Midwives, like all health care providers, have an important role to play in the prevention of health care associated infections. These are illnesses that arise from exposure to bacteria and viruses within any health care setting, and are associated with longer hospitals stays and higher costs to the public health system. We know that many Ontarians become sick or even die from infections that they get from interactions within our health care services. As midwives, you can minimize the risk of harm to your clients caused by health care associated infections.
A large proportion of these infections are preventable. Evidence shows that when we use effective infection prevention and control (IPAC) measures; from masks, to gloves, to correct isolation of people who are sick; we can decrease health care associated infection rates over time.
Midwives may risk exposing their clients to infection through various means, for example if they care for clients when they themselves are sick or living with a transmissible disease, or if they are not diligent in maintaining clean or sterile equipment and surfaces within the health care environment.
Preventing the transmission of infectious diseases from midwives to clients is a standard of care that keeps everyone safe. It’s essential that we utilize a combination of standard precautions, adhere to specific guidelines for infected health care workers, and ensure robust infection prevention and control practices to reduce risk of infectious disease transmission. Infection prevention and control strategies midwives must employ include the use of personal protective equipment, proper hand hygiene, safe injection practices, and appropriate care of your own health.
Relevant Professional Standards
43. Ensure that any physical or mental health condition does not affect your ability to provide safe and effective care.
44. Recognize the limits imposed by fatigue, stress, or illness, and adjust your practice to the extent that is necessary to provide safe and effective care.
Midwives who are practice owners must also:
10. Maintain a practice environment that supports compliance with relevant legislation, regulations, policies, and standards governing the practice of midwifery.
11. Ensure essential operational and clinical supplies are available to midwives in your practice.
12. Develop and maintain quality improvement systems to support the professional performance of midwives and to enhance the quality of client care.
Standard Precautions
Treating all bodily fluids as infectious:
Blood and other potentially infectious materials should always be treated as if they are carriers of pathogens. This includes respiration; as we learned during the COVID-19 pandemic, viruses and bacteria can travel through air or within droplets of our breath. Midwives who follow effective IPAC measures understand how disease transmission occurs, and how to prevent it.
Personal Protective Equipment (PPE):
Midwives understand and use the correct amount of PPE, including gloves, gowns, masks, and/or eye protection, to reduce the risk of transmission in every clinical scenario. This reduces the risk of midwife to client transmission of illness, and vice-versa, keeping you and your clients safe.
Hand hygiene:
The importance of consistent hand hygiene in health care settings cannot be understated; it’s often the best and most effective way to reduce transmission of disease within a health care setting.
Safe injection practices:
Midwives perform exposure-prone procedures as part of routine midwifery practice; these procedures may increase the risk of disease transmission from midwife to client, because there’s a risk of a needle stick injury which may lead to a client being exposed to their midwife’s blood. It is a midwife’s responsibility to carry essential equipment; and handle, use, and dispose of used sharps following existing protocols to reduce the risk of infectious disease exposure. Additionally, it’s imperative for midwives to follow organizational and hospital policies on personal care following a needle-stick injury.
When Midwives Are Living with an Infectious Disease
National Guidelines:
The Public Health Agency of Canada has a guideline specifically addressing the prevention of blood borne virus transmission from infected health care workers to patients. Blood borne viruses include HIV, HCV, and HBV. Midwives must know, understand, and adhere to these guidelines to protect their clients’ health and safety.Midwives living with HIV, HBV, or HCV must consult and adhere to the recommendations provided by the Public Health Agency of Canada related to testing and monitoring their condition, particularly when they perform exposure-prone procedures, and understand and adhere to recommendations for adapting the care that they provide to protect their clients from unintended exposure or harm.
Restrictions on Practice:
In some cases, midwives with certain infections will be recommended by guidance from the Public Health Agency of Canada to restrict the types of procedures they can perform to minimize risk of transmission to their clients. It is a midwife’s responsibility to know, understand, and implement all relevant infectious disease transmission-reducing protocols, and only provide care that does not increase risk of harm.
Education and Training:
Midwives must engage in regular, ongoing education and training on infection prevention and control practices. This includes understanding national guidelines on blood borne virus prevention, staying up to date on recommendations on infection prevention and control practices, and understanding the determinants of risk of transmission of blood borne and respiratory viruses. It is important for midwives to stay current on best practice as and adapt their practice as evidence evolves.
Reporting and Management:
Midwives must know and understand all protocols that are in place within their organization or hospital related to infectious disease transmission prevention, and ensure they follow all policies for reporting and managing occupational exposures to blood and body fluids.
Midwives: Call to Action
Midwifery care can carry risks of exposure to infectious diseases, as is the case in all other health care settings. Midwives have the knowledge, skills, and judgement to protect themselves from being exposed to viruses at work, and to keep their clients safe from unintended harms caused by disease transmission through health care associated interactions. It is a midwife’s professional responsibility to maintain current understanding of disease transmission risks, IPAC best practice, and organization policies related to infectious disease exposure.
Reference
Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings, Public Health Agency of Canada