Tuesday, December 19, 2023

You Had One Job! On IPACs Refusal to Prevent or Control Infection

The Infection Prevention and Control (IPAC) of Canada is a registered charity making some questionable decisions recently.

They promote themselves as, "Focussing on infection prevention and control in the community and in healthcare facilities." Their mission is "to advance infection prevention and control by advocating for our members and providing access to evidence-based resources, education and networking opportunities," and their vision is "a world without preventable infections." Their goal is, "Not one preventable infection. Ever." In their promotional video they say, "IPAC Canada members are dedicated to supporting efforts in eliminating preventable infections."

Dr. Lisa Iannattone noted the power they have:

"As soon as the IPAC email goes out letting everyone know they need to wear masks, everyone wears masks. If IPAC decides everyone has to wear respirators, then everyone wears respirators. This actually isn't hard at all. Why leadership would make it seem like it is, is baffling. They lean on hand wave-y Concepts like mask fatigue when I have never once received a survey asking me how I felt about masking. None of this is evidence based. Since 2022, they seem to be making decisions based on 'feels'. 
Do you know what happens in hospitals when healthcare workers fatigue? They hire people to patrol the wards and make sure we're washing our hands when we're going in and out of patient rooms. They don't give us hand washing breaks and just let C. difficile run wild for a while. We do so much to prevent infections that don't even crack the top 20 leading causes of death while allowing rampant transmission of the #1 infectious disease cause of death. There's so much internal inconsistency with our infection control policies lately, it makes my head spin."

Barry Hunt wrote to them about taking more precautions in hospitals. They wrote back. He posted: 

"IPAC is not going to lead us to masking. The cavalry is not coming. They have decidedly decided to not take a stand"

The IPAC wrote back:

"Dear Mr. Hunt...

Thank you for your thought-provoking suggestion that IPAC Canada take a public stand in favour of universal masking in healthcare spaces. Any recommended increase in mask usage beyond the current guidelines has become difficult to implement due to the very strong feelings about masking on both sides of the argument. This has become a highly politicized and emotional debate, with many facets being brought forward. In addition to the supportive and intuitive hypothesis that universal masking will potentially decrease nosocomial transmission of respiratory illness, there are several non-supportive arguments, including concerns about environmental waste, and negative effects on patient care to our many delirious and hearing-impaired patients (as well as everyone else that would generally like to be able to see the faces of their loved ones and care team.)" 

The environmental waste argument peeves me to no end. As a mom of kids who sometimes order in fast food, the waste from one fast food order is more than the waste from all the masks I've thrown out for all of us combined all year. The IPAC also appears completely oblivious to N95s with windows in them. As much as we all love seeing each other's faces in the hospital, I'd much rather have my child come home without an additional illness from the hospital. They're making the mistake of weighing the short term reward of happier patients with the long term problems of patients later much sicker, disabled, or deceased. 

"There are also increasing reports and several publications that outline the adverse effects of wearing masks for extended periods, including headaches, breathing issues, skin problems, thermal discomfort, cognitive impairment, and impediments to vision and communication. IPAC Canada is not a research body to attempt to prove or disprove the hypothesis that universal masking is unequivocally beneficial, and without at minimum best practice guidance and support, we are not able to make a public statement for or against universal use of masks in healthcare spaces. We continue to support the best practices as they are developed and refined by the expert bodies who take on that role. At this point in time, suggesting everyone masks in hospital as a long term or permanent mandatory strategy would be in direct opposition to our healthcare authorities. Thank you for the opportunity to respond to your concerns. We truly appreciate your ongoing support of Infection Prevention and Control." 

None of the adverse effects of masks come close to the magnitude of the longterm adverse effects of Covid. The inability to think without "best practice guidance and support" is a version of "Not it!" ducking of responsibility.

Barry responded to the letter further:

"For years I've said that 'best practice' was a misnomer that really meant the opposite, 'least practice'. A 'least practice' will never achieve an ambitious publicly stated target like zero preventable infections. A 'best practice' would be optimized to follow the Precautionary Principle and aggressively ELIMINATE each source of infection, one by one orin groups, until there were no more preventable infections." 

"As long as IPAC continues to simply promote 'least practices' as determined by others, they will continue to fail miserably in contributing to their stated vision of 'a world without preventable infections'. I mean, come on, who do they expect is going to deliver that world of zero preventable infections for them??? You can't phone this stuff in. If you want to achieve lofty, laudable goals, you have to stand up for something and put in the effort. Hospital-acquired infections (HAIs) are mostly preventable, but they're getting worse in Canada, not better. According to the Canadian Institute for Health Information (CIHI), one in ten inpatients suffered an HAI in Canada BEFORE COVID. Now it's worse, but there are no reliably reported Canadian numbers during Covid. Convenient. That's IPAC's job, to report the numbers. In the 2023 IPAC promo video, they bizarrely quote American HAI stats: one in 31 inpatients getting infected. But in Canada, it's more than one in ten. Why report some other country's numbers who happen to be three times better than your own? Huh??

There's also no good reporting in Canada of mortality associated with Covid-HAIs. The best reporting has come from the UK. there was also some leaked reporting from Australia. There is zero reason to expect Canadian Covid-HAIs are any better than Australia or UK's 10%. 10% is 100 times higher than Covid mortality rate outside of hospital. That reason alone should be enough for IPAC to insist on mandatory N95s in hospitals. And if it's not, why not?"
You would think that at the very least we could protect one another from infectious disease in the best ways possible in hospitals. They're clearly not going to bring in any more regulations to protect citizens from illness despite it being their only job. It's up to individuals to protect themselves and others by wearing an N95 when they enter a healthcare facility. Know that you can request your temperature be taken from your ear or armpit instead of your mouth. Be the change you want to see! We're all we've got!

ETA: More info on IPAC: Allegedly, the person leading IPAC, Julie Weir, is CEO of a nursing home association that relies on droplet dogma or else would have to actually put more money into actually making their LTC homes safer. And, apparently, there are no educational requirements to be in IPAC. Just this:
These are the people deciding that we don't need N95s in hospitals in Canada. No PhDs on the board, no air quality engineers, nobody specialized to make the very best decisions around protecting lives during an airborne pandemic. A little unnerving, but par for the course at this point. 

Be Covid wise with N95s.

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