We are writing to provide an update about expectations regarding the provision of Personal Protective Equipment (PPE) for workers in hospitals, long-term care homes and retirement homes during the COVID-19 pandemic, as part of our shared commitment to the safety of the health care workforce.
The Ontario government is continuously monitoring data related to COVID-19, including the variants of concern. On January 29, 2021, the Ontario government released Ontario’s six point variant action plan, which enhances the existing coordinated and ongoing efforts of the province to prevent, detect, track, trace and contain the spread of COVID-19. Public Health Ontario also released updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19, which includes a
reference to the primacy of Directive 5.
The Ministry of Health confirms that Directive 5, updated on October 8, 2020, is the framework in place for the use of PPE in hospitals and long-term care homes. In addition, in accordance with O. Reg 68/20 made under the Retirement Homes Act, retirement homes must take all reasonable steps to follow the required precautions in the Directive. Directive 5 states that where it conflicts with another Directive, Directive 5 takes precedence. Directive 5 is the provincial baseline standard for provision of personal protective equipment for hospitals, long term care homes and retirement homes.
In recognition of our shared commitment to occupational health and safety, the ministries are writing to support the continued implementation of Directive 5.
- The ministries request that employers review all guidance, policies, procedures and practices for management and staff to ensure alignment with Directive 5. This includes clarity that N-95 respirators or equivalent protection can be accessed by workers based on a point-of-care risk assessment (PCRA) or workers determination, depending on the circumstance.
- Directive 5 clarifies the role of the PCRA for accessing N-95 respirators for both regulated and unregulated health care workers, even if not performing Aerosol Generating Medical Procedures (AGMPs). It also outlines how an unregulated worker in a setting in outbreak can determine whether an N-95 respirator or equivalent is needed.
- Employers are reminded that they are not to deny a worker access to an N-95 respirator when the process outlined in Directive 5 has been followed.
- An updated Directive 5 FAQ, dated February 19, is attached.
- As employers continue in their stewardship role of ensuring an adequate supply of PPE, if they are having difficulty in securing adequate supplies of N-95 respirators, they are encouraged to access provincial stockpiles following the steps described in Appendix A, below. Employers should regularly review inventory to ensure they have adequate supplies and not resort to using expired products. In extraordinary circumstances, where efforts to secure timely PPE have not been successful, and where PPE has expired, the ministries expect employers to be guided by Ontario Health’s Optimizing the Supply of Personal Protective Equipment During the COVID19 Pandemic.
- Fit testing may be required on an ongoing basis to support new workers or to respond to the availability of different sizes of respirators. For access to fit testing resources for long-term care homes and retirement homes, please refer to Appendix B, below.
- The Ministry of Labour, Training and Skills Development has put in place a mechanism to provide an urgent inspector response to complaints in the health care and retirement home sectors. This includes where workers have conducted a PCRA, have determined a certain level of PPE Is required and are not being provided with that level of PPE. This service is available at the Occupational Health and Safety Contact Centre during regular business hours at 1-877-202-0008 and at the Spills Action Centre after hours at 416-325-3000.
The government continues to monitor the supply of PPE and is taking steps to ensure adequate supply through the spring and summer.
The provision and correct use of PPE is one part of successful occupational health and infection prevention and control (IPAC) practices. The ministries recognize that there may be new workers on site at any given time, requiring a process of continued training and onsite information resources and guidance about PPE access and IPAC practices. For access to IPAC expertise, employers can engage their local IPAC hub or contact EOCoperations.moh@ontario.ca.
The ministries recognize that employers and unions have local processes in place to address issues related to compliance with Directive 5 and other guidance and directives related to IPAC.
Health care workers are the most important resource Ontario has in our response to the COVID-19 pandemic.
Thank you for your continued commitment to their safety.
Sincerely,
Helen Angus, Deputy Minister, Ministry of Health
Richard Steele, Deputy Minister, Ministry of Long-Term Care
Denise Cole, Deputy Minister, Ministry for Seniors and Accessibility
Greg Meredith, Deputy Minister, Ministry of Labour, Training and Skills Development