Pairing lectures with an engaging virtual community of practice can significantly boost the confidence and interest of infection prevention and control (IPAC) leads in long-term care settings to pursue the long-term care certification in infection prevention and control (LTC-CIP). Providing adult learners the opportunity to clarify concepts within a community of practice is an effective supplement to didactic lecture-based learning in supporting their pursuit of LTC-CIP.
Background: Recent evidence highlights the critical influence nurses may have in antimicrobial stewardship (AMS). However, nurses’ express knowledge gaps and a lack of confidence in leading AMS interventions. The AMS competencies framework was developed to address these challenges by providing a foundation for optimizing AMS-related nursing interventions with guidance and expected competencies that can be adapted to different practice settings and nursing categories. Methods: The framework development began with a literature review of nurses’ role in AMS across all nursing practice settings and was followed by a cross-Canada survey that involved 261 nurses, with 94% of respondents in non-prescribing roles and 6% in prescribing roles (nurse prescribers). Key survey findings were explored in virtual focus groups. Findings from the literature review, survey, and focus groups informed the initial draft of the AMS competency framework. The draft underwent internal review, and external validation through a Delphi Method with 33 reviewers and achieved high agreement (over 90%) on competency statements. Results: The AMS competency framework is organized within a matrix of seven AMS domains, nurses’ roles, and the competencies (knowledge, skills, attitudes) that nurses and nurse prescribers require to participate in AMS within their practice setting. The competencies are broadly divided into three types: Core, additional, and optional competencies. Additionally, an evaluation framework provides individual nurses and partners with potential guidance and approaches to measure outcomes associated with the achievement of the AMS competencies. Conclusion: Nurses’ impact on antimicrobial resistance (AMR) and involvement in AMS activities can have far-reaching benefits because nurses are at the forefront and interface across numerous care and practice settings. However, nurses’ engagement in AMS varies greatly and can be impacted by both individual factors (e.g., knowledge level, confidence, engagement) and contextual influences (e.g., workload, resources, leadership support, and advocacy to support nurses’ role in AMS). Coupled with contextual supports, the AMS competency framework represents an evidence-informed approach to define and support the knowledge, skills, and attitudes needed to maximize nurses’ role in AMS.
A retrospective analysis of healthcare-associated infections was conducted among patients admitted to a 12-bed paediatric intensive care unit in Ottawa, Ontario, Canada, from January 2019 to December 2023. No significant changes to healthcare-associated infection rates or length of stay were observed among patients admitted during the pre-pandemic, pandemic, or post-pandemic periods.
Infection prevention and control (IPAC) staffing models vary widely across Canadian healthcare facilities. To explore this variation, a national survey was conducted in March 2025 through the IPAC Canada network. The survey explored staffing models, coverage patterns, and key operational challenges across different facility types. Most respondents reported at least some evening or weekend IPAC coverage. Increasing workload demands post-pandemic and difficulties with recruitment and retention emerged as common staffing barriers. These findings underscore the need for national guidance and strategic collaboration to support consistent, adequate, and sustainable IPAC staffing across healthcare settings.
Background: Debriefing is an essential component of outbreak management – an opportunity to evaluate response measures, discuss what worked well, and identify gaps and areas for improvement. This study aimed to assess whether post-outbreak debriefing is practiced in long-term care (LTC) and retirement homes (RHs) and to explore its role and value in strengthening outbreak response efforts. Methods: A review of current literature on outbreak debriefing was conducted, and a survey was created and sent via email to infection prevention and control (IPAC) Leads in all 48 LTC and RHs in Mississauga and south Etobicoke, Ontario, Canada. Active institutional outbreak updates were obtained from the two local public health units covering these regions over six months, from September 2023 to February 2024. These updates were reviewed for the scope and duration of outbreaks. Results: Fifteen of 48 facilities responded (31% response rate). Of these, 80% (12/15) reported conducting outbreak debriefings using a standardized process. Eighty percent also indicated that debriefs were held via in-person meetings and 73% stated that the debrief took place within a week of declaring the outbreak over. Importantly, there was inconsistency in the content of debrief documents and over one-third of respondents did not include front-line staff in the process. Conclusion: The findings suggest that LTC and RHs recognize the value of post-outbreak debriefings as a learning and practice improvement exercise. However, variation in debrief modalities may potentially influence IPAC-related processes and outcomes.
Background: Rotavirus is a commonly recognized cause of gastrointestinal illness in infants and young children. It is an under-appreciated cause of gastroenteritis in adult patients. Clostridioides (formerly Clostridium) difficile is the most important infectious cause of antibiotic-associated diarrhea worldwide. A mixed infection outbreak involving rotavirus and Clostridioides difficile has not been fully characterized. Methods: This report highlights a mixed outbreak of Clostridioides difficile infection (CDI) and rotavirus among adult patients in a community hospital in Alberta, Canada, and describes the interventions implemented. Results: On March 20, a CDI outbreak was declared following five cases of hospital-acquired CDI, and on March 25, one patient was identified with a co-infection. A mixed pathogen outbreak was then declared after three new cases of rotavirus were detected on the same unit. Infection prevention and control (IPAC) measures were implemented in accordance with local IPAC guidelines. In addition, hand hygiene, environmental cleaning, and fluorescent marker audits were conducted. A hand hygiene audit of 21 opportunities revealed 66.7% compliance. Fluorescent marker audits showed improper cleaning of patient environments and shared equipment. The ward received targeted education and enhanced cleaning based on audit findings. The rotavirus and CDI outbreaks were declared over on April 2 and April 10, respectively. Conclusion: Considering that rotavirus is an under-recognized cause of gastrointestinal disease in adults, awareness of this pathogen as a potential cause of an outbreak is important to prompt early testing and ensure appropriate infection control interventions to prevent its spread.
Infection prevention and control (IPAC) practices are both impacted by and contribute to climate change and pollution. The World Health Organization (WHO, 2018) has identified climate change as the greatest global threat of the 21st century. Canada is warming more than twice as fast as the global rate, and the Canadian Arctic almost four times as fast (Rantanen et al., 2022). Extreme weather events from climate change are increasingly impacting the health of Canadians directly, through heat stroke (Adam-Poupart et al., 2014, 2015) and cardiorespiratory issues (Paterson et al., 2012; Levison et al., 2018). Global warming has contributed to the rise in diseases like Lyme disease in Canada, spread by vectors which can now live further north (Ogden et al., 2014; Canadian Medical Association, 2022; Romanello et al., 2024), and the simultaneous emergence of multidrug-resistant Candida auris in three continents may be linked to thermal adaptation (Casadevall et al., 2019).
As members of the Ontario Infection Control Professionals Action Coalition (OICPAC), we write to highlight a critical gap in Ontario’s healthcare system, the absence of regulation for Infection Prevention and Control (IPAC) professionals. Despite playing an essential role in safeguarding patient safety and public health, IPAC professionals are not a recognized or self-regulated health profession in Ontario (or elsewhere in Canada). They lack title protection, entry-to-practice requirements, a regulatory body, and a legislative framework. IPAC professionals in Ontario come from diverse fields such as laboratory science, nursing, medicine, microbiology, public health, and more, including internationally trained healthcare professionals. While these backgrounds offer foundational knowledge, none provides the specialized formal training required for effective IPAC practice. Many pursue voluntary educational certificates such as those offered by IPAC Canada, and/or attempt certification exams through the U.S.-based Certification Board of Infection Control (CBIC). However, without regulation, entry-to-practice standards, accountability, and advocacy remain inconsistent, and public safety can be compromised. The need for a Canadian certification framework remains urgent but lies beyond the scope of this letter.
A recently published measles seroprevalence study of about 350,000 individuals in Ontario underscored the fragility of Canada’s measles elimination status and revealed notable immunity gaps among adolescents, young adults, and immigrant populations (Ariyarajah et al., 2025). The findings corroborate Ontario’s epidemiological reality in 2025, marked by an alarming resurgence of measles. As of July 2025, Public Health Ontario has reported more than 2,000 confirmed cases of measles, making it the highest annual total since measles was officially eliminated in Canada (Public Health Ontario, 2025). The age distribution of the majority of measles cases reported in 2025 aligns closely with the findings of Ariyarajah et al. (2025).
Background: Studies have provided strong evidence that personal protective equipment (PPE) effectively reduces the risk of transmitting highly infectious emerging diseases among healthcare providers (HCPs). However, literature examining this phenomenon specifically within the context of the COVID-19 pandemic remains limited. This study explored the behaviours and contributing factors influencing HCPs’ use of PPE, as well as how they established a sense of safety while caring for patients with COVID-19. Methods: We conducted 22 semi-structured interviews with HCPs who provided direct care to patients with COVID-19 in the medical and critical care units of a large urban hospital in Vancouver, British Columbia. An interpretive description approach was used to understand staff narratives and identify key themes. Results: Staff reported high confidence in their PPE practices, citing factors such as emerging evidence and guidance, infection prevention and control (IPAC) protocols, occupational experience, specific PPE workflows, and point-of-care risk assessments. Within the broader context of the COVID-19 pandemic in British Columbia, staff identified several factors that influenced their PPE behaviours: PPE accessibility and availability, staff education, environmental reminders, staffing levels, environmental cleaning, physical space, time constraints, patient acuity and workload, PPE fatigue, the evolution of SARS-CoV-2 variants, vaccination status, occupational culture, and systemic trust. Conclusions: Overall, our findings highlight the importance of a relational approach in supporting HCPs to keep both patients and colleagues safe during the pandemic. By fostering trust and open communication, infection control practitioners (ICPs) can help HCPs navigate the challenges of misinformation and psychological stress. Identifying the factors that shape PPE behaviour enables ICPs to design targeted interventions that address frontline staff needs and promote effective PPE practices. Ultimately, the development of realistic, context-sensitive guidelines — along with addressing the mental and informational challenges faced by HCPs – is crucial to enhancing safety and adherence to infection control practices in future public health emergencies.
Background: Clostridiodes difficile infection (CDI) is a prevalent healthcare-associated infection that also occurs in community settings. Household hygiene may be an under-utilized strategy for controlling environmental spore contamination. Currently, no standardized protocol exists for cleaning the homes of individuals with CDI, and patients often lack guidance on effective hygiene practices. Objective: This study aimed to explore the household hygiene experiences and practices of patients discharged from hospital following a CDI diagnosis. Methods: Semi-structured interviews were conducted with individuals diagnosed with CDI within one year of hospital discharge. Seven interviews were completed – four in person and three by telephone. An inductive content analysis approach was used to code and analyze the transcripts. Results: Participants generally lacked awareness of CDI transmission pathways. Cleaning routines were based on habit (e.g., weekly schedules) or visible dust accumulation, rather than the potential for contamination or transmission risk. Most cleaning products used were not effective against spores. Conclusion: The hygiene practices reported by participants were unlikely to adequately decontaminate their home environments. Developing and providing a targeted hygiene protocol at discharge may help reduce the risk of reinfection or transmission to household members.
Background: The role of infection control professionals has evolved with the increasing complexity of healthcare and the diversity of professional backgrounds, including nursing, epidemiology, and public health. This diversity presents challenges for orientation and professional development. Recognizing the importance of competency-based frameworks, the Alberta Health Services Provincial Infection Prevention and Control (IPAC) program implemented a strategic initiative to define and operationalize competencies across IPAC roles. This study evaluated the initiative using the RE-AIM framework. Methods: The IPAC competency framework was launched in March 2022. A multi-method evaluation was conducted between January and March 2024, consisting of an anonymous survey distributed to 217 IPAC staff and follow-up interviews with senior leadership. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) guided the evaluation. Results: Sixty percent of staff (130/217) completed the survey. Under the Reach domain, most staff reported using and understanding the competencies, though some found prioritization challenging. Effectiveness was reflected in 79% of staff setting learning goals and 88% developing actionable plans. Adoption showed high satisfaction, with 88% of respondents using competency tools, though some reported perceived redundancy. Conclusions: Factors influencing the use of the IPAC competency tools included alignment with program goals, leadership engagement, delegation of champions, and barriers to staff engagement. Ongoing evaluation was recommended to monitor progress and enhance sustainability. The RE-AIM framework proved useful in identifying both successes and potential risks to the long-term success of the competency framework. Key barriers included limited team size and competing priorities; however, continued training and perceived value were identified as critical to sustained engagement.
Background: The Community of Practice (CoP) group, comprising members from Trillium Health Partners (THP), Halton Healthcare (HH) and William Osler Health System (WOHS) executed an education needs assessment survey. The objective of this survey was to evaluate the knowledge and understanding of carbapenemase-producing Enterobacterales (CPE) best practices amongst frontline staff across three organizations. Methods: A quantitative, cross-sectional survey consisting of 10 questions was developed and distributed across the three organizations. Responses were independently reviewed by each site, and data from all sites were aggregated. The combined data were subsequently examined, charted and graphed in Microsoft Excel. The results were displayed both by hospital site and in a combined format. Results: A total of 514 frontline staff completed the survey across all sites. While 86% of respondents were familiar with the term CPE, only 30% felt confident in explaining what CPE is. Furthermore, only 67% of respondents identified the appropriate isolation measures for CPE-positive patients, and 61% recognized the appropriate measures for CPE-exposed patients. Additionally, 57% were unable to identify the correct disposal process for liquid waste. Although 81% of respondents understood the severity of CPE infections, only 57% agreed that CPE-positive patients require ongoing additional precautions. Finally, only 25% could correctly identify when to collect CPE screening swabs for newly admitted patients per hospital policy. Conclusions: The survey responses revealed consistent gaps in CPE knowledge and education across all three organizations. Although respondents demonstrated some understanding of CPE infections, including the ability to identify the organism and recognize its potential negative patient outcomes, significant knowledge deficiencies were evident. Across all sites, there was low confidence in managing CPE-positive patients and implementing appropriate additional precautions. Moreover, respondents exhibited a lack of comprehension regarding organizational policies and practices related to hand hygiene sink usage, liquid waste disposal, and screening of new admissions. These findings highlight the need for targeted educational interventions to address these deficiencies and enhance CPE management practices across the organizations.
Background: One of the major challenges faced by healthcare facilities in Quebec, Canada, is the shortage of nurses specializing in Infection Prevention and Control (IPC), exacerbated by the broader nursing shortage. This survey aimed to identify effective strategies for retaining IPC nurses in Montreal, Canada, amidst the ongoing staff shortages and frequent rotations. Methods: A descriptive cross-sectional survey was conducted with a convenience sample of IPC nurses in Montreal, utilizing both open- and closed-ended questions. The survey was developed following a literature review. A pilot testing was followed by an open-ended survey in 2023 targeting IPC and clinical managers to gather further perspectives. Quantitative analysis was applied to the closed-ended responses, while thematic analysis was conducted on the open-ended responses. Bivariate analysis was employed to explore relationships between variables. Results: Quantitative and qualitative analyses identified five key strategies to address the IPC nurse shortage. Respondents, including IPC nurses and managers highlighted the importance of integrating non-nursing professionals into the IPC roles. A significant concern among IPC nurses was the lack of funding for specialized training and certification. Other retention challenges included inadequate salary recognition for educational qualifications, limited opportunities for career advancement, and insufficient organizational recognition of the importance of infection control. Moreover, the work environment was deemed essential for retaining IPC professionals. Conclusions: The findings from the current study provide valuable insights for policymakers seeking to improve IPC staff retention. Addressing Quebec’s nursing shortages involves integrating non-nursing professionals into IPC roles and implementing retention strategies tailored to generational needs, such as horizontal promotions linked to progressive salary scales and educational requirements. Additionally, fostering a supportive work environment with work-life and study balance, flexible scheduling, and strong organizational recognition, while cultivating a robust infection control culture, is crucial for retaining IPC staff.
Background: Candida auris (C. auris) has been identified as an emerging pathogen of interest in healthcare settings. Its resistance to antimicrobials, high mortality rates, ability to persist in the environment and increasing instances of outbreaks in healthcare settings constitute major concerns among healthcare practitioners across the globe. To address concerns regarding preventing transmission of C. auris, the Public Health Agency of Canada (PHAC) conducted a literature review to inform guidance for the infection prevention and control of C. auris in hospitals and long-term care facilities (LTC). Methods: Electronic databases were searched to identify peer-reviewed evidence published between database inception until September 7, 2023. Peer-reviewed primary evidence and literature reviews, in English or French, reporting on infection prevention and control (IPC) practices put into place to prevent transmission of C. auris in healthcare settings were eligible for inclusion. Title and abstract screening, full-text review, critical appraisal, and data extraction processes were performed by two reviewers using DistillerSR systematic review software and the PHAC Infection Prevention and Control Critical Appraisal Toolkit. A scan of grey literature was also conducted to inform the review. Results: Thirty-two articles of medium- to high-quality detailing C. auris IPC were included in the review. Settings reporting no transmission beyond the index case were more likely to report the use of risk-factor-based screening, private accommodation with dedicated toileting facilities, the use of personal protective equipment (PPE) consisting of gown and gloves at all times and the application of no-touch cleaners and disinfectants. Conclusion: Multiple IPC interventions appear to be effective at minimizing transmission. However, determining effectiveness is challenging due to variability in intervention reporting and due to the lack of understanding of C. auris burdens before and after their implementation. Increased vigilance with screening and reporting would be advisable, and future work would benefit from multi-centre comparison of interventions using prevalence data.
Background: Tracking healthcare-associated infections (HAIs) is crucial for reducing and preventing transmission. This study aimed to evaluate the validity and reliability of the Canadian Nosocomial Infection Surveillance Program (CNISP) COVID-19 surveillance data by assessing key metrics, including case definition, case classification, and outcomes. Methods: In December 2022, a survey containing 12 COVID-19 case study questions was administered to staff from 81 eligible hospitals across 32 hospital networks. These staff members were responsible for submitting data using a standardized protocol and case definitions. Results: Fifty-four (67%) of the 81 CNISP hospital sites completed the survey. The mean survey score was 79% with a median of 83%, and a range of 58-91%. Scores varied by question theme, from 70% for reasons for admission, to 93% for multiple positives. Conclusion: The study findings indicate that CNISP case definitions and classifications were consistently and accurately applied across most case study questions. These results underscore the robust quality of COVID-19 data gathered through the national surveillance platform.
Background: Early neonatal sepsis poses a significant public health challenge worldwide, especially in Colombia and Latin America. It remains a leading cause of morbidity and mortality among newborns, particularly affecting those born prematurely or with low birth weights. Despite advancements in care and preventive strategies, the prevalence of sepsis continues to be alarming. Methods: A descriptive study employing retrospective data was conducted in the PROCAREN Neonatal Intensive Care Unit (NICU) from May 2015 to January 2018. The study aimed to assess the prevalence and identify factors associated with early neonatal sepsis. A total of 88 medical records of neonates diagnosed with sepsis, either clinically or microbiologically, were reviewed, excluding those with incomplete records. Results: Of the neonates studied, 55% were male, and 56% resided outside the metropolitan area. Maternal risk factors identified included chorioamnionitis (85.7%) and nearly half (46%) of women did not receive full prenatal care. Neonatal risk factors included pre-term birth (52.3%), low birth weight (49%), and a 5.7% mortality rate due to sepsis. Additionally, 37 neonates exhibited factors associated with early sepsis, with higher prevalence rates of hypoglycemia (29.7%), pneumonia (24.3%), and urinary tract infections (13.5%). Conclusions: Our findings corroborate those in the literature, emphasizing socio-demographic and neonatal risk factors for early neonatal sepsis. Notable maternal factors identified included chorioamnionitis and prolonged rupture of membranes, while the main neonatal factors were pre-term birth and low birth weight. Despite preventive measures, high incidence and mortality rates due to sepsis persist, underscoring the importance of addressing these factors to improve neonatal outcomes.
We report a chickenpox outbreak among international students in Ontario, Canada. This paper highlights the complex challenges of clinical and public health response to outbreak situations. While the incidence of varicella infection has decreased due to widespread vaccination programs in Canada, specific groups, such as international students from areas with lower vaccination rates, remain at risk. The outbreak involved primarily unvaccinated international students residing in a college residence building. Coordinated and prompt contact tracing and administration of post-exposure vaccination were core strategies to control the outbreak. The incident highlighted several challenges that can arise in varicella outbreak management, from determining when and how to order and interpret serological tests, to adjusting isolation measures based on the community’s low vaccination rate. Ethical considerations surrounding vaccination policies, particularly for international students came to the forefront. The disparity in access to preventive care highlights broader public health implications and prompts a discussion on equitable vaccination strategies.
Background: Antimicrobial resistance (AMR) represents a major public health concern worldwide. To effectively combat AMR, the use of point-of-care (POC) diagnostic tests is recommended by the World Health Organization (WHO). In this qualitative study, we investigated the drivers that influence the implementation and adoption of POC diagnostic tests in healthcare settings in Quebec, Canada, to help fight against AMR. Methods: Interviews were conducted with experts on AMR and/or diagnostic tests at the federal and provincial (Quebec) levels. Applying Greenhalgh and colleagues’ non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework as a theoretical basis, we examined the complexities involved in implementing diagnostic innovations aimed at reducing AMR. Results: A total of 42 participants were interviewed. We identified multiple drivers across the development, assessment and implementation stages of new POC tests: the complexities associated with evolving AMR and POC technology development; issues related to trust in test results; challenges of cost-benefit analyses; considerations regarding user impact; local organizational aspects related to POC tests; the regulatory, political, and economic contexts; and the impact of the COVID-19 pandemic on public health priorities. Conclusion: The implementation of diagnostic tests that deliver rapid results to inform antibiotic prescription is a priority in Canada and globally. However, our study underscores the complexity and challenges involved in adopting new POC tests. Despite presenting challenges, the COVID-19 pandemic has also facilitated the development and assessment of diagnostic innovation in healthcare settings. Our study further emphasizes the need for AMR to be elevated as a political priority for effective management.
