SARS Commission’s Recommendation of the “Precautionary Principle” Results in New Regulation Mandating Better Protective Equipment for Hospital Employees

By Kate Hughes 

The Government of Ontario has recently introduced new regulations and initiatives that provide improved protective equipment for health care professionals. These measures are in part, the result of the comprehensive review of the SARS outbreak conducted by the Honourable Mr. Justice Archie Campbell.

In December 2006, Mr. Justice Campbell released his report regarding the SARS outbreak in Ontario entitled, “Spring of Fear”. He opened his Executive Summary of this report by stating:

“SARS was a tragedy. In the space of few months, the deadly virus emerged from the jungles of central China, killed 44 in Ontario and struck down more than 330 others with serious lung disease. It caused untold suffering to its victims and their families, forced thousands into quarantine, brought the health system in the Greater Toronto Area and other parts of the province to its knees and seriously impacted health systems in other parts of the country.

Nurses lived daily with the fear that they would die or infect their families with a fatal disease. The nine-year old daughter of one nurse asked:

Mommy, are you going to die?

Respiratory technicians, doctors, hospital workers, paramedics and home care workers lived with the same fear.”

Mr. Justice Campbell made a number of important recommendations to avoid future outbreaks of infectious diseases. He stated the most important lesson of SARS was implementing the “precautionary principle”, which was described as follows:

Where there is reasonable evidence of an impending threat to public harm, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat...that reasonable efforts to reduce risk need not await scientific proof.

Mr. Justice Campbell held that this principle should be adopted as a guiding principle throughout Ontario’s public health and worker safety systems.

One clear problem in the SARS outbreak identified by the Commission was the lack of adequate protective equipment for health care professionals. A small step in this regard was recently made by a new regulation under the Occupational Health and Safety Act (Regulation 474/07, introduced in August 2007) mandating Hospitals to take measures to prevent needlestick/sharps injuries. The evidence of Nurses and others being injured by needlestick/sharps and being put at risk of infections by blood borne pathogens is widespread across the province. Numerous studies have indicated the critical need for such new needle safety regulations.

The new regulation mandates that hospitals must provide safety engineered needles, or a needleless system in all hospitals as of September 1, 2008. These new protective safety engineered medical devices (referred to as SEMDs) will be mandated in long-term care facilities, psychiatric facilities, laboratory and specimen collection centres in 2009 and other health care workplaces including home care, doctor’s offices, and ambulances in 2010.

Another recent development in protective equipment for healthcare workers, is the Ontario government’s recent announcement on August 24, 2007 that it would be purchasing up to 55 million “N95 respirators”. These respirators provided a significantly higher level of respiratory protection for health care workers during the SARS outbreak, as opposed to the inadequate surgical masks used by many Hospitals. Mr. Justice Campbell called the N95 respirators one of the most contentious issues in the SARS outbreak. Although the Occupational Health and Safety Act has required since 1993 that anyone using a N95 mask be properly trained and fitted to ensure full protection, few Hospitals complied with the Act and some even denied its existence. Fit testing was the subject of official confusion and heated public debate and many Labour Board complaints and grievances were initiated by ONA, OPSEU and other unions. Mr. Justice Campbell called it a “lightening rod” for all the underlying problems of worker safety in Hospitals.

If you have any questions regarding this new regulation under the Occupational Health and Safety Act, the SARS recommendations or issues of protective equipment for workers, please contact Kate Hughes or Elizabeth McIntyre.