hands to dry
c. Use alcohol-based hand rub
d. Wash hands when a handwashing sink along with soap and water become available
Cleaning your hands also includes maintaining intact skin. Regular use of hand lotion is
recommended to prevent chapping/cracking of the skin.
15
Gloves




Wear gloves when touching blood, body fluids, secretions, excretions, non-intact skin and
contaminated items.
Change gloves between tasks and procedures on the same individual and after contact with
material that may contain infectious agents.
Remove gloves promptly after use, before touching non-contaminated items and environmental
surfaces, and before going to another individual.
Wash hands immediately after removing gloves to avoid transfer of infectious agents to other
individuals and environments.
Mask, Eye Protection, Face Shield

Wear a mask, eye protection or a face shield as per employer policy to protect mucous
membranes of the eyes, nose and mouth during procedures and activities that are likely to
generate splashes, sprays, aerosolization of blood, body fluids, secretions and excretions.
Protective Clothing

Wear clothing to protect skin and wear extra protective clothing to prevent uniforms or
personal clothing during procedures that are likely to generate splashes and sprays of blood,
body fluids, secretions or excretions.
Other Precautions





Handle needles and other sharp instruments safely and with care.
Handle and dispose of potentially contaminated items using carefully established
procedures.
Cover all personal abrasions and areas of damaged skin before contact.
Refrain from direct care or handling of equipment if you have lesions or dermatitis.
Do not eat, drink or smoke in areas where there is potential for exposure.
For further information on Routine Practices and Additional Precautions, please refer to the following
website:
http://www.oahpp.ca/resources/pidac-knowledge/best-practice-manuals/routine-practices-andadditional-precautions.html
For the PIDAC Best Practice Manual: Hand Hygiene, please refer to the following website:
http://www.oahpp.ca/resources/pidac-knowledge/best-practice-manuals/hand-hygiene.html
16
Handwashing
To wash hands properly, rub all parts of the hands and wrists with soap and water or an alcohol-based hand
rub. Wash hands for at least 15 seconds or more. Pay special attention to fingertips, between fingers, backs
of hands and base of the thumbs.
•
•
•
•
• Wash wrists and forearms if they are likely to have
been contaminated
• Make sure that sleeves are rolled up and do not get
wet during washing
Keep nails short
Remove watches, rings and bracelets
Do not use artificial nails
Avoid chipped nail varnish
If you have any questions regarding cuts, sores, allergies or pre-existing skin conditions,
call Telehealth Ontario at 1-866-797-0000, TTY 1-866-797-0007.
Handwashing with soap and water
1
2
3
4
5
6
Remove jewellery
and wet hands
and wrists with
warm water.
Use 1 or 2 squirts
of liquid or foam
soap.
Lather soap and
scrub hands well,
palm to palm.
Scrub in
between and
around fingers.
Scrub back
of each hand
with palm of
other hand.
Scrub fingertips
of each hand in
opposite palm.
7
8
9
10
11
Scrub each thumb
clasped in opposite
hand.
Scrub each
wrist clasped in
opposite hand.
Rinse thoroughly
under running
water.
Pat hands dry with
paper towel.
Turn off water
using same
paper towel.
1
2
3
4
5
6
Apply 1 to 2 pumps
of product to palms
of dry hands.
Rub hands
together, palm
to palm.
Rub in
between and
around fingers.
Rub back of each
hand with palm
of other hand.
Rub fingertips
of each hand in
opposite palm.
Rub each thumb
clasped in
opposite hand.
7
8
Rub each wrist
clasped in
opposite hand.
Rub hands until
product is dry.
Do not use paper
towels.
Catalogue No. CIB-4446797 100M Mar/07 © Queen’s Printer for Ontario
Cleaning with alcohol-based hand rub
References
CDC. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to
HIV and Recommendations for Post-Exposure Prophylaxis. MMWR 54:RR-9, 2005.
Ontario Hospital Association, Ontario Medical Association and Ministry of Health and Long-Term Care.
Blood-Borne Diseases Surveillance Protocol for Ontario Hospitals, 2010.
PIDAC (2011). Routine Practices and Additional Precautions : In All Health Care Settings.
Tooley, L. (2010). Detecting HIV earlier: Advances in HIV testing : Prevention in Focus, Catie.
Wilton, J. (2011). Post-Exposure Prophylaxis (PEP), Catie.
Understanding Influenza
Common Cold
What is it?
Influenza, or the flu, is a common and highly contagious, infectious
respiratory disease that affects the nose, throat and lungs.
Influenza viruses can change rapidly. That’s why there is a new flu shot
made every year to protect against the circulating virus strains.
Symptoms
Almost always
• Sudden onset of
cough and fever
Common
• Fatigue
• Muscle aches
• Sore throat
• Headache
• Decreased appetite
• Runny nose
Severity Indicators
If you develop the following symptoms, you
need to see a health care provider right away:
• Shortness of breath, rapid or difficulty breathing
• Chest pain
• Bluish or grey skin color
• Bloody or coloured mucus/spit
• Sudden dizziness or confusion
• Severe or persistent vomiting
• High fever lasting more than three days
• Low blood pressure
Additional symptoms to watch for in children:
• Not drinking enough fluids or eating
• Not waking up or interacting
• Irritability; not wanting to play or be held
Sometimes
• Nausea
• Vomiting
• Diarrhea
A cold is a mild infection of the
nose and throat caused by a variety
of viruses.
Although a cold might linger, the
symptoms remain mild.
• Runny nose
•Sneezing
•Cough
• Sore throat
© Her Majesty the Queen in Right of Canada, 2010 • ISBN# 978-1-100-17270-2 • CAT# HP40-58/2010E-PDF
Seasonal Flu
People at Risk of Complications
The following groups are not more likely to get the flu. However, they are
more at risk of developing complications if they do get sick:
1.Children under five years of age (especially those less than two years old)
2.Women who are pregnant
3.People with chronic conditions such as:
• Heart disease
• Liver disease
• Kidney disease
• Blood disorders
• Diabetes
• Severe obesity
• Asthma and chronic lung disease
• Immunosuppressed (people taking cancer drugs or people with HIV/AIDS)
• Neurological disorders
4.Aboriginal people
IMPORTANT If you have flu symptoms and you have one of these risk factors,
contact a health care provider as soon as possible — antiviral medications may
be needed.
To find out more, visit www.fightflu.ca or call 1
800 O-Canada (1-800-622-6232) (TTY 1-800-926-9105)
Public
Health
Division
Pertussis Fact Sheet
This fact sheet provides basic information only. It must not take the place of medical advice, diagnosis or treatment. Always talk to a health care
professional about any health concerns you have, and before you make any changes to your diet, lifestyle or treatment.
What is Pertussis?
How is the disease spread?
Pertussis (whooping cough) is a serious, sometimes
fatal, respiratory infection caused by the bacterium,
Bordetella pertussis. It is very contagious and one
of the most common vaccine-preventable diseases.
World-wide pertussis is responsible for about
300,000 deaths in children annually.
People with pertussis spread the disease by
coughing or sneezing while in direct or close
contact with others, who then breathe in the
droplets carrying pertussis bacteria.
In most cases the disease usually begins with coldlike symptoms including runny nose or congestion,
sneezing, and mild cough or fever. After one to
two weeks, the disease progresses to severe
coughing spells with a loud “whooping” sound
while inhaling. Coughing spells may end in
vomiting. Pertussis can occur in individuals of all
ages, but is most severe in the very young,
especially those less than one year of age. Older
children and adults may have a prolonged cough
without the “whoop” or vomiting.
Pertussis is unlike many other diseases. Although
pertussis infection usually results in prolonged
immunity, repeat infections can occur. The most
effective way to be protected against pertussis is
through immunization.
What are the complications of Pertussis?
Complications among adolescents and adults
include fainting, interruptions in sleep, rib fractures
and pneumonia. Complications among infants
include pneumonia, seizures, inflammation of the
brain and permanent brain damage. Around one in
every 250 children under six months of age who
contract pertussis will die. The most common
cause of death is from pertussis pneumonia.
Many infants who get pertussis are infected by
older siblings or parents who might not even know
they have the disease.
Symptoms can take seven to 21 days to develop
after contact with an infected person. The
incubation period is commonly seven to 10 days
and not more than 21 days. A person with pertussis
can infect others from seven days after they have
been exposed to pertussis to three weeks after the
onset of violent coughing.
Children should be excluded from child care
facilities until they are well and until five days
after starting antibiotic treatment.
What should be done when someone has
pertussis, or if pertussis is suspected?
If pertussis is suspected, contact your health care
provider or your local public health unit. Since
pertussis is a reportable disease, local public health
units monitor all cases and contacts of pertussis. A
person infected with pertussis should stay home
and avoid pregnant women and infants (less than
12 months) until they have received at least five
days of the 7-day course of antibiotics. Close
contacts should have their immunization status
reviewed and updated by their health care
practitioner.
How is pertussis treated?
A person with pertussis is usually given a course of
antibiotics. In some cases, antibiotics may also be
advised for close contacts of someone who has
pertussis. This may include people living in the
same house, if there is an infant less than one year
of age or a pregnant woman in the 3rd trimester.
The treatment usually takes seven days.
How is pertussis prevented?
The best way to prevent pertussis is to get
immunized. In Ontario, two kinds of combination
vaccines are publicly funded.
DTaP-IPV, for children less than seven years old,
provides safe protection against diphtheria, tetanus,
polio and pertussis diseases when given in the
appropriate number of doses. Children should
receive five doses of the combination vaccine by
the time they are four to six years old at two, four,
six and 18 months and one dose before entering
school.
Is the pertussis vaccine safe?
The vaccine is safe. Side effects are usually mild
and may include soreness, swelling and redness at
the spot where the needle was given. Some people
may get a mild fever, body aches, and feel tired for
a day or two after the immunization.
Serious allergic reactions, though rare, may occur
with any vaccine or drug. Serious reactions should
be reported to your local public health unit or
health care provider.
The benefits of protection against disease
significantly outweigh any risk from the vaccine.
For more information, contact your health care
provider or your local public health department.
For a listing of Ontario health units, visit:
http://www.health.gov.on.ca/english/public/contact
/phu/phuloc_mn.html
Catalogue # CIB-012995 April 2009 © Queen’s Printer for Ontario
Tdap provides safe protection against tetanus,
diphtheria and pertussis. The vaccine is publicly
funded for adolescents 14 to 16 years of age
(booster dose) and for unimmunized children seven
to 17 years of age (as a three-dose series).
Adults who are properly immunized against
pertussis will not only protect themselves, but also
help to protect children who are much more likely
to experience complications from the disease.
Pertussis immunization for adults is not publicly
funded.
Your health care provider will know which vaccine
and how many doses are right for you and your
family members.
In addition to immunization, infections like
pertussis can be minimized or prevented by
practicing good hand hygiene (washing your hands
properly and with soap), and covering your nose
and mouth with your upper arm or a tissue when
coughing or sneezing.
2
Fact Sheet
Group A Streptococcal Disease
Group A Streptococcal disease (GAS) is a common bacteria that is found in many people’s throats
or on their skin. It can be carried in the throat or skin of healthy people who show no signs or
symptoms. If GAS is found in unusual places like the blood, the cerebral spinal fluid, the lining of
the muscles, or the joints, it is called “invasive disease”.
How is GAS spread?
- Direct contact with the nose or mouth secretions of an infected person
- Direct contact with infected lesions on the skin (touching a wound or sharing needles)
Signs and symptoms of GAS
The symptoms depend on the type of infection. They may include:
- necrotizing fasciitis or myositis: fever, severe pain, swelling and/or redness of the muscles
or soft tissue;
- meningitis: fever, severe pain on movement of the neck, nausea and/or vomiting; or
- Streptococcal toxic shock syndrome: fever, a general feeling of unwellness, dizziness,
confusion, and/or a flat red rash on the body.
Precautions to be taken to prevent GAS
- Use good personal hygiene, especially frequent and thorough hand washing
- Cover your cough or sneeze with a tissue or upper sleeve
- Wounds and cuts should be well cleansed, disinfected, and covered
Treatment for GAS
- Antibiotics will be prescribed to treat the infection
- Close contacts of someone with severe GAS may be prescribed antibiotics to help prevent
them from getting the infection
- Close contacts include:
Those living in the same household as the person with GAS
Those sharing sleeping arrangements or had sexual relations with
the person with GAS
Thos who have had direct contact with the person with GAS
through mouth to mouth resuscitation, open mouth kissing, or
touching of an open skin lesion
Injection drug users who have shared needles with the person with
GAS
All cases are investigated by Public Health and all close contacts are notified, advised to watch for
signs and symptoms and see their doctors if they begin to feel unwell within one month of being
in contact with the person who has GAS.
For more information, contact the Infectious Disease Department at 705-267-1181, or toll free at
1-800-461-1818.
2011-09-23
Hepatitis B
This fact sheet provides basic information only. It must not take the place of medical advice, diagnosis or treatment. Always talk to a
healthcare professional about any health concerns you have, and before you make any changes to your diet, lifestyle or treatment.
What is it ?
How is it treated ?
Hepatitis B is a serious infection of the liver.
It is common and caused by a virus.
Symptoms may be tiredness, loss of appetite,
stomach discomfort and yellow skin. The
virus is found in blood, semen, vaginal fluids
and saliva. Hepatitis B is the only sexually
transmitted disease that has a safe and
effective vaccine to protect against infection.
There is no specific treatment for hepatitis B.
Do not drink alcohol if you have hepatitis. A
special diet may be needed if you have severe
disease. Your doctor will advise you.
How did I get it ?
There are several ways of getting hepatitis B.
One way is by sexual contact with an
infected person.
There is a greater chance of getting the
infection through anal sex. Another way is by
sharing personal items (toothbrushes, razors,
etc.) with an infected person. Another way is
through contact with infected blood in dirty
needles used for injecting drugs.
What can it do to me ?
Most people get better and can no longer pass
on the virus. A small number die (less than
1%). Others will always carry the virus and
continue to be infectious (able to pass it on to
others). They are called "carriers." Some
carriers will go on to have chronic liver
disease. Some will develop cancer of the
liver.
Could I give it to other people ?
Yes. As long as you carry the virus, you can
infect others. You may pass it on to your sex
partner(s), to those who live in close contact
with you, and to those who share your
needles for injecting drugs. All of these
contacts should be examined by a doctor. If
they are not yet infected, they should be
vaccinated.
Pregnant women who are carriers may pass
hepatitis B on to their babies around the time
of birth. Most infected infants become
carriers. A pregnant woman should have a
test for hepatitis B at her first visit to a
doctor. If she is a carrier, the infant can be
vaccinated at birth to protect against
infection.
When can I have sex again ?
When you can no longer pass the infection on
to others. If you are infectious (a carrier), do
not have unprotected sex until your partner is
vaccinated.
Is follow-up important ?
Government of Ontario
Yes. It is important to be checked to see if
you are still infectious (a carrier). If you are a
hepatitis B carrier, you should see your
doctor at regular intervals.
For information about health services and
resources :
www.health.gov.on.ca
Remember :
•
•
•
•
Return for check-up visits as your
doctor or clinic asks;
Tell people you have had sex with
during the past 6 months. They should
be examined, and vaccinated if
necessary;
Use condoms to lower the chance of
infections in future;
If you are carrying the virus, never
donate blood, semen or body organs.
If you are still worried or have more
questions, call your local health unit or STD
clinic.
For consumer-friendly health tips and
information :
www.HealthyOntario.com
INFOline: 1-877-234-4343;
TTY:
1-800-387-5559
Telehealth Ontario:
1-866-797-0000; TTY 1-866-797-0007
INFOline is open during business hours
and can provide general information on
healthcare.
Telehealth Ontario is a 24/7 service which
uses nurse practitioners to answer your
immediate health concerns.
Hepatitis C: What you need to know
More than 110,000 people in Ontario are infected
with the hepatitis C virus. Often there are no
symptoms for many years, and about 35,000
Ontarians do not realize they are infected.
How you could become infected
You are at risk of hepatitis C infection if you share
blood. For instance:
• Sharing used needles or syringes (for steroid,
prescription or street drug use)
• Sharing other drug-using equipment such as
cookers, cotton, crack cocaine and water pipes
(even if you only shared them once or briefly)
• Sharing straws, bills or other utensils used for
snorting cocaine or other drugs
• Receiving a blood transfusion or blood products
before 1992
• Needle-stick injuries
• Tattooing, piercing or acupuncture with
equipment that may have been improperly
sterilized
• Many of the risk factors listed above are also
associated with HIV (See Co-infection with HIV)
Lower risks of infection:
• Sexual activity that includes contact with blood
or exchange of blood
• An expectant mother carrying the hepatitis C
virus can infect her unborn baby
• Sharing razors, toothbrushes, tweezers, manicure
or pedicure equipment (such as nail clippers)
How to protect yourself from infection
• Do not share needles or drug-using equipment
• Do not share personal items such as razors,
toothbrushes, tweezers, manicure or
pedicure equipment
• Wear protective gloves if you are likely to be in
contact with someone else’s blood
• Avoid blood-to-blood contact during sexual
activity
• If you are getting a tattoo or piercing, make sure
that:
(a) the service you choose is regulated
or inspected
(b) the needle is single-use disposable and has
never been used (if you’re getting acupuncture,
make sure the needles are sterile)
(c) all other equipment is sterile
How the hepatitis C virus can affect you
Without treatment, over 80 percent of hepatitis C
infections progress to chronic hepatitis C, a disease
that attacks your liver. After 10 to 20 years, chronic
hepatitis C can cause cirrhosis. After 20 to 40 years it
can cause liver cancer.
Common symptoms
Because hepatitis C progresses slowly, most infected
people experience no symptoms at all for many years
after being infected. If you do have symptoms, they
could include:
• Jaundice (your skin or eyes turn yellow)
• Itching in different parts of your body
See your health care provider if you believe you
may have been exposed to the hepatitis C virus.
Catalogue No. 7610-2150100 14M March/07 © Queen’s Printer for Ontario
Hepatitis C is an infection caused by the hepatitis C
virus, which is carried in the blood. This virus can
cause liver disease, including cirrhosis and cancer.
How hepatitis C is detected
If you believe you may have been exposed to the
hepatitis C virus, ask your health care provider to
test you. If the results show that you have the
hepatitis C virus in your blood, your health care
provider may order a second test to confirm it. If you
are infected, talk to your health care provider about
treatment options.
Co-infection with HIV
The human immunodeficiency virus (HIV) and the
hepatitis C virus (HCV) are both carried in the blood.
Some risk factors are common to both HIV and
hepatitis C; for instance, sharing drug-using
equipment such as needles, cookers, cotton, crack
cocaine and water pipes. If you are concerned that
you may have been exposed by sharing drug-using
equipment, talk to your health care provider about
testing for hepatitis C as well as HIV.
How to maintain your health if you
have hepatitis C
Get plenty of rest and avoid alcohol. Even moderate
amounts of alcohol will speed up the progression of the
disease and reduce the effectiveness of treatment drugs.
You should also talk to your health care provider
about hepatitis A and hepatitis B vaccinations.
There is no vaccination against hepatitis C.
How to avoid infecting others if you
have hepatitis C
• Do not donate blood, organs for transplants
or semen for artificial insemination
• Do not share razors, toothbrushes,
tweezers, manicure or pedicure equipment
• If you use drugs, do not share needles or other
drug-related equipment
• Always remember to tell health care providers
about your condition if it is possible that they
may be exposed to your blood
• Avoid blood-to-blood contact during sexual activity
Treatment
There are effective treatments for hepatitis C.
Your health care provider will discuss with you what
treatment is available and assess whether it is
appropriate for you. Treatment takes from 24
to 48 weeks.
Want to learn more?
For more information:
• Call 1-877-234-4343 (TTY 1-800-387-5559)
• Visit www.hepContario.ca
• Ontario Ministry of Health and Long-Term
Care website, www.health.gov.on.ca/hepatitec
HIV&
AIDS
BASIC FACTS
There is no vaccine to prevent HIV.
There is no cure for HIV but there is treatment.
Anyone can be infected with HIV.
What are HIV & AIDS?
HIV is a virus that can make you sick.
•
•
•
HIV weakens your immune system, your body’s
built-in defence against disease and illness.
You can have HIV without knowing it. You
may not look or feel sick for years, but you
can still pass the virus on to other people.
Without HIV treatment, your immune system
can become too weak to fight off serious
illnesses. HIV can also damage other parts of
your body. Eventually, you can become sick
with life-threatening infections. This is the most
serious stage of HIV infection, called AIDS.
HIV stands for
Human Immunodeficiency Virus.
AIDS stands for Acquired
ImmunoDeficiency Syndrome.
There is no cure for HIV…
but there is treatment.
•
•
There is no cure for HIV, but with proper care
and treatment, most people with HIV can avoid
getting AIDS and can stay healthy for a long time.
Anti-HIV drugs have to be taken every
day. They cannot get rid of HIV but
they can keep it under control.
Who can get HIV?
Anyone can be infected with HIV, no matter...
• your age
• your sex
• your race or ethnic origin
• who you have sex with
1201_CATIE_hivbasicfacts_ENG.indd 1-9
How does HIV get passed from
one person to another?
•
•
•
Only five body fluids can contain enough HIV to
infect someone: blood, semen (including pre-cum),
rectal fluid, vaginal fluid and breast milk.
HIV can only get passed when one of these fluids
from a person with HIV gets into the bloodstream
of another person—through broken skin, the
opening of the penis or the wet linings of the
body, such as the vagina, rectum or foreskin.
HIV cannot pass through healthy, unbroken skin.
The two main ways that HIV can get passed
between you and someone else are:
•
through unprotected sex (anal or
vaginal sex without a condom)
•
by sharing needles or other equipment
to inject drugs (including steroids)
HIV can also be passed:
•
by sharing needles or ink to get a tattoo
•
by sharing needles or jewellery
to get a body piercing
•
by sharing acupuncture needles
•
to a fetus or baby during pregnancy,
birth or breast-feeding
HIV cannot be passed by:
•
talking, shaking hands, working or
eating with someone who has HIV
•
hugs or kisses
•
coughs or sneezes
•
swimming pools
•
toilet seats or water fountains
•
bed sheets or towels
•
forks, spoons, cups or food
•
insects or animals
HIV & Sex
HIV & Drug Use
HIV can be passed during
unprotected sex.
HIV can be passed on
through shared needles and
other drug equipment.
This means:
•
vaginal or anal sex without a condom
•
oral sex without a condom or dental dam
(a piece of latex used to cover the vulva or anus)
•
sharing sex toys
Another virus called hepatitis C can also be
spread when sharing drug equipment. Hepatitis
C damages the liver. It is passed when the
blood from someone who has hepatitis C gets
into the bloodstream of another person.
Protect yourself and the
people you do drugs with.
Protect yourself and your partner(s)
from HIV and other sexually
transmitted infections (STIs).
Safer sex protects you and your
partner(s) from HIV and STIs.
You can have sex with little or no risk of passing
on or getting HIV. This is called safer sex.
HIV & Pregnancy
People can have HIV or other STIs without knowing
it because these infections often do not cause
symptoms. You could have HIV or another STI and
not know it. Also, don’t assume that your partner(s)
knows whether they have HIV or any other STI.
The only way to know for sure is to be tested.
HIV can pass from a
woman to her baby:
•
•
•
•
•
Use a latex or polyurethane condom correctly
every time you have vaginal or anal sex.
Use only water-based or siliconebased lubricants. (Oil-based lubricants
can make latex condoms break.)
Get tested for STIs regularly. Having an STI
increases your risk of getting and passing
on HIV.
Avoid sharing sex toys, and if you do, cover
each one with a new condom before
each use. It is also important to clean
your toys between vaginal and anal use.
Use a condom or dental dam
every time you have oral sex.
Choose forms of sexual stimulation
that pose little or no risk for HIV, like
masturbation or sensual massage.
If you use drugs, there are things you can do
to protect yourself and use drugs in a safer
way. This is called harm reduction.
To practise safer drug use…
Safer sex also helps protect you and your partner(s)
from other STIs, such as gonorrhea and syphilis.
•
•
Sharing needles and other drug
equipment is very risky.
Oral sex is not as risky as vaginal or
anal sex, but it’s not completely safe.
To practise safer sex…
If you do not have access
to a needle exchange…
•
•
•
during pregnancy
at birth
through breast-feeding
Protect your baby.
If you are HIV-positive and pregnant, proper HIV
treatment and care can reduce the risk of your
child being HIV-positive to less than 2 percent.
Talk with your healthcare provider to find out more.
If you are pregnant or thinking about
getting pregnant, get tested for HIV.
If you are HIV-positive, with proper
treatment you can have a healthy
pregnancy and a healthy baby.
•
•
•
•
Use a clean new needle and
syringe every time you use.
Use your own drug equipment (such as
pipes, bills, straws, cookers, water, alcohol
swabs) every time. Never share equipment,
not even with your sex partner.
Get new needles and supplies from your
local harm reduction program, needle
exchange or community health centre.
Get tested for HIV and hepatitis C. If you
know that you have HIV or hepatitis C, you
can take steps to protect yourself and others.
As a last resort, your own needles can be
cleaned before each time you use them, but
it is still best not to share with other people.
Cleaning means flushing the syringe twice
with clean water, twice with bleach, and then
twice with new water. Each flushing should
last 30 seconds. This will kill HIV, but it
will not protect you from hepatitis C.
HIV & Blood Products
Since November 1985, all blood products in
Canada are checked for HIV. A person’s
risk of getting infected from a
blood transfusion in Canada
is extremely low.
There is no chance of
getting HIV from
donating blood.
You are better off
knowing if you have HIV.
If you know you have HIV, you can get the
treatment and care you need to stay healthy
and avoid passing it on to others.
If you think you may have
been exposed to HIV, it is
important to get tested.
•
•
•
If you have HIV, you have a legal duty to tell your
sex partner(s) before having any kind of sex that
could put them at “significant risk” of getting HIV.
• The law is not completely clear on what
“significant risk” means. It is clear, however, that
unprotected vaginal or anal sex is considered to
pose a “significant risk” of HIV transmission.
• People with HIV have been convicted of serious
crimes for not telling their sex partners they
have HIV (not disclosing their status) before
having unprotected vaginal or anal sex.
For more information on HIV, contact:
• a public health unit
• your local sexual health or family planning clinic
• your local AIDS organization
• an AIDS and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or,
in Quebec, a CLSC
You can’t tell whether you have been
infected with HIV by how you feel.
•
•
Some people have flu-like symptoms
when they first get infected (fever, sore
throat or swollen glands). But some
people have no symptoms at all.
You can have HIV and not know it.
If you test positive:
•
•
HIV & the Law
The only way to know if you have HIV is to get
tested. The HIV test is a simple blood test.
After HIV enters the body, it may take time
before the test can detect the virus (this is
known as the window period). Different
HIV tests have different window periods.
Don’t wait. Speak to a health-care
provider about getting tested for HIV as
well as other STIs and hepatitis C.
Contact Information:
•
•
The law is not clear about whether people
with HIV must disclose their status before
having sex using a condom or before
having oral sex (without a condom).
For more information on HIV and the law,
contact the Canadian HIV/AIDS Legal Network.
It may be able to refer you to a lawyer but
cannot provide you with legal advice.
www.aidslaw.ca
[email protected]
416-595-1666
There have been significant advances in
the care and treatment of HIV, and with
the right treatment, you can stay healthy.
To protect yourself and your partner(s), practise
safer sex and do not share drug equipment.
Get connected. Contact CATIE for more
information on HIV services in your area.
About one in every four
Canadians with HIV does not
know they have it. The only
way to know for sure if you
have HIV is to get tested.
An HIV test could save your life.
Need more information
and resources on HIV or
hepatitis C?
Contact CATIE at:
1-800-263-1638
416-203-7122
www.catie.ca
[email protected]
CATIE accepts collect calls
from Canadian prisons.
HIV & AIDS: Basic Facts, 2010. Based on a publication originally
produced by the Canadian Public Health Association (CPHA).
Production of this document has been made
possible through a financial contribution from the
Public Health Agency of Canada (PHAC).
CATIE Ordering Centre Catalogue Number ATI-40223
10-04-27 3:58 PM
HIV&
AIDS
BASIC FACTS
There is no vaccine to prevent HIV.
There is no cure for HIV but there is treatment.
Anyone can be infected with HIV.
What are HIV & AIDS?
HIV is a virus that can make you sick.
•
•
•
HIV weakens your immune system, your body’s
built-in defence against disease and illness.
You can have HIV without knowing it. You
may not look or feel sick for years, but you
can still pass the virus on to other people.
Without HIV treatment, your immune system
can become too weak to fight off serious
illnesses. HIV can also damage other parts of
your body. Eventually, you can become sick
with life-threatening infections. This is the most
serious stage of HIV infection, called AIDS.
HIV stands for
Human Immunodeficiency Virus.
AIDS stands for Acquired
ImmunoDeficiency Syndrome.
There is no cure for HIV…
but there is treatment.
•
•
There is no cure for HIV, but with proper care
and treatment, most people with HIV can avoid
getting AIDS and can stay healthy for a long time.
Anti-HIV drugs have to be taken every
day. They cannot get rid of HIV but
they can keep it under control.
Who can get HIV?
Anyone can be infected with HIV, no matter...
• your age
• your sex
• your race or ethnic origin
• who you have sex with
1201_CATIE_hivbasicfacts_ENG.indd 1-9
How does HIV get passed from
one person to another?
•
•
•
Only five body fluids can contain enough HIV to
infect someone: blood, semen (including pre-cum),
rectal fluid, vaginal fluid and breast milk.
HIV can only get passed when one of these fluids
from a person with HIV gets into the bloodstream
of another person—through broken skin, the
opening of the penis or the wet linings of the
body, such as the vagina, rectum or foreskin.
HIV cannot pass through healthy, unbroken skin.
The two main ways that HIV can get passed
between you and someone else are:
•
through unprotected sex (anal or
vaginal sex without a condom)
•
by sharing needles or other equipment
to inject drugs (including steroids)
HIV can also be passed:
•
by sharing needles or ink to get a tattoo
•
by sharing needles or jewellery
to get a body piercing
•
by sharing acupuncture needles
•
to a fetus or baby during pregnancy,
birth or breast-feeding
HIV cannot be passed by:
•
talking, shaking hands, working or
eating with someone who has HIV
•
hugs or kisses
•
coughs or sneezes
•
swimming pools
•
toilet seats or water fountains
•
bed sheets or towels
•
forks, spoons, cups or food
•
insects or animals
HIV & Sex
HIV & Drug Use
HIV can be passed during
unprotected sex.
HIV can be passed on
through shared needles and
other drug equipment.
This means:
•
vaginal or anal sex without a condom
•
oral sex without a condom or dental dam
(a piece of latex used to cover the vulva or anus)
•
sharing sex toys
Another virus called hepatitis C can also be
spread when sharing drug equipment. Hepatitis
C damages the liver. It is passed when the
blood from someone who has hepatitis C gets
into the bloodstream of another person.
Protect yourself and the
people you do drugs with.
Protect yourself and your partner(s)
from HIV and other sexually
transmitted infections (STIs).
Safer sex protects you and your
partner(s) from HIV and STIs.
You can have sex with little or no risk of passing
on or getting HIV. This is called safer sex.
HIV & Pregnancy
People can have HIV or other STIs without knowing
it because these infections often do not cause
symptoms. You could have HIV or another STI and
not know it. Also, don’t assume that your partner(s)
knows whether they have HIV or any other STI.
The only way to know for sure is to be tested.
HIV can pass from a
woman to her baby:
•
•
•
•
•
Use a latex or polyurethane condom correctly
every time you have vaginal or anal sex.
Use only water-based or siliconebased lubricants. (Oil-based lubricants
can make latex condoms break.)
Get tested for STIs regularly. Having an STI
increases your risk of getting and passing
on HIV.
Avoid sharing sex toys, and if you do, cover
each one with a new condom before
each use. It is also important to clean
your toys between vaginal and anal use.
Use a condom or dental dam
every time you have oral sex.
Choose forms of sexual stimulation
that pose little or no risk for HIV, like
masturbation or sensual massage.
If you use drugs, there are things you can do
to protect yourself and use drugs in a safer
way. This is called harm reduction.
To practise safer drug use…
Safer sex also helps protect you and your partner(s)
from other STIs, such as gonorrhea and syphilis.
•
•
Sharing needles and other drug
equipment is very risky.
Oral sex is not as risky as vaginal or
anal sex, but it’s not completely safe.
To practise safer sex…
If you do not have access
to a needle exchange…
•
•
•
during pregnancy
at birth
through breast-feeding
Protect your baby.
If you are HIV-positive and pregnant, proper HIV
treatment and care can reduce the risk of your
child being HIV-positive to less than 2 percent.
Talk with your healthcare provider to find out more.
If you are pregnant or thinking about
getting pregnant, get tested for HIV.
If you are HIV-positive, with proper
treatment you can have a healthy
pregnancy and a healthy baby.
•
•
•
•
Use a clean new needle and
syringe every time you use.
Use your own drug equipment (such as
pipes, bills, straws, cookers, water, alcohol
swabs) every time. Never share equipment,
not even with your sex partner.
Get new needles and supplies from your
local harm reduction program, needle
exchange or community health centre.
Get tested for HIV and hepatitis C. If you
know that you have HIV or hepatitis C, you
can take steps to protect yourself and others.
As a last resort, your own needles can be
cleaned before each time you use them, but
it is still best not to share with other people.
Cleaning means flushing the syringe twice
with clean water, twice with bleach, and then
twice with new water. Each flushing should
last 30 seconds. This will kill HIV, but it
will not protect you from hepatitis C.
HIV & Blood Products
Since November 1985, all blood products in
Canada are checked for HIV. A person’s
risk of getting infected from a
blood transfusion in Canada
is extremely low.
There is no chance of
getting HIV from
donating blood.
You are better off
knowing if you have HIV.
If you know you have HIV, you can get the
treatment and care you need to stay healthy
and avoid passing it on to others.
If you think you may have
been exposed to HIV, it is
important to get tested.
•
•
•
If you have HIV, you have a legal duty to tell your
sex partner(s) before having any kind of sex that
could put them at “significant risk” of getting HIV.
• The law is not completely clear on what
“significant risk” means. It is clear, however, that
unprotected vaginal or anal sex is considered to
pose a “significant risk” of HIV transmission.
• People with HIV have been convicted of serious
crimes for not telling their sex partners they
have HIV (not disclosing their status) before
having unprotected vaginal or anal sex.
For more information on HIV, contact:
• a public health unit
• your local sexual health or family planning clinic
• your local AIDS organization
• an AIDS and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or,
in Quebec, a CLSC
You can’t tell whether you have been
infected with HIV by how you feel.
•
•
Some people have flu-like symptoms
when they first get infected (fever, sore
throat or swollen glands). But some
people have no symptoms at all.
You can have HIV and not know it.
If you test positive:
•
•
HIV & the Law
The only way to know if you have HIV is to get
tested. The HIV test is a simple blood test.
After HIV enters the body, it may take time
before the test can detect the virus (this is
known as the window period). Different
HIV tests have different window periods.
Don’t wait. Speak to a health-care
provider about getting tested for HIV as
well as other STIs and hepatitis C.
Contact Information:
•
•
The law is not clear about whether people
with HIV must disclose their status before
having sex using a condom or before
having oral sex (without a condom).
For more information on HIV and the law,
contact the Canadian HIV/AIDS Legal Network.
It may be able to refer you to a lawyer but
cannot provide you with legal advice.
www.aidslaw.ca
[email protected]
416-595-1666
There have been significant advances in
the care and treatment of HIV, and with
the right treatment, you can stay healthy.
To protect yourself and your partner(s), practise
safer sex and do not share drug equipment.
Get connected. Contact CATIE for more
information on HIV services in your area.
About one in every four
Canadians with HIV does not
know they have it. The only
way to know for sure if you
have HIV is to get tested.
An HIV test could save your life.
Need more information
and resources on HIV or
hepatitis C?
Contact CATIE at:
1-800-263-1638
416-203-7122
www.catie.ca
[email protected]
CATIE accepts collect calls
from Canadian prisons.
HIV & AIDS: Basic Facts, 2010. Based on a publication originally
produced by the Canadian Public Health Association (CPHA).
Production of this document has been made
possible through a financial contribution from the
Public Health Agency of Canada (PHAC).
CATIE Ordering Centre Catalogue Number ATI-40223
10-04-27 3:58 PM
HIV&
AIDS
BASIC FACTS
There is no vaccine to prevent HIV.
There is no cure for HIV but there is treatment.
Anyone can be infected with HIV.
What are HIV & AIDS?
HIV is a virus that can make you sick.
•
•
•
HIV weakens your immune system, your body’s
built-in defence against disease and illness.
You can have HIV without knowing it. You
may not look or feel sick for years, but you
can still pass the virus on to other people.
Without HIV treatment, your immune system
can become too weak to fight off serious
illnesses. HIV can also damage other parts of
your body. Eventually, you can become sick
with life-threatening infections. This is the most
serious stage of HIV infection, called AIDS.
HIV stands for
Human Immunodeficiency Virus.
AIDS stands for Acquired
ImmunoDeficiency Syndrome.
There is no cure for HIV…
but there is treatment.
•
•
There is no cure for HIV, but with proper care
and treatment, most people with HIV can avoid
getting AIDS and can stay healthy for a long time.
Anti-HIV drugs have to be taken every
day. They cannot get rid of HIV but
they can keep it under control.
Who can get HIV?
Anyone can be infected with HIV, no matter...
• your age
• your sex
• your race or ethnic origin
• who you have sex with
1201_CATIE_hivbasicfacts_ENG.indd 1-9
How does HIV get passed from
one person to another?
•
•
•
Only five body fluids can contain enough HIV to
infect someone: blood, semen (including pre-cum),
rectal fluid, vaginal fluid and breast milk.
HIV can only get passed when one of these fluids
from a person with HIV gets into the bloodstream
of another person—through broken skin, the
opening of the penis or the wet linings of the
body, such as the vagina, rectum or foreskin.
HIV cannot pass through healthy, unbroken skin.
The two main ways that HIV can get passed
between you and someone else are:
•
through unprotected sex (anal or
vaginal sex without a condom)
•
by sharing needles or other equipment
to inject drugs (including steroids)
HIV can also be passed:
•
by sharing needles or ink to get a tattoo
•
by sharing needles or jewellery
to get a body piercing
•
by sharing acupuncture needles
•
to a fetus or baby during pregnancy,
birth or breast-feeding
HIV cannot be passed by:
•
talking, shaking hands, working or
eating with someone who has HIV
•
hugs or kisses
•
coughs or sneezes
•
swimming pools
•
toilet seats or water fountains
•
bed sheets or towels
•
forks, spoons, cups or food
•
insects or animals
HIV & Sex
HIV & Drug Use
HIV can be passed during
unprotected sex.
HIV can be passed on
through shared needles and
other drug equipment.
This means:
•
vaginal or anal sex without a condom
•
oral sex without a condom or dental dam
(a piece of latex used to cover the vulva or anus)
•
sharing sex toys
Another virus called hepatitis C can also be
spread when sharing drug equipment. Hepatitis
C damages the liver. It is passed when the
blood from someone who has hepatitis C gets
into the bloodstream of another person.
Protect yourself and the
people you do drugs with.
Protect yourself and your partner(s)
from HIV and other sexually
transmitted infections (STIs).
Safer sex protects you and your
partner(s) from HIV and STIs.
You can have sex with little or no risk of passing
on or getting HIV. This is called safer sex.
HIV & Pregnancy
People can have HIV or other STIs without knowing
it because these infections often do not cause
symptoms. You could have HIV or another STI and
not know it. Also, don’t assume that your partner(s)
knows whether they have HIV or any other STI.
The only way to know for sure is to be tested.
HIV can pass from a
woman to her baby:
•
•
•
•
•
Use a latex or polyurethane condom correctly
every time you have vaginal or anal sex.
Use only water-based or siliconebased lubricants. (Oil-based lubricants
can make latex condoms break.)
Get tested for STIs regularly. Having an STI
increases your risk of getting and passing
on HIV.
Avoid sharing sex toys, and if you do, cover
each one with a new condom before
each use. It is also important to clean
your toys between vaginal and anal use.
Use a condom or dental dam
every time you have oral sex.
Choose forms of sexual stimulation
that pose little or no risk for HIV, like
masturbation or sensual massage.
If you use drugs, there are things you can do
to protect yourself and use drugs in a safer
way. This is called harm reduction.
To practise safer drug use…
Safer sex also helps protect you and your partner(s)
from other STIs, such as gonorrhea and syphilis.
•
•
Sharing needles and other drug
equipment is very risky.
Oral sex is not as risky as vaginal or
anal sex, but it’s not completely safe.
To practise safer sex…
If you do not have access
to a needle exchange…
•
•
•
during pregnancy
at birth
through breast-feeding
Protect your baby.
If you are HIV-positive and pregnant, proper HIV
treatment and care can reduce the risk of your
child being HIV-positive to less than 2 percent.
Talk with your healthcare provider to find out more.
If you are pregnant or thinking about
getting pregnant, get tested for HIV.
If you are HIV-positive, with proper
treatment you can have a healthy
pregnancy and a healthy baby.
•
•
•
•
Use a clean new needle and
syringe every time you use.
Use your own drug equipment (such as
pipes, bills, straws, cookers, water, alcohol
swabs) every time. Never share equipment,
not even with your sex partner.
Get new needles and supplies from your
local harm reduction program, needle
exchange or community health centre.
Get tested for HIV and hepatitis C. If you
know that you have HIV or hepatitis C, you
can take steps to protect yourself and others.
As a last resort, your own needles can be
cleaned before each time you use them, but
it is still best not to share with other people.
Cleaning means flushing the syringe twice
with clean water, twice with bleach, and then
twice with new water. Each flushing should
last 30 seconds. This will kill HIV, but it
will not protect you from hepatitis C.
HIV & Blood Products
Since November 1985, all blood products in
Canada are checked for HIV. A person’s
risk of getting infected from a
blood transfusion in Canada
is extremely low.
There is no chance of
getting HIV from
donating blood.
You are better off
knowing if you have HIV.
If you know you have HIV, you can get the
treatment and care you need to stay healthy
and avoid passing it on to others.
If you think you may have
been exposed to HIV, it is
important to get tested.
•
•
•
If you have HIV, you have a legal duty to tell your
sex partner(s) before having any kind of sex that
could put them at “significant risk” of getting HIV.
• The law is not completely clear on what
“significant risk” means. It is clear, however, that
unprotected vaginal or anal sex is considered to
pose a “significant risk” of HIV transmission.
• People with HIV have been convicted of serious
crimes for not telling their sex partners they
have HIV (not disclosing their status) before
having unprotected vaginal or anal sex.
For more information on HIV, contact:
• a public health unit
• your local sexual health or family planning clinic
• your local AIDS organization
• an AIDS and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or,
in Quebec, a CLSC
You can’t tell whether you have been
infected with HIV by how you feel.
•
•
Some people have flu-like symptoms
when they first get infected (fever, sore
throat or swollen glands). But some
people have no symptoms at all.
You can have HIV and not know it.
If you test positive:
•
•
HIV & the Law
The only way to know if you have HIV is to get
tested. The HIV test is a simple blood test.
After HIV enters the body, it may take time
before the test can detect the virus (this is
known as the window period). Different
HIV tests have different window periods.
Don’t wait. Speak to a health-care
provider about getting tested for HIV as
well as other STIs and hepatitis C.
Contact Information:
•
•
The law is not clear about whether people
with HIV must disclose their status before
having sex using a condom or before
having oral sex (without a condom).
For more information on HIV and the law,
contact the Canadian HIV/AIDS Legal Network.
It may be able to refer you to a lawyer but
cannot provide you with legal advice.
www.aidslaw.ca
[email protected]
416-595-1666
There have been significant advances in
the care and treatment of HIV, and with
the right treatment, you can stay healthy.
To protect yourself and your partner(s), practise
safer sex and do not share drug equipment.
Get connected. Contact CATIE for more
information on HIV services in your area.
About one in every four
Canadians with HIV does not
know they have it. The only
way to know for sure if you
have HIV is to get tested.
An HIV test could save your life.
Need more information
and resources on HIV or
hepatitis C?
Contact CATIE at:
1-800-263-1638
416-203-7122
www.catie.ca
[email protected]
CATIE accepts collect calls
from Canadian prisons.
HIV & AIDS: Basic Facts, 2010. Based on a publication originally
produced by the Canadian Public Health Association (CPHA).
Production of this document has been made
possible through a financial contribution from the
Public Health Agency of Canada (PHAC).
CATIE Ordering Centre Catalogue Number ATI-40223
10-04-27 3:58 PM
HIV&
AIDS
BASIC FACTS
There is no vaccine to prevent HIV.
There is no cure for HIV but there is treatment.
Anyone can be infected with HIV.
What are HIV & AIDS?
HIV is a virus that can make you sick.
•
•
•
HIV weakens your immune system, your body’s
built-in defence against disease and illness.
You can have HIV without knowing it. You
may not look or feel sick for years, but you
can still pass the virus on to other people.
Without HIV treatment, your immune system
can become too weak to fight off serious
illnesses. HIV can also damage other parts of
your body. Eventually, you can become sick
with life-threatening infections. This is the most
serious stage of HIV infection, called AIDS.
HIV stands for
Human Immunodeficiency Virus.
AIDS stands for Acquired
ImmunoDeficiency Syndrome.
There is no cure for HIV…
but there is treatment.
•
•
There is no cure for HIV, but with proper care
and treatment, most people with HIV can avoid
getting AIDS and can stay healthy for a long time.
Anti-HIV drugs have to be taken every
day. They cannot get rid of HIV but
they can keep it under control.
Who can get HIV?
Anyone can be infected with HIV, no matter...
• your age
• your sex
• your race or ethnic origin
• who you have sex with
1201_CATIE_hivbasicfacts_ENG.indd 1-9
How does HIV get passed from
one person to another?
•
•
•
Only five body fluids can contain enough HIV to
infect someone: blood, semen (including pre-cum),
rectal fluid, vaginal fluid and breast milk.
HIV can only get passed when one of these fluids
from a person with HIV gets into the bloodstream
of another person—through broken skin, the
opening of the penis or the wet linings of the
body, such as the vagina, rectum or foreskin.
HIV cannot pass through healthy, unbroken skin.
The two main ways that HIV can get passed
between you and someone else are:
•
through unprotected sex (anal or
vaginal sex without a condom)
•
by sharing needles or other equipment
to inject drugs (including steroids)
HIV can also be passed:
•
by sharing needles or ink to get a tattoo
•
by sharing needles or jewellery
to get a body piercing
•
by sharing acupuncture needles
•
to a fetus or baby during pregnancy,
birth or breast-feeding
HIV cannot be passed by:
•
talking, shaking hands, working or
eating with someone who has HIV
•
hugs or kisses
•
coughs or sneezes
•
swimming pools
•
toilet seats or water fountains
•
bed sheets or towels
•
forks, spoons, cups or food
•
insects or animals
HIV & Sex
HIV & Drug Use
HIV can be passed during
unprotected sex.
HIV can be passed on
through shared needles and
other drug equipment.
This means:
•
vaginal or anal sex without a condom
•
oral sex without a condom or dental dam
(a piece of latex used to cover the vulva or anus)
•
sharing sex toys
Another virus called hepatitis C can also be
spread when sharing drug equipment. Hepatitis
C damages the liver. It is passed when the
blood from someone who has hepatitis C gets
into the bloodstream of another person.
Protect yourself and the
people you do drugs with.
Protect yourself and your partner(s)
from HIV and other sexually
transmitted infections (STIs).
Safer sex protects you and your
partner(s) from HIV and STIs.
You can have sex with little or no risk of passing
on or getting HIV. This is called safer sex.
HIV & Pregnancy
People can have HIV or other STIs without knowing
it because these infections often do not cause
symptoms. You could have HIV or another STI and
not know it. Also, don’t assume that your partner(s)
knows whether they have HIV or any other STI.
The only way to know for sure is to be tested.
HIV can pass from a
woman to her baby:
•
•
•
•
•
Use a latex or polyurethane condom correctly
every time you have vaginal or anal sex.
Use only water-based or siliconebased lubricants. (Oil-based lubricants
can make latex condoms break.)
Get tested for STIs regularly. Having an STI
increases your risk of getting and passing
on HIV.
Avoid sharing sex toys, and if you do, cover
each one with a new condom before
each use. It is also important to clean
your toys between vaginal and anal use.
Use a condom or dental dam
every time you have oral sex.
Choose forms of sexual stimulation
that pose little or no risk for HIV, like
masturbation or sensual massage.
If you use drugs, there are things you can do
to protect yourself and use drugs in a safer
way. This is called harm reduction.
To practise safer drug use…
Safer sex also helps protect you and your partner(s)
from other STIs, such as gonorrhea and syphilis.
•
•
Sharing needles and other drug
equipment is very risky.
Oral sex is not as risky as vaginal or
anal sex, but it’s not completely safe.
To practise safer sex…
If you do not have access
to a needle exchange…
•
•
•
during pregnancy
at birth
through breast-feeding
Protect your baby.
If you are HIV-positive and pregnant, proper HIV
treatment and care can reduce the risk of your
child being HIV-positive to less than 2 percent.
Talk with your healthcare provider to find out more.
If you are pregnant or thinking about
getting pregnant, get tested for HIV.
If you are HIV-positive, with proper
treatment you can have a healthy
pregnancy and a healthy baby.
•
•
•
•
Use a clean new needle and
syringe every time you use.
Use your own drug equipment (such as
pipes, bills, straws, cookers, water, alcohol
swabs) every time. Never share equipment,
not even with your sex partner.
Get new needles and supplies from your
local harm reduction program, needle
exchange or community health centre.
Get tested for HIV and hepatitis C. If you
know that you have HIV or hepatitis C, you
can take steps to protect yourself and others.
As a last resort, your own needles can be
cleaned before each time you use them, but
it is still best not to share with other people.
Cleaning means flushing the syringe twice
with clean water, twice with bleach, and then
twice with new water. Each flushing should
last 30 seconds. This will kill HIV, but it
will not protect you from hepatitis C.
HIV & Blood Products
Since November 1985, all blood products in
Canada are checked for HIV. A person’s
risk of getting infected from a
blood transfusion in Canada
is extremely low.
There is no chance of
getting HIV from
donating blood.
You are better off
knowing if you have HIV.
If you know you have HIV, you can get the
treatment and care you need to stay healthy
and avoid passing it on to others.
If you think you may have
been exposed to HIV, it is
important to get tested.
•
•
•
If you have HIV, you have a legal duty to tell your
sex partner(s) before having any kind of sex that
could put them at “significant risk” of getting HIV.
• The law is not completely clear on what
“significant risk” means. It is clear, however, that
unprotected vaginal or anal sex is considered to
pose a “significant risk” of HIV transmission.
• People with HIV have been convicted of serious
crimes for not telling their sex partners they
have HIV (not disclosing their status) before
having unprotected vaginal or anal sex.
For more information on HIV, contact:
• a public health unit
• your local sexual health or family planning clinic
• your local AIDS organization
• an AIDS and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or,
in Quebec, a CLSC
You can’t tell whether you have been
infected with HIV by how you feel.
•
•
Some people have flu-like symptoms
when they first get infected (fever, sore
throat or swollen glands). But some
people have no symptoms at all.
You can have HIV and not know it.
If you test positive:
•
•
HIV & the Law
The only way to know if you have HIV is to get
tested. The HIV test is a simple blood test.
After HIV enters the body, it may take time
before the test can detect the virus (this is
known as the window period). Different
HIV tests have different window periods.
Don’t wait. Speak to a health-care
provider about getting tested for HIV as
well as other STIs and hepatitis C.
Contact Information:
•
•
The law is not clear about whether people
with HIV must disclose their status before
having sex using a condom or before
having oral sex (without a condom).
For more information on HIV and the law,
contact the Canadian HIV/AIDS Legal Network.
It may be able to refer you to a lawyer but
cannot provide you with legal advice.
www.aidslaw.ca
[email protected]
416-595-1666
There have been significant advances in
the care and treatment of HIV, and with
the right treatment, you can stay healthy.
To protect yourself and your partner(s), practise
safer sex and do not share drug equipment.
Get connected. Contact CATIE for more
information on HIV services in your area.
About one in every four
Canadians with HIV does not
know they have it. The only
way to know for sure if you
have HIV is to get tested.
An HIV test could save your life.
Need more information
and resources on HIV or
hepatitis C?
Contact CATIE at:
1-800-263-1638
416-203-7122
www.catie.ca
[email protected]
CATIE accepts collect calls
from Canadian prisons.
HIV & AIDS: Basic Facts, 2010. Based on a publication originally
produced by the Canadian Public Health Association (CPHA).
Production of this document has been made
possible through a financial contribution from the
Public Health Agency of Canada (PHAC).
CATIE Ordering Centre Catalogue Number ATI-40223
10-04-27 3:58 PM
HIV&
AIDS
BASIC FACTS
There is no vaccine to prevent HIV.
There is no cure for HIV but there is treatment.
Anyone can be infected with HIV.
What are HIV & AIDS?
HIV is a virus that can make you sick.
•
•
•
HIV weakens your immune system, your body’s
built-in defence against disease and illness.
You can have HIV without knowing it. You
may not look or feel sick for years, but you
can still pass the virus on to other people.
Without HIV treatment, your immune system
can become too weak to fight off serious
illnesses. HIV can also damage other parts of
your body. Eventually, you can become sick
with life-threatening infections. This is the most
serious stage of HIV infection, called AIDS.
HIV stands for
Human Immunodeficiency Virus.
AIDS stands for Acquired
ImmunoDeficiency Syndrome.
There is no cure for HIV…
but there is treatment.
•
•
There is no cure for HIV, but with proper care
and treatment, most people with HIV can avoid
getting AIDS and can stay healthy for a long time.
Anti-HIV drugs have to be taken every
day. They cannot get rid of HIV but
they can keep it under control.
Who can get HIV?
Anyone can be infected with HIV, no matter...
• your age
• your sex
• your race or ethnic origin
• who you have sex with
1201_CATIE_hivbasicfacts_ENG.indd 1-9
How does HIV get passed from
one person to another?
•
•
•
Only five body fluids can contain enough HIV to
infect someone: blood, semen (including pre-cum),
rectal fluid, vaginal fluid and breast milk.
HIV can only get passed when one of these fluids
from a person with HIV gets into the bloodstream
of another person—through broken skin, the
opening of the penis or the wet linings of the
body, such as the vagina, rectum or foreskin.
HIV cannot pass through healthy, unbroken skin.
The two main ways that HIV can get passed
between you and someone else are:
•
through unprotected sex (anal or
vaginal sex without a condom)
•
by sharing needles or other equipment
to inject drugs (including steroids)
HIV can also be passed:
•
by sharing needles or ink to get a tattoo
•
by sharing needles or jewellery
to get a body piercing
•
by sharing acupuncture needles
•
to a fetus or baby during pregnancy,
birth or breast-feeding
HIV cannot be passed by:
•
talking, shaking hands, working or
eating with someone who has HIV
•
hugs or kisses
•
coughs or sneezes
•
swimming pools
•
toilet seats or water fountains
•
bed sheets or towels
•
forks, spoons, cups or food
•
insects or animals
HIV & Sex
HIV & Drug Use
HIV can be passed during
unprotected sex.
HIV can be passed on
through shared needles and
other drug equipment.
This means:
•
vaginal or anal sex without a condom
•
oral sex without a condom or dental dam
(a piece of latex used to cover the vulva or anus)
•
sharing sex toys
Another virus called hepatitis C can also be
spread when sharing drug equipment. Hepatitis
C damages the liver. It is passed when the
blood from someone who has hepatitis C gets
into the bloodstream of another person.
Protect yourself and the
people you do drugs with.
Protect yourself and your partner(s)
from HIV and other sexually
transmitted infections (STIs).
Safer sex protects you and your
partner(s) from HIV and STIs.
You can have sex with little or no risk of passing
on or getting HIV. This is called safer sex.
HIV & Pregnancy
People can have HIV or other STIs without knowing
it because these infections often do not cause
symptoms. You could have HIV or another STI and
not know it. Also, don’t assume that your partner(s)
knows whether they have HIV or any other STI.
The only way to know for sure is to be tested.
HIV can pass from a
woman to her baby:
•
•
•
•
•
Use a latex or polyurethane condom correctly
every time you have vaginal or anal sex.
Use only water-based or siliconebased lubricants. (Oil-based lubricants
can make latex condoms break.)
Get tested for STIs regularly. Having an STI
increases your risk of getting and passing
on HIV.
Avoid sharing sex toys, and if you do, cover
each one with a new condom before
each use. It is also important to clean
your toys between vaginal and anal use.
Use a condom or dental dam
every time you have oral sex.
Choose forms of sexual stimulation
that pose little or no risk for HIV, like
masturbation or sensual massage.
If you use drugs, there are things you can do
to protect yourself and use drugs in a safer
way. This is called harm reduction.
To practise safer drug use…
Safer sex also helps protect you and your partner(s)
from other STIs, such as gonorrhea and syphilis.
•
•
Sharing needles and other drug
equipment is very risky.
Oral sex is not as risky as vaginal or
anal sex, but it’s not completely safe.
To practise safer sex…
If you do not have access
to a needle exchange…
•
•
•
during pregnancy
at birth
through breast-feeding
Protect your baby.
If you are HIV-positive and pregnant, proper HIV
treatment and care can reduce the risk of your
child being HIV-positive to less than 2 percent.
Talk with your healthcare provider to find out more.
If you are pregnant or thinking about
getting pregnant, get tested for HIV.
If you are HIV-positive, with proper
treatment you can have a healthy
pregnancy and a healthy baby.
•
•
•
•
Use a clean new needle and
syringe every time you use.
Use your own drug equipment (such as
pipes, bills, straws, cookers, water, alcohol
swabs) every time. Never share equipment,
not even with your sex partner.
Get new needles and supplies from your
local harm reduction program, needle
exchange or community health centre.
Get tested for HIV and hepatitis C. If you
know that you have HIV or hepatitis C, you
can take steps to protect yourself and others.
As a last resort, your own needles can be
cleaned before each time you use them, but
it is still best not to share with other people.
Cleaning means flushing the syringe twice
with clean water, twice with bleach, and then
twice with new water. Each flushing should
last 30 seconds. This will kill HIV, but it
will not protect you from hepatitis C.
HIV & Blood Products
Since November 1985, all blood products in
Canada are checked for HIV. A person’s
risk of getting infected from a
blood transfusion in Canada
is extremely low.
There is no chance of
getting HIV from
donating blood.
You are better off
knowing if you have HIV.
If you know you have HIV, you can get the
treatment and care you need to stay healthy
and avoid passing it on to others.
If you think you may have
been exposed to HIV, it is
important to get tested.
•
•
•
If you have HIV, you have a legal duty to tell your
sex partner(s) before having any kind of sex that
could put them at “significant risk” of getting HIV.
• The law is not completely clear on what
“significant risk” means. It is clear, however, that
unprotected vaginal or anal sex is considered to
pose a “significant risk” of HIV transmission.
• People with HIV have been convicted of serious
crimes for not telling their sex partners they
have HIV (not disclosing their status) before
having unprotected vaginal or anal sex.
For more information on HIV, contact:
• a public health unit
• your local sexual health or family planning clinic
• your local AIDS organization
• an AIDS and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or,
in Quebec, a CLSC
You can’t tell whether you have been
infected with HIV by how you feel.
•
•
Some people have flu-like symptoms
when they first get infected (fever, sore
throat or swollen glands). But some
people have no symptoms at all.
You can have HIV and not know it.
If you test positive:
•
•
HIV & the Law
The only way to know if you have HIV is to get
tested. The HIV test is a simple blood test.
After HIV enters the body, it may take time
before the test can detect the virus (this is
known as the window period). Different
HIV tests have different window periods.
Don’t wait. Speak to a health-care
provider about getting tested for HIV as
well as other STIs and hepatitis C.
Contact Information:
•
•
The law is not clear about whether people
with HIV must disclose their status before
having sex using a condom or before
having oral sex (without a condom).
For more information on HIV and the law,
contact the Canadian HIV/AIDS Legal Network.
It may be able to refer you to a lawyer but
cannot provide you with legal advice.
www.aidslaw.ca
[email protected]
416-595-1666
There have been significant advances in
the care and treatment of HIV, and with
the right treatment, you can stay healthy.
To protect yourself and your partner(s), practise
safer sex and do not share drug equipment.
Get connected. Contact CATIE for more
information on HIV services in your area.
About one in every four
Canadians with HIV does not
know they have it. The only
way to know for sure if you
have HIV is to get tested.
An HIV test could save your life.
Need more information
and resources on HIV or
hepatitis C?
Contact CATIE at:
1-800-263-1638
416-203-7122
www.catie.ca
[email protected]
CATIE accepts collect calls
from Canadian prisons.
HIV & AIDS: Basic Facts, 2010. Based on a publication originally
produced by the Canadian Public Health Association (CPHA).
Production of this document has been made
possible through a financial contribution from the
Public Health Agency of Canada (PHAC).
CATIE Ordering Centre Catalogue Number ATI-40223
10-04-27 3:58 PM
Tuberculosis (TB)
healthful
What is TB?
TB is a contagious disease caused by TB germs. TB usually attacks
the lungs but can affect any part of the body. TB has been around for
centuries.
TB germs become active when the body’s immune system cannot
stop the germs from growing. The active TB germs begin to grow
and cause damage to the body. Symptoms of TB disease are:
•
•
•
•
cough (lasting longer than 3 weeks)
fever/chills/night sweats
feeling tired
unexplained weight loss/loss of appetite
lf the TB disease is in another part of the body, the symptoms will depend on where the TB is
growing, for example swollen lymph node or joint pain.
How is it spread?
Is there a test for TB?
TB is not highly contagious
but it is spread from person
to person through the
air (through a cough or
sneeze). Close, prolonged
or regular contact with
someone who is sick with
TB disease is needed to
spread this disease.
The tuberculin skin test (TST)
can help detect the presence
of tuberculin bacillum in a
person by testing his or her
skin’s sensitivity to the test.
If there’s swelling and
induration (hardening of the
skin) larger than 10 mm at
the site of injection, it means
that the person has been in
contact with the tuberculosis
bacillum. This contact could
be recent or date back many
years, so it is not necessarily
a sign of an active case of
TB. But, it is important to
see a doctor for additional
investigation.
www.porcupinehu.on.ca
January 2011
Who should get this
test?
The test is most often
used to check people who
have been in contact with
an active, contagious
lung TB. Sometimes, it is
used to screen students
or workers in the health
care field or in institutions,
or for certain travellers,
or people foreign-born
from areas where TB is
common.
Questions?
705-267-1181
1 800-461-1818
Bureau de santé Porcupine Health Unit
Adapted
from
Eastern
Ontario
Health
Adapted
from
thethe
Eastern
Ontario
Health
UnitUnit
What is the Test?
The TST is given into the skin of the inner forearm using a fine needle. A doctor or nurse
must read it 48 to 72 hours later. Persons with significant reaction should have a complete
tuberculosis assessment.
Possible Side Effects
There are no side effects. Some people who are highly sensitive may have a large, swollen
area that may be itchy and tender for up to a couple of months. Occasionally, people may
have a severe reaction causing blistering or ulceration.
How is TB infection different from TB Disease?
TB Infection
• You cannot spread it.
• You do not feel sick.
• Germs are sleeping and do not harm you.

TB Disease
• You can spread it.
• You can feel sick.
• Germs are awake and growing in
your body.
Medications for Tuberculosis
Tuberculosis is treatable and preventable. It no longer requires long periods in a hospital. The
medications used in the treatment of tuberculosis are effective, simple to take and usually
well tolerated. The medications ordered by your physician will be supplied free of charge by
the Porcupine Health Unit.
To be effective, the medication must be taken exactly as your physician ordered. This may
be for a long time, possibly as long as a year. If not taken as prescribed, the tuberculosis
germ may become resistant to the drug, making the management of the disease much more
difficult. Keep taking your medications even though you feel better.
Healthy
Lifestyle Tips
A person with tuberculosis should:
1. Eat a sensible diet.
2. Get plenty of sleep in a well ventilated area.
3. Cover nose and mouth when coughing or sneezing and put sputum and
secretion tissues in a plastic bag.
4. Wash hands often (this is very important).
No special precautions are needed for dishes, laundry, etc. These can be
washed in hot, soapy water.
...Tuberculosis (TB) is treatable and preventable
Exposure of Emergency Service Workers to Infectious Diseases Protocol
Preamble
The Ontario Public Health Standards (OPHS) are published by the Minister of Health and Long-Term Care under the
authority of the Health Protection and Promotion Act (HPPA)1 to specify the mandatory health programs and services
provided by boards of health. Protocols are program and topic specific documents which provide direction on how boards
of health must operationalize specific requirement(s) identified within the OPHS. They are an important mechanism by
which greater standardization is achieved in the province-wide implementation of public health programs.
Protocols identify the minimum expectations for public health programs and services. Boards of health have the authority to
develop programs and services in excess of minimum requirements where required to address local needs. Boards of health
are accountable for implementing the standards including those protocols that are incorporated into the standards.
Purpose
The purpose of this protocol is to ensure that:
• Emergency service workers (ESWs) are notified by the medical officer of health or designate, in the event that s/he may
have been exposed to an infectious disease of public health importance, so that appropriate action can be taken.
• Designated officers are able to obtain advice from boards of health through the medical officer of health or designate
regarding possible exposure(s) of ESWs to infectious diseases of public health importance.
This protocol replaces the roles, responsibilities, and requirements of boards of health found in the Notification of
Emergency Service Workers Protocol, 1994.
This protocol does not address requirements of boards of health under the Mandatory Blood Testing Act, 2006 (MBTA)2,
which is administered by the Ministry of Community Safety and Correctional Services. This protocol addresses
responsibilities of boards of health with regard to notifying ESWs of possible exposures to infectious diseases of
public health importance where:
• Diseases are not limited to those named under the MBTA2 (it is currently restricted to hepatitis B, hepatitis C and HIV); or
• An ESW has not made an application under the MBTA2, but the board of health and/or medical officer of health or
designate suspects that an ESW may have been exposed to an infectious disease of public health importance.
Reference to the Standards
The table below identifies the OPHS standard and requirement to which this protocol relates.
Standard
Requirement
Infectious
Diseases
Prevention
and Control
Requirement #7: The board of health shall ensure that the medical officer of health or designate is available
on a 24/7 basis to receive reports of and respond to infectious diseases of public health importance in
accordance with the Health Protection and Promotion Act; the Mandatory Blood Testing Act; the Exposure
of Emergency Service Workers to Infectious Diseases Protocol, 2008 (or as current); the Infectious
Diseases Protocol, 2008 (or as current); the Institutional/Facility Outbreak Prevention and Control
Protocol, 2008 (or as current); and the Public Health Emergency Preparedness Protocol, 2008 (or as
current).
Exposure of Emergency Service Workers to Infectious Diseases Protocol
1) Operational Roles and Responsibilities
a) The board of health shall have an on-call system for receiving and responding to reports of infectious diseases of
public health importance on a 24 hours per day, 7 days a week (24/7) basis.
b) The board of health shall ensure that the medical officer of health or designate is available on a 24/7 basis to receive
and respond to reports of infectious diseases of public health importance in accordance with this protocol to ensure
that:
i) Reports of a possible exposure of an ESW are received, assessed, and responded to as soon as possible, but
not later than 48 hours (depending on situation and disease, response may be required sooner) after receiving
notification; and
ii) Reports of all infectious diseases of public health importance are received and assessed, with particular
consideration given to potential exposures of ESWs.
c) The board of health shall contact emergency services in their health unit and request that they identify designated
officers for their respective emergency service (i.e., police, firefighters, ambulance) in order to facilitate the exposure
notification process.
d) The board of health* shall advise designated officers in their health unit regarding the possible exposure of an ESW to
an infectious disease of public health importance when made aware by:
i) Having the medical officer of health or designate actively seek out contacts of cases with infectious diseases of
public health importance, even if a designated officer has not contacted the medical officer of health or designate
regarding the possible exposure and no application has been made by an individual under the MBTA2;
ii) Informing the respective designated officer that an ESW might have been exposed to an infectious disease of
public health importance during his/her work. This is not dependent on laboratory confirmation – e.g., the case
can exhibit clinical signs and symptoms of a particular infectious disease; and
iii) Informing the designated officer regarding any specific actions to be taken based on the designated officer’s
report, including advising ESWs to seek medical attention and the initiation of post-exposure prophylaxis if
applicable.
e) When a designated officer makes an incident report of a possible exposure to an infectious disease of public health
importance to the board of health, the board of health shall:
i) Review and assess the information provided;
ii) Contact health care facilities and other persons (e.g., infection control practitioners and/or attending physicians)
to obtain additional information on the specific case, as necessary, based on the assessment of the incident by the
medical officer of health, or designate; and
iii) Inform the designated officer as soon as possible and no later than 48 hours after receiving notification
(depending on the disease) of advised actions to be taken, including accessing medical care by the ESW.
• Advice shall include, but is not limited to assessing the possible risk of occupational exposure and setting
standards of practice, appropriate use of personal protective equipment, training for employees to prevent
possible exposures; and
• Follow up with the designated officer to ascertain what action has been taken.
f) In the event that there is a disagreement between the designated officer and the medical officer of health or designate
regarding a possible exposure, the designated officer may refer the matter to the Chief Medical Officer of Health or
designate.
* A decision by the board of health to contact the designated officer can be made on a case-by-case basis, based on clinical assessment which could include,
but is not limited to degree of risk, type of exposure, etc.
2
Exposure of Emergency Service Workers to Infectious Diseases Protocol
Glossary
Designated officer: A person identified in an emergency service (i.e., police, firefighters, ambulance) who is responsible for
receiving and assessing reports regarding the possible exposure of an emergency service worker to an infectious disease of
public health importance and then contacting the medical officer of health or designate.
Emergency service worker: A person working in an emergency service (i.e., police, firefighters, ambulance).
Infectious diseases of public health importance: Diseases include, but are not limited to, those specified reportable
diseases as set out by O. Reg. 559/913 (as amended) under the HPPA1, and include zoonotic diseases.
References
ISBN: 978-1-4249-7588-4 Oct/08 © Queen’s Printer for Ontario
1. Health Protection and Promotion Act, R.S.O. 1990, c. H.7.
Available from http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm.
2. Mandatory Blood Testing Act, 2006, S.O. 2006, c. 26.
Available from http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_06m26_e.htm.
3. O. Reg. 559/91. Available from http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_910559_e.htm.
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