Infection prevention and control�

Carien Weyers

Introduction

• EHPs make decision that affect others
• Decisions not based solely on science or legislation – guided by professional ethics
• Ethics framework – fair, accountable, respectful and in best interest
• Should strengthen public confidence
• Entrusted with responsibilities beyond technical knowledge
• Protect public health
• Safeguard environment
• Promote patient safety
• Respect human dignity
• Act honestly
• Maintain professional competence
• Legislative compliance
• Demonstrate ethical leadership
• Assist to determine
• Right, fair, responsible, best interest of people
• Ethics should compliment and extend beyond compliance

Professionalism

• Reflects attitudes, behaviours and values and should be demonstrated in every interaction
• Characteristics:
• Integrity
• Honesty
• Respect
• Accountability
• Compassion
• Competence
• Fairness
• Confidentiality
• Reliability
• Commitment to lifelong learning

Ethical responsibility

• Responsibility towards:
• Patients
• Healthcare workers
• Colleagues
• Employers
• Communities
• Environment
• Profession
• Society
• Require careful ethical judgement

Professional responsibility

• Maintain professional competence
• Following legislation
• Comply with HPCSA requirements
• Protecting public health
• Supporting IPC
• Reporting significant risks
• Maintaining professional standards

1. Professional Ethics for EHPs

• Essential moral compass
• The Distinction Between Law and Ethics
• Complementary Role
• Beyond Legal Compliance

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The Ethical Decision-Making Model�

• Severe dilemmas
• Individual rights versus public health mandates, or
• Limited isolation rooms during outbreaks
• EHPs use a structured 8-step model:

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2. Professionalism and Conduct�

• Manifestation of internal values
• Dictates how EHPs carry themselves,
• Interact with stakeholders, and
• Manage their daily responsibilities

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Professional Accountability & Duty of Care�

• Non-Delegable Accountability
• Duty of Care

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• Responsible for
• Public funds
• Equipment
• Water
• Energy
• Medical sullies
• PPE
• Cleaning materials
• Healthcare risk waste service

Ethical leadership

• Lead by example
• Demonstrate fairness
• Encourage transparency
• Promote
• teamwork
• Support continuous improvement
• Foster a culture of safety
• Encourage respectful communication

Professional relationships – multidisciplinary teamwork

• IPC practitioners
• Nurses
• MP
• OHS practitioners
• Engineers
• Pharmacists
• Lab staff
• Housekeeping staff
• Waste contractors
• Hospital management

Environmental Stewardship�

• Protection of Present & Future Generations
• Independent Advice

Competence, Learning, and Whistleblowing�

• Lifelong Learning
• Reporting Unsafe Practices
• Protected Disclosures (Whistleblowing)

Session 2

Practical scenarios

Practical Scenario: The Pressure to Delay�

• The Situation: During a routine inspection at a regional hospital, an EHP discovers that untreated clinical healthcare risk waste (HCRW) is being improperly stored and mixed with general waste due to a broken-down refrigeration unit and a shortage of compliant storage bins. Next week, the hospital is scheduled for a major external accreditation inspection. The hospital CEO approaches the EHP, requesting that the finding be omitted or delayed in the official report, arguing that a negative report will cost the hospital its accreditation and disrupt critical public funding.
• The 8-Step Ethical Decision-Making Walkthrough

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• Step 1: Identify the ethical issue
• What is the core conflict?
• Conflict is between organizational loyalty/operational demands and
• Professional duty/public safety
• Step 2: Gather relevant information
• What are the facts?
• Untreated clinical waste is actively mixing with general waste.
• The refrigeration unit is broken, and HCRW storage bins are in short supply.
• There is an immediate risk of pathogen transmission, needle-stick injuries among waste handlers, and environmental contamination.
• An accreditation audit is imminent.

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• Step 3: Identify affected stakeholders
• Who will be impacted by the decision?
• Primary: Waste handlers and housekeeping staff (direct exposure risk).
• Secondary: Patients and healthcare workers within the facility.
• Wider Community: Municipal waste collectors and the public exposed to the transport chain.
• Institutional: Hospital management and the facility’s reputation/accreditation status.
• Professional: The EHP (integrity, legal liability, and HPCSA registration).
• Step 4: Review legislation and policies
• What rules apply?
• National health acts, environmental management waste regulations, local municipal bylaws regarding HCRW handling, and the Health Professions Council of South Africa (HPCSA) ethical guidelines. Legally, concealing this hazard constitutes a failure of statutory duty.
• Step 5: Consider ethical principles
• Which principles are at play?
• Non-maleficence (Do no harm): The primary drive to prevent disease transmission and protect workers from biohazards.
• Beneficence: Acting to secure a safe, hygienic environment.
• Justice & Autonomy: Ensuring fair protection for vulnerable workers who may not have a voice in operational decisions.
• Integrity/Truth-telling: Resisting external pressure to falsify or sanitize official records.

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• Step 6: Evaluate possible options
• Option A: Comply with management's request, omit the finding, and give the hospital time to fix it quietly.
• Consequence: Protects the hospital’s short-term reputation, but leaves workers and the public at severe risk of infection, violating the law and professional ethics.
• Option B: Refuse to inspect further or aggressively fine the facility without offering solutions.
• Consequence: Creates hostility and fails to foster a collaborative safety culture.
• Option C: Document the findings accurately, report them immediately through official channels, outline the public health risks, and issue a compliance notice with a strict, short-term corrective action plan.
• Consequence: Unpopular with management in the short term, but upholds public safety, legal requirements, and professional integrity.

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• Step 7: Select the option that best protects health, safety, and professional integrity
• The Decision: Option C is chosen. Public health, worker safety, and environmental protection must always take precedence over institutional convenience or commercial/administrative pressures.

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• Step 8: Document the decision and monitor outcomes
• Execution & Follow-up:
• The EHP writes an objective, factual report detailing the HCRW violation.
• A formal compliance notice is issued requiring emergency procurement of storage bins and repair of the refrigeration unit.
• The EHP schedules a strict follow-up inspection within 48 to 72 hours to verify that corrective actions have been fully implemented, documenting every step of the communication.
• Why This Model Matters
• Systematic break down – removes emotional reactions and external pressures
• Framework provides defensible, transparent justification for difficult decision
• Protect community and EHP professional standing

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Practical Scenario: The Waterborne Outbreak�

• The Situation: During a routine epidemiological surveillance spike in a densely populated urban settlement, an EHP identifies a localized outbreak of acute gastroenteritis and suspected cholera. Laboratory tests trace the vector to a community water standpipe contaminated by a nearby broken municipal sewer line. As the EHP prepares to recommend an immediate, public shutdown of the water source and a localized quarantine/boil-water advisory, local business owners and community leaders plead with the EHP to downplay or delay the public warning. They argue that a public health panic will devastate local street vendors, close schools, and ruin the reputation of the neighbourhood market.

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• The 8-Step Ethical Decision-Making Walkthrough

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• Step 1: Identify the ethical issue
• What is the core conflict?
• Individual/community economic freedom and privacy versus the collective duty to protect public health and prevent loss of life
• Step 2: Gather relevant information
• What are the facts?
• Confirmed microbiological contamination is present in the local water supply
• Infection numbers are rising daily, disproportionately threatening vulnerable populations
• Delaying action will exponentially increase transmission rates, hospitalizations, and potential fatalities
• Step 3: Identify affected stakeholders
• Who will be impacted by the decision?
• Primary: The local community members consuming the water and vulnerable patients
• Secondary: Local street food vendors, traders, and small business owners facing financial losses
• Institutional: Municipal authorities, public health clinics, and the healthcare system facing an influx of patients
• Professional: The EHP (charged with statutory protection of public health)

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• Step 4: Review legislation and policies
• What rules apply?
• National health acts,
• public health bylaws governing infectious disease control and water safety,
• municipal emergency response protocols, and
• HPCSA guidelines on epidemic management and public safety
• Step 5: Consider ethical principles
• Which principles are at play?
• Beneficence & Non-maleficence: The urgent imperative to stop disease transmission, save lives, and prevent severe harm
• Justice: Ensuring equitable protection and safe resources for all community members, especially those unable to afford bottled water alternatives
• Autonomy vs. Public Health: Respecting the community's right to know the truth versus restricting normal activities to contain a biohazard
• Transparency: Maintaining public trust through honest, evidence-based communication

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• Step 6: Evaluate possible options
• Option A: Keep the findings quiet, advise only a few local leaders privately, and wait for the municipality to fix the pipe slowly without issuing a public advisory
• Consequence: Avoids short-term economic panic, but directly causes preventable infections, severe illness, and potentially death. This is an ethical and legal failure
• Option B: Issue an immediate, heavy-handed blanket shutdown and quarantine with armed enforcement, without providing alternative water infrastructure or clear communication
• Consequence: Triggers widespread panic, social unrest, and disproportionately harms marginalized residents who rely on daily wages
• Option C: Immediately issue an evidence-based public health advisory (boil-water notice/standpipe closure), coordinate emergency water tankers with local authorities, engage transparently with community leaders, and fast-track pipe repairs
• Consequence: Causes short-term economic disruption, but successfully halts the outbreak, saves lives, upholds the law, and maintains long-term public trust

• Step 7: Select the option that best protects health, safety, and professional integrity
• The Decision: Option C is chosen. Preventing loss of life and stopping the spread of a communicable disease must always override economic convenience and political pressure. However, the EHP must mitigate collateral damage by simultaneously demanding alternative safe water provisions (such as water tankers) from the municipality

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• Step 8: Document the decision and monitor outcomes
• Execution & Follow-up:
• The EHP formally documents the investigation findings, water test results, and epidemiological data
• A public health notice is executed alongside municipal partners
• The EHP oversees the emergency repair of the sewer line, conducts follow-up water testing to verify zero coliform counts, and monitors infection rates until the outbreak is officially declared over
• Why This Model Matters in Outbreaks
• During a localized outbreak, panic and pressure can easily sway decision-making.
• By following a structured 8-step framework, response remains
• scientifically sound,
• legally defensible, and
• ethically unshakeable, prioritizing human life above all else

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Thank you

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Questions/comments??

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