Risk Assessment Process

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INSPQ offers a Blood-Borne Infection Risk Assessment Unit service (Service d’évaluation des risques de transmission d’infections hématogènes – SERTIH). SERTIH provides a mechanism to assess the risk for caregivers to transmit a blood-borne infection to their patients in the course of their practice or internship. Here are the key steps of the assessment:

If your situation requires a SERTIH risk assessment, your informed consent will first be obtained by means of a form.

Once your signed consent forms have been received, SERTIH collects medical records relating to the blood-borne infection in question.

Risk assessment committee

After your medical information has been transferred, a risk assessment commitee will then be formed to perform an analysis of your exposure-prone procedure practice and your viral contagion risk. The committee will differ for each assessment.

If you are currently a student, the SERTIH team can prepare the assessment report without submitting your file to an assessment committee. This may apply in cases where precedents have been established and the SERTIH team considers that previously issued recommendations may apply to a new assessment request.

However, a committee could be formed if the team deems it appropriate.

Composition

Each committee is made up of:

  • A physician specializing in medical microbiology and infectious diseases;
  • A physician specializing in public health and preventive medicine or a general practitioner with skills and experience in public health and infectious diseases;
  • If necessary, a professional practicing in your field, or a program manager if you are a student.

The medical specialist and the professional at SERTIH will also attend the risk assessment committee meeting, and they will be the only individuals to know your identity. Other committee members will have access to non-nominal (anonymous) data only.

Mandate

The risk assessment committee will:

  • Assess the risk of blood-borne infection transmission based on your health status and the nature of the exposure-prone procedures that you perform or may perform as part of your clinical practice or training.
  • Issue, if necessary, recommendations for your future practice or training.
  • Issue, if necessary, recommendations for your medical follow-up to enable you to perform exposure-prone procedures.

Limitation thresholds and recommendations

The expert consensus recommendations for each pathogen (HIV, HBV, and HCV) are updated regularly. These recommendations are based on the scientific literature and relevant global recommendations on the subject (in French only).

Follow-up

This service is confidential, and the recommendations will be discussed with you first. SERTIH will then forward the recommendations to your professional order or educational institution which will oversee their application and follow-up. The recommendations will also be forwarded to your attending physician.

For most SERTIH recommendations, changes can be made to your working practices so that you can start or continue your studies or career in accordance with the guidelines of your professional order or educational institution.

Assessment Request Pathway

You contact SERTIH

Informants

We explain how it works, anonymously if you wish, along with the potential impacts of your assessment:

  • Verbal and written information are provided.
  • If your practice is determined to be safe because it does not involve any exposure-prone procedures, a letter is prepared and can be sent to you upon request.
  • If your practice involves exposure-prone procedures, your consent is required before any other steps are taken.
  • This consent includes obtaining your personal information.

SERTIH advises informants that it cannot conduct an individual assessment without the consent of the concerned caregiver.

You decide to withdraw from the process and remain anonymous

SERTIH reminds you of your ethical obligations.

You want to continue and you consent to an assessment of your file

SERTIH collects the necessary information from you and your attending physician

An ad hoc assessment committee is formed

SERTIH's assessing physician presents your situation to the ad hoc assessment committee, without naming

  • The SERTIH team prepares an assessment report and sends it to you.
  • A copy of the report is sent to your professional order or educational institution.
  • Any SERTIH recommendations for clinical follow-up are also sent directly to your attending physician.

If applicable, informants may be referred to the regional director of public health.

If necessary, the regional director of public health may use his investigative powers under the Public Health Act to advise the responsible organization (professional order, educational institution, or employer). The organization may decide that you are unfit to perform exposure-prone procedures if you have not obtained a SERTIH assessment.

If SERTIH identifies any potential health threats or risks for people you have cared for, in compliance with the law, it reports the situation to the regional director of public health, who then assess the need to recall these people for screening.

Steering Committee

The Steering Committee defines SERTIH's orientations and responsibilities and approves the operational procedures, promotional tools, and assessment framework. This committee may also make recommendations to the Ministère de la Santé et des Services sociaux (MSSS) on ways to prevent the transmission of blood-borne infections by caregivers carrying these infections during healthcare delivery.

The Steering Committee is chaired by a healthcare professional who is not a permanent member of a professional order, a professional association, an institutional association, the MSSS, or INSPQ. Its members are:

  • The Chief Executive Officer of the Institut national de santé publique du Québec;
  • The National Director of Public Health;
  • The Head of the ITSS Scientific unit of INSPQ;
  • An ethics consultant.

And one person representing:

  • The Collège des médecins du Québec;
  • The Ordre des infirmières et infirmiers du Québec;
  • The Ordre des infirmières et infirmiers auxiliaires du Québec;
  • The Ordre des dentistes du Québec;
  • The Ordre des hygiénistes dentaires du Québec;
  • The Ordre des sages-femmes du Québec;
  • The Ordre des podiatres du Québec;
  • The university community;
  • The general public.
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