Updates from the Non-Hospital Medical and Surgical Facilities Program

Single-use devices and multi-dose vials standard

An investigation into a hepatitis C outbreak in late 2013 at a Kitchener, Ontario colonoscopy facility has determined that the likely cause was a lapse in infection control practices related to the use of multi-dose vials.

As a result of this situation, the NHMSFP Committee wishes to remind all non-hospital facilities of the standard, Single-use Devices and Multi-dose Vials, which states that whenever possible, single-use vials should be used instead of multi-dose vials. The standard further outlines the required practices if multi-use vials are used.

Please review the Single-use Devices and Multi-dose Vials standard.

iSTENT—a micro-invasive treatment for open-angle glaucoma

Medical directors are reminded that in accordance with section 5-16(1) of the Bylaws, a registrant may only perform those procedures which are permitted within the facility, and which the registrant is individually authorized by the NHMSFP Committee to perform.

The committee has received applications for approval to perform iSTENT procedures in the non-hospital setting; however, the committee determined that before any new technology is introduced into the non-hospital setting, a systematic, evidence-based analysis should be conducted. The College is currently discussing health technology review processes with the Ministry of Health, therefore, at this time, iSTENT is not currently approved for the non-hospital setting.

Managing hypotension in a non-hospital setting

Post-operative hypotension is a common yet recognized complication, therefore, the NHMSFP Committee recommends that facilities have a clear policy for its treatment and management including notification of the most responsible physician. As non-hospital facilities do not possess the same resources and capabilities of a hospital, this policy should also include indications for transfer to hospital.