Workplace safety in Ontario long-term care

The Personal Support Worker operates in one of Ontario's most hazardous occupational sectors. According to the Workplace Safety and Insurance Board (WSIB) 2023 statistics, the long-term care sector has a Lost-Time Injury rate of 5.8 per 100 workers — nearly four times the provincial average across all industries (1.5/100). The two leading causes of injury are musculoskeletal disorders (MSDs) from manual patient handling (43 percent of claims) and workplace violence and harassment from clients with cognitive impairment (22 percent).

Ontario law imposes a layered duty of care on the PSW through the Occupational Health and Safety Act, R.S.O. 1990, c. O.1 (OHSA). Section 28 of the OHSA places three specific duties on every worker: (a) work in compliance with the Act and regulations; (b) use any equipment, protective devices, or clothing required by the employer; and (c) report any hazard immediately to a supervisor. Failure to comply may result in disciplinary action and, in cases of gross negligence, personal prosecution.

According to the Public Health Agency of Canada (PHAC), «Routine Practices are a system of infection prevention and control practices recommended for all patient care, regardless of the suspected or confirmed infection status of any individual.»
Source: PHAC, Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings, 2017.

Routine Practices — the foundation of infection prevention

Routine Practices apply to every client, every interaction, every time. The core elements are:

1. Hand hygiene

The single most important measure in preventing healthcare-associated infections (HAIs). Use the Four Moments for Hand Hygiene developed by Public Health Ontario:

1. Before initial client contact or client environment contact
2. Before aseptic procedure
3. After body fluid exposure risk
4. After contact with client or client environment

Use alcohol-based hand rub (ABHR) at 70–90 percent when hands are NOT visibly soiled. Apply enough product to cover all surfaces of both hands; rub until dry (approximately 15–30 seconds). When hands are visibly soiled, with blood, or after contact with C. difficile or norovirus, you MUST use soap and running water for at least 15 seconds, because alcohol is ineffective against spore-forming organisms.

2. Personal Protective Equipment (PPE)

3. Additional Precautions — when Routine Practices are not enough

Three categories of Additional Precautions are layered on top of Routine Practices based on the route of transmission:

• Contact Precautions — MRSA, VRE, C. difficile, scabies, RSV: gloves + gown for any contact with the client or environment; dedicated equipment; private room or cohorting
• Droplet Precautions — influenza, pertussis, group A streptococcus, COVID-19, RSV (also droplet): surgical mask within 2 m + eye protection; client to wear a mask during transport
• Airborne Precautions — tuberculosis, measles, varicella, disseminated zoster: N95 respirator (fit-tested); negative-pressure isolation room (AIIR); door closed

WHMIS 2015 / GHS — understanding chemical hazards

The Workplace Hazardous Materials Information System (WHMIS) 2015, harmonized with the Globally Harmonized System (GHS), is enforced in Ontario through Regulation 860 under the OHSA. Every PSW must be WHMIS-trained before handling cleaners, disinfectants, or any hazardous product. Employers must update training annually or when new products are introduced.

The three pillars of WHMIS

1. Labels — supplier labels on original containers (mandatory elements: product identifier, hazard pictogram, signal word DANGER or WARNING, hazard statement, precautionary statement, supplier identifier) AND workplace labels on decanted containers
2. Safety Data Sheets (SDS) — 16-section technical document accessible at all times to workers. PSW must know how to locate Section 4 (First Aid) and Section 8 (Exposure Controls / PPE)
3. Worker education and training — documented and repeated annually

Safe transfers and body mechanics

A safe transfer protects both the client and the worker. The Ontario Ministry of Labour Patient Handling Practice and the Public Services Health and Safety Association (PSHSA) Resident Handling toolkit (2018) set the standard. The cardinal rule: NO LIFT POLICIES are now enforced in over 90 percent of Ontario long-term care homes — meaning no PSW lifts a resident manually except in an emergency.

Body mechanics principles

• Stand with feet shoulder-width apart, one foot slightly forward (wide base of support)
• Keep knees flexed and back in neutral alignment — bend at the hips and knees, NEVER the waist
• Keep the load close to your body (within the load zone, less than 25 cm from your trunk)
• Push, do not pull, when possible
• Pivot with the feet — never twist the spine
• Use breathing: exhale during exertion

Mechanical lift indications

Emergency response — fire and codes

Every Ontario long-term care home is required by the LTCHA section 90 to have a documented emergency plan. The two most common protocols you will use are RACE for fire response and PASS for fire-extinguisher use:

Most long-term care facilities use a colour-code system for other emergencies: Code Red (fire), Code White (violent/responsive behaviour), Code Blue (cardiac arrest), Code Yellow (missing resident), Code Black (bomb threat), Code Grey (system failure / utility loss).

Key points to remember

• Hand hygiene is the single most effective infection control intervention
• PPE donning: Gown-Mask-Eyes-Gloves; doffing reverse with mask LAST
• C. difficile and norovirus REQUIRE soap and water; alcohol is ineffective
• NEVER mix bleach and ammonia — produces toxic chloramine gas
• Body mechanics: wide base, bent knees, neutral spine, load close, NO twisting
• Non-weight-bearing client = mechanical lift + 2 trained staff (no manual lifts)
• RACE for fire response, PASS for fire extinguisher

For further study

• PHAC — Routine Practices and Additional Precautions
• CCOHS — WHMIS 2015 / GHS
• PSHSA — Handle with Care patient-handling toolkit
• Public Health Ontario — Four Moments for Hand Hygiene