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Ministry of Labour Enforcement Approach for the Health Care Sector, Including Infection Control
Download presentation Download presentation Tuesday, March 23, 2004
Operator: Good afternoon, ladies and gentlemen. Welcome to Health Care Health
and Safety Association Ministry of Labour Approach in Health Care, including
infection control, conference call. I would now like to turn the meeting over to
Mr. Craig Lawrie, OSACH consultant, Kingston region. Please go ahead, Mr. Lawrie. Craig Lawrie, OSACH Consultant, Kingston Region: Good afternoon, and on
behalf of the Ontario Safety Association for Community and Healthcare, I'd like to thank and
welcome all the participants for attending today. Today our presentation is
about the Ministry of Labour's enforcement strategies in the health-care sector,
including infection control. Following the presentation of both of our speakers, we invite you to stay on
the line for a question and answer period. Please note that the question and
answer period is on a limited time, so if time runs out and your question is not
addressed, please stay on the line and the operator will take your information. Before introducing our speakers, I have a few reminders for the audience.
First, please try to eliminate all background noise or discussion during your
call, since this will affect audio quality. Come to the microphone if you're in
a large room so that everyone will be able to hear you. Turn off all of your
pagers and cell phones. And finally, if your building has a PA system, turn it
down or turn it off, if possible. I would like to point out at this time that this teleconference is related to
the Ministry's proactive activities in the health-care sector. Ministry staff
will not be able to discuss issues related to SARS either generally or
specifically. Okay. Our speakers today are Audrey Birkbeck and Dr. Leon Genesove. Audrey
Birkbeck is a provincial specialist with the Ministry of Labour's Industrial
Health and Safety Program, which is part of the Occupational Health and Safety
branch. Audrey provides program support and technical guidance to health and
safety inspectors and other Ministry staff across the province. Her
responsibilities include the development of industrial sector enforcement
strategies by monitoring existing Ministry enforcement activities and consulting
with Ministry staff, Health and Safety System partners and other stakeholders to
identify emerging health and safety issues. As well, Audrey plays a key role in
evaluating the application of Ministry policies and regulations, working with
the Ministry's policy division and legal services branch. As the Ministry
spokesperson for a variety of industrial sectors, Audrey often provides
information on program direction and works closely with Health and Safety System
partners on the development of various prevention strategies. Dr. Genesove is a provincial physician with the Ontario Ministry of Labour.
He advises the Ministry on the health needs of both individuals and groups with
respect to their working environment. Dr. Genesove is certified in the specialty
of occupational medicine by the Royal College of Physicians and Surgeons of
Canada. He lectures on occupational medicine at the University of Toronto,
Faculty of Medicine. Welcome, Audrey and Dr. Genesove. Audrey Birkbeck, Ministry of Labour Industrial Health & Safety
Program, Provincial Specialist: Thank you, Craig. I'll begin by speaking
generally about the Ministry of Labour's role within the occupational health and
safety system in Ontario. I'll be speaking about our general approach towards
enforcement in the industrial program, and as well I'll be speaking out our
general approach with regards to enforcement in the health-care sector. If you'd like to turn along with me, if you've got your slides available to
you, I'd like to just start by giving a very broad overview of the Occupational
Health and Safety System in Ontario. You may know it's made up of three key
partners: the Workplace Safety and Insurance Board, Health and Safety
Association, and the Ontario Ministry of Labour. Of course, the Workplace Safety
and Insurance Board administers injury insurance programs, financial
interventions, certified member programs for joint health and safety committees,
and it oversees health and safety associations. Health and safety associations like the Health Care Health and Safety
Association conduct training, they are responsible for consultative
interventions, as well as opportunities to volunteer. And as well, we have
broader health and safety partnerships including public health departments for
outbreaks of infectious diseases in workplaces, for example, the Ministry of
Health and Long-Term Care, and other key stakeholder groups such as OHA, ONA, to
bring provincial issues to the attention of the Ministry of Labour. So within the Occupational Health and Safety System, the Ministry of Labour
is committed to the prevention of workplace deaths, injuries and disease by
setting standards, communicating standards and enforcing standards. Under the Occupational Health and Safety Act, the roles and responsibilities
and powers and duties of the workplace parties, as I hope you know, are very
well laid out, the powers of inspectors as well. The Health and Safety
regulations are more specific: either workplace regulations or hazard-specific
regulations that address specific issues and hazards-for example, the regulation
for health care and residential facilities, the WHMIS regulations, the X-ray
regulations. Our role in enforcing standards is twofold. We conduct, on a reactive basis,
investigations. We also conduct, on a proactive basis, inspections to targeted
workplaces. Investigations can result from workplace injuries and fatalities,
from workplace complaints, from work refusals, or for occurrences where there
are no injuries. It's our job with regards to inspections to get to the priority
workplaces and targets for priority hazards. But how do we do that with over 4.5 million workers in the province? We try
to concentrate our enforcement on the poor performers, the vulnerable workers,
and workplaces where self-reliance is not evident. We then encourage
self-reliance in other workplaces. We consider vulnerable workers to include those that may be non-unionized,
temporary or contract workers, workers where there are language barriers present
who may be underqualified, et cetera. And we regard self-reliance to be the
ability of a workplace and the workplace parties to identify and address the
health and safety issues without outside intervention. A self-reliant workplace
is able to demonstrate improvements in health and safety performance. In order to get to priority workplaces in the industrial health and safety
program, we group workplaces into 29 industrial centres. These are based on
standard industrial classifications whereby we put similar types of industries
into 29 different sectors made up of similar industries. We try to identify the
priority sectors using a risk assessment to allocate our field visit resources. In developing our sector-specific enforcement strategies, we do consult with
our health and safety system partners in the Occupational Health and Safety
System to identify some of the merging hazards and issues for each of the
sectors, and we develop sector-specific enforcement strategies that are used in
conjunction with WSIB and Ministry of Labour data to target the priority
workplaces for inspection purposes. The benefits of this approach are multifold. First of all, it gives us an
efficient use of resources. We have better alignment of the health and safety
system's strategic plans both at the MOL, the Workplace Safety and Insurance
Board, and the various health and safety associations. It ensures that our
resources are focused on priority workplaces and priority hazards It promotes effective enforcement as well. Through a risk-assessed based
targeting strategy for the 29 sectors, we can be responsive to changes in the
different workplaces, emerging hazards that might be coming towards us, new
technology, a different labour relations climate. As well, it ensures quality of
enforcement, consistent enforcement cross the province, creating a level playing
field and a basis for formal performance measurements and progress improvements
at the Ministry of Labour. Specifically dealing with the health-care sector, this is quite a diverse
sector. It's made up of various-if you're looking at slide number 8, you'll see
it includes very different types of health-care services, including acute-care
facilities, long-term care facilities, home-care services, group homes, health
laboratories, doctors' offices and clinics, and social service organizations. It
therefore requires various enforcement strategies. Specifically, section 2(1) of the health care regulation specifies the types
of facilities that would fall under the health-care regulations. It is a
comprehensive regulation and has a very powerful requirement for written
measures and procedures for the protection of workers. This is a formal approach
of reducing any measures and procedures taken to protect workers into writing
that must be reviewed annually, applied broadly and must involve the
participation of all workers-of all workplace parties, excuse me. Slide 10 illustrates the various areas of coverage under the health-care
regulations with very specific requirements. Furthermore, on slide 11, you'll
see that the written measures and procedures that are required under section
9(1) of the regulations are listed; however, the employer is not limited to the
list of items in slide 11. Section 9(1) of the health-care regulations states
that the employer shall reduce all measures and procedures to protect workers to
writing, and they may deal with, but are not limited to, the list on side number
11. In doing so, the employer must consult with the joint health and safety
committee on all measures and procedures for items such as workplace violence,
patient handling, and lifting, and any other hazards in the workplace that are
not included here. Once again, this is a very powerful requirement within the
health-care regulations that you should be familiar with. Other regulations that may apply to the health-care sector include the WHMIS regulation (as mentioned before), the X-ray regulation, regulation
regarding exposure to biological and chemical agents, various designated
substance regulations, asbestos on construction, and window-cleaning
regulations. There are workplaces in the health-care sector that don't fall under the
specific workplace regulation. This would include home-care services and various
clinics. Ministry of Labour inspectors enforce the general duty requirements
under the Occupational Health and Safety Act in these workplaces. The key hazards that we target generally in this sector include the top
non-injury types based on WSIB and Ministry of Labour data. They include, as you
hopefully know, sprains and strains due to over-exertion, slips, trips and
falls, communicable diseases, hazardous substances, workers being struck be
objects and patient violence. We utilize WSIB injury and illness claims data as
well as our own Ministry of Labour data including reported injuries and
fatalities, previous orders we might have issued associated with our inspections
or investigations, and any complaints and work refusals that have been notified
to the Ministry of Labour. The approach that we take with respect to enforcement is multi-disciplinary.
We have a team of health and safety inspectors in each of our four regions. As
well, we have technical experts-ergonomists, hygienists, medical consultants,
engineers and radiation protection officers-to provide assistance to our health
and safety inspectors. Our Ministry of Labour inspectors are provided with
recommended field delivery strategies on an annual basis for identification of
key hazards and emerging issues. We use risk-based criteria to identify the individual workplaces that are to
be inspected, and the WSIB data used identifies a high injury cost to workplaces
to the sector, including small business firms. As with all sectors, the internal
responsibility system is generally enforced with orders, particularly in
workplaces with fewer health and safety resources and with vulnerable workers. Within the last week, the Minister of Labour has announced a minister's
action group for the health-care sector. This action group will include
employers, unions, health and safety system partners, and other experts. It will
identify gaps in existing prevention strategies and it will also identify best
practices, programs, policies and standards to reduce injuries and illnesses. The Minister of Labour feels that, with almost 2,000 nurses currently on
long-term disability, injury rates that are approximately 150 times the
provincial average, there is definitely a need to work together to identify some
of the immediate steps to achieve measurable improvements to health and safety
in this sector. This group will be asked to examine the challenges and seek new
and innovative ways to make health-care workers safer and healthier. If you're interested in finding out more about this action group, there is
information on our Ministry of Labour website, and I encourage you to have a
read, and if you have any questions, feel free to call me. Thank you. I'd like to now turn the call over to Dr. Genesove. Dr. Leon Genesove, Ontario Ministry of Labour, Provincial Physician:
Thank you, Audrey. In the proactive inspection program in the health-care sector, this program
started in December 2003, and the Ministry of Labour began with inspections of
11 acute-care hospitals in the greater Toronto area. This program is being
rolled out throughout the entire province with the goal of visiting all Ontario
acute-care facilities during 2004. Once that's achieved, we'll be moving on to
long-term care facilities also. There are a number of items of interest in the proactive inspection program.
The major focus is on prevention of illness and injury. Next slide. I just want to talk briefly about occupational health section
controls, some of the legislation that applies, standards and guidelines. The main legislation, of course, is the Occupational Safety Act which Audrey
has outlined for us, and the regulation for health-care residential facilities.
There are also a number of other standards and guidelines that we'll be looking
at in addition to the regulation for health-care residential facilities. We'll
be evaluating health-care facilities and their implementation if appropriate, to
the circumstances, to the directed standards published by the Ministry of Health
and Long-Term Care. We're also looking at, in terms of a proactive inspection, the Health Canada
infection control guidelines, the two main ones being the Routine Practices and
Additional precautions, 1999 and the prevention and control occupation
infections document from 2002. These are both excellent documents on infection
control and prevention of occupational infections. Another excellent guideline from the Health Care and Safety Association on
many infection controls and on respirator uses in the health-care sector, the
documents from Health Care and Safety Association are excellent documents and
there's excellent resources there. And I urge everyone to make good use of the
professional resources available from the Health Care and Safety Association. In addition, there are other guidelines from Health Canada on infection
control issues, the guidelines from the CDC in the United States, BC and from
the World Health Organization that may also be relevant to the issue of
infection control and prevention of occupational infection. In addition, there's another handbook. There's a handbook published by APIC,
the association for professionals in infection control and epidemiology, which
is also a very useful resource that I refer to. On the next slide, slide 3, just a general overview of the scope of our
health care sector activities and the proactive inspections. The main thing here
is that we are looking at first is the joint health and safety committees, we're
looking at employer responsibilities, assuming more health and safety in the
health-care sector, infection control procedures which of course is the main
focus that we're looking at, physical plant issues such as ventilation and
general maintenance, and WHMIS: workplace hazardous material information system. On page 4, the joint health and safety committee, what are we looking for?
What are the Ministry of Labour inspectors looking for during the course of
their inspections? They'll be checking the structure and functionality of the
joint health and safety committee as outlined in section 9 in the Occupational
Health and Safety Act, the issues of certification of members according to,
again, subsection 9(12), monthly inspections as carried out by the committee.
The inspectors will also be looking at the frequency of meetings over the past
year, they may be looking at minutes of the joint health and safety committee
meetings, and they'll be looking for postings of names or work locations of the
joint health and safety committee members as required by the Occupational Health
and Safety Act. Just to let you know, I saw a very nice outline recently of a joint health
and safety committee terms of reference in the spring of 2004 this year Safe
Angle from Ontario Safety Association for Community and Healthcare. You may want to make
reference to that in terms of reference. It's a very good outline. One of the other issues that has become apparent during these practice
inspections is the joint health and safety committee liaising with the hospital
infection control committee. On the issue of prevention of occupational
infections, it's very clear that the two committees-the joint health and safety
committee and the infection control committee-has to be in liaison with each
other to ensure that proper infection control measures are implemented to
protect worker health and safety. On slide 5, employer duties, outline several responsibilities the employer
has to implement from an administrative standpoint. There has to be a health and
safety manual, there has to be policies, written policies and procedures,
reporting requirements, and I'll be elaborating a little bit on this as we go
along. There has to be details of personal protective equipment to be used in
situations, training records. Training is an extremely important issue, and it's
very important that all health-care workers be trained in infection control
procedures and the other measures and procedures I'll be talking about today,
and that the employer carry out this responsibility. There are requirements for infection control measures and protocols that are
outlined in the regulation for health-care residential facilities, there are
occupational and safety references required. In terms of the physical plant, for
example, records of inspections of the mechanical ventilation system and
maintenance of equipment. Again, there's requirements for reporting occupational
illnesses and critical injury notifications. There are requirements for written measures and procedures that our
inspectors would be looking for, and this is just one of the programs for legal
compliance. Sharps injury prevention, work immunization, respiratory protection,
and possibly some disease-specific guidelines-for example, for influenza and
tuberculosis - those are some of the issues that they'll be looking for in the
written policies and procedures. Now, slide 6 touches a little bit on infection control measures and
procedures, again from the standpoint of employer obligations. But as I
mentioned, there has to be worker education and training in place, and I think
that's one of the cornerstones of worker protection. So it's to provide them
with education and training, personal protective equipment, as I mentioned,
whatever's required to protect them, whether it be respirators, gloves, gowns,
et cetera, whatever is appropriate to the situation. And again, as I mentioned,
the specific physical plant requirements, whether it be isolation in negative
pressure rooms, whether the requirement is to inspect the mechanical ventilation
system. In section 9 of the regulations for health care and residential facilities,
there's a list of measures and procedures which the employers discuss with the
joint health and safety committee and implement, write down those measures and
implement them when they're appropriate. These are the measures and procedures.
I've mentioned some of them already, but they include and are not limited to the
following: safe work practices, proper hygiene practices, use of PPE, control of
infections, immunization against infectious disease, use of appropriate
antiseptics, disinfectants and decontaminants against specific issues hazards of
biological, chemical and physical agents in the workplace, including the hazards
of infections. There have to be measures and procedures to protect workers from
exposure to biological, chemical or physical agents that may be hazardous to the
reproductive capacity of a worker or to the pregnancy of a worker or to the
nursing of a child of the worker. It's all specified in the regulations. Again, the list going to the use, wearing and care of personal protective
equipment and its limitations; and the handling, cleaning, disposal of soiled
linen, sharp objects and waste through the use of safe procedures, and I'm going
to say this further on, the engineered devices to prevent needle stick injuries. Now, all these written measures and procedures have to be reviewed at least
once a year and revised as necessary in the light of current knowledge and
practice in the area of health safety. The review and revision of these written
measures and procedures has to be done more frequently than annually if there is
a change in circumstances. And then the employer is required to develop and
establish and revise training and educational programs in the health and safety
measure and procedures for workers that are relevant to the workers' work. Okay. Going on to slide number 7, a little bit about notification
requirements for occupational procedures and illnesses. The notification
requirements are listed in these regulations for health care and residential
facilities section 5(5): if a worker does develop an occupational illness as a
result of the workplace, the notification requirement in terms of the
information that has to be provided and who that has to be provided to is listed
in the regulations, including the details that have to be listed, with the name
and address of the employer and the nature of the occupational illness, the
description of the occupational illness, and a list of other items, and then,
again, the steps taken to prevent further illness. So this protection issue is
extremely important and one of the items the inspectors look at when they
receive such notifications. Slide 8 is WHMIS workplace hazardous material information systems. I'll just
briefly discuss that. It involves having written measures and procedures and
labelling requirements for biologic, chemical and physical agents. There's
requirements for labelling of biologic waste containers, there has to be an
annual review in consultation with the joint health and safety committee, and
there should be other, instruction and training in WHMIS. One of the things the inspectors will be looking for is for all the procedure
manuals for the particular facility essentially that deals with WHMIS controls.
They'll be looking for labelling of containers that are required for physical
biologic hazards, ensuring that these labels are fixed to the containers. If
there's any new chemicals from a chemical standpoint that are used in health
care facilities, these should be understood and procedures specifically in place
for that, an annual review by the health and safety committee, and again order,
education and training. Moving on to slide 9, a little bit more on instruction and control measures.
The measures that you should be looking for again relate to sections 8 and 9 in
the regulations for health care and residential facilities: infection control
policies and procedures for workers' safety. And again if you would like, some
of the resources and documents from the Health Care Health and Safety
Association would assist with this. We expect these health-care facilities, that
when these policies and procedures for infection control are developed, that it
be on a risk-based approach. And this is outlined in the Health Canada documents for 2002 and it discusses
in developing and putting into effect policies and procedures for infection
control, this should be based on a risk assessment which includes an evaluation
of the workplace to identify hazards related to different occupations such as
nursing or housekeepers, laundry, lab workers, contractor workers, as well as
looking at risk-control measures. So what control measures have been implemented
to prevent or manage exposures or infections of the workers? So, for example, safety engineering control- negative pressure rooms, for
example, for isolation. Are there safety engineered medical devices? Are there
administrative controls in place (meaning policies and procedures) to support
these engineering controls and work practices and use of personal protective
equipment where required? Are proper workplace practices in place to reduce risk
of exposure? Are there immunizations in place? Are there gloves and gowns and
respirators or masks available? Are splash shields or eye goggles available to
the appropriate situation? Is there appropriate education programming? People, workers need training and
educational programs with respect to the measures and procedures that are
necessary for infection control, and it has to be relevant to the work. And again, the last part of this approach that Health Canada outlined is the
evaluation: there has to be a review of the measures and procedures and
improvements or changes if necessary, depending on the outcome of the
implementation. The other items I've listed on the slide, education I've mentioned,
monitoring and follow-up for worker implementation of measures (that's part of
the evaluation process), and the evaluation of the physical plant, including the
general mechanical ventilation system and facility maintenance schedules. So
when a Ministry of Labour inspector comes in, they may be asking to see your
maintenance records for mechanical ventilation system to ensure that the proper
evaluations have been done. Health-care regulations require inspections every
six months of the mechanical ventilation system. There are a number of other issues in infection prevention that are important
to implement, and it'll be part of the Ministry of Labour's enforcement
activity, and this includes the prevention of needle stick injuries, the use of
safety engineered medical devices. Again, the inspectors will be looking at
appropriate personal protective equipment as well as the worker instruction and
training in the use of personal protective equipment, they'll be looking at
measures that are implemented to ensure the proper fit and use and maintenance
of personal protection equipment. Again, that's all required in the regulations
for health-care and residential facilities. In section 10, it outlines
requirements for personal protective equipment. And there are other issues in
terms of hygiene facility, other equipment used in the hospital and handling of
waste, and various other procedures. A little bit more on needle stick injuries in terms of needle stick injury
prevention. This is on slide 10. One of the things we're looking at is the
evaluation of risk in your particular facility. Now, there are a number of
high-risk devices, medical devices identified by Health Canada, and you may want
to look in Health Canada's recent report, it's a communicable disease report of
December the 15th, 2003, on blood-borne pathogens, and they have the list of
higher risk medical devices, and these are some of the things our inspectors may
be looking at when they come into your facility. Again, these are things that are very important in your facility for the
employer, for the joint health and safety committee to review the use of these
devices, but there are safety engineered medical devices available: for
phlebotomy needles, for hypodermic needles, for intravenous catheter needles,
for wing needles, and, generally speaking, we would expect that the use of these
devices would be evaluated in your facility and implemented as appropriate. This additional information, safety engineered medical devices. If you need
additional information from the Ontario Safety Association for Community and Healthcare, call
your local consultant for further advice. They have some excellent material
also, and some of the Health Canada guidelines are available to help you with
that. Just briefly in terms of interim results, from our inspection activity, as I
mentioned it began in December, so what I call phase one of our December visits
to health-care facilities, Ministry of Labour inspectors visited 11 acute-care
hospitals in the GTA trial area in early and middle December. In those 11
acute-care facilities, there are 200 or so compliance orders issued. It was a
very active session and enforcement program that we see here. Phase two in January, January 2004, early January 2004, nine acute-care
hospitals have been visited, and in those nine acute-care hospitals in the GTA
area, 65 compliance orders were issued. These orders in the two phases so far have dealt with issues such as
maintenance, training, policies and procedures, WHMIS, notification of
occupational disease, joint health and safety committee issues, the measures to
procedures that I mentioned in section 8 and 9 of the health care reg,
especially the issues surrounding controlled infection and safe work practices
and hygiene facilities and the proper use and maintenance of equipment, disposal
of hazardous waste in a safe manner, issues surrounding personal protective
equipment including training and ensuring that the personal protective equipment
has a proper fit as required by section 10.2(b) in the regulations for
health-care and residential facilities, orders surrounding the mechanical
ventilation systems to ensure that they're inspected every six months and that
reports on these inspections be given to the joint health and safety committees,
and orders have been issued for safety engineered medical devices in some of the
facilities, or to the facilities to perform assessments of the implementation of
the engineered medical devices on a risk-assessment basis. And there have been
additional orders issued of a more miscellaneous nature, and this is where we're
standing right now. As I say, up until mid-January. These sessions have been continuing in
February and March and are continuing right now to acute health-care facilities
in the province, following acute health-care facilities in the province, and
then moving on to the long-term care facilities. Thank you very much. Craig, I'll return it to you. Craig Lawrie: Okay. This concludes the formal part of the
presentations today, and at this time we will open it up to questions from the
community at large. Operator: Thank you, Mr. Lawrie. We will now take questions from the
telephone lines. If you have any questions, please press *1 on your telephone
keypad. If you are using a speaker phone, please lift the handset and then press
*1. If at any time you wish to cancel your question, please press the pound
sign. Please take note that we will only accept one question per participant.
Please press *1 at this time if you have a question. There will be a brief pause
while the participants register for questions. Thank you for your patience.
(pause) The first question is from Sharon Thompson. Please go ahead. Sharon Thompson: I had a question about the immunization procedures in
the hospital and the relatively poor rates of compliance with influenza
immunization. I'm just wondering what if anything you're going to be doing about
compliance orders in that regard, because the issue of civil rights of the
worker not to have vaccines thrust upon them has been raised. This is an issue
not only in terms of employee health and making your employees sick, but it's
also a very real issue for the patients who very often contract those illnesses
from staff that are carrying it. Thank you. Dr. Leon Genesove: Okay. That certainly is a question in get
periodically, and a difficult one. There's two aspects. In terms of the
regulation for health-care and residential facilities, there's a requirement for
the employer to have measures and procedures dealing with immunization and
inoculation against infectious diseases. So from a staff point of implementation
and enforcement, the Ministry of Labour wants to ensure that employers are
offering or arranging the appropriate vaccinations, making it available to
employees, and providing education and training to the employees in the
immunizations that are necessary, and what the risks and benefits are of the
immunizations. From the other standpoint, in terms of the staff vaccinations, this gets a
little bit more complex, because there's other players in the game: the public
health departments also have the protection of patients. That gets a little bit
more complex. So one of the things you have to look at is the surveillance
protocols developed by the Ontario Medical Association and the Ontario Hospital
Association that are required to be implemented in hospitals, what's
appropriate, and there are other issues. So there are also a few labour relations issues in there which I acknowledge,
but they aren't part of the Occupational Safety Act or the regulations for
health-care residential facilities. Basically, the bottom line is, from the standpoint of the Occupational Health
and Safety Act, the employer has to make the vaccines available and has to
provide education and training to the workers on what vaccines are appropriate
to protect their own safety. Operator: Thank you. The next question is from Charlene Loady from the
Ontario Association. Please go ahead. Charlene Loady: Yes. You spoke about the various phases that you're
going through with the focus right now being on-I think you said acute-care
hospitals. I represent the long-term care sector and I know you've made
reference to "and move on to long-term care." Do you have any sense of
when that will be? Dr. Leon Genesove: Any minute now. Be prepared. Operator: Thank you. Please press *1 at this time if you have a
question. (pause) There are no further questions registered at this time. I
would now like to turn the meeting back over to you, Mr. Lawrie. Craig Lawrie: Okay then. Well, I'd like to thank our speakers for
taking the time out of their busy schedules to speak to us today. I'm sure we
all agree how valuable it is to get current and up-to-date information from the
field. Thank you once again, Audrey and Dr. Genesove. This concludes our presentation today, but before we end, I'd like to remind
you that our next teleconference will take place on June 22nd of this year, and
at that time we will be presenting defensive driving and driver safety. Please
check our website at www.osach.ca for more details, or contact our head
office at 416-250-7444 for further information about that. Once again, I thank you and I wish you a safe day.
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