Those experiencing homelessness in Toronto has become an increasing issue with up to 35,000 experiencing homelessness on any given night with Ontario’s capital city having the largest homeless population in the country.Sources: 1 As people experiencing homelessness tend to end up sleeping on the streets and other places, there is an increased risk of infectious diseases spreading from person to person, especially from those who frequent shelters, kitchens, and other services for those who experience homelessness.Sources: 2
Facing the Challenges
Individuals experiencing homelessness are at a higher risk of contracting infectious diseases than the general population. This is in part due to the difficulties this demographic experiences in:
Personal hygiene: Those experiencing homelessness who sleep on the streets or even in shelters, have limited access to hygiene products or facilities that offer proper showering systems, bathrooms, sinks and more that result in less hand washing, and oral care that in turn opens the door to susceptibility to various diseases.
Accommodation (i.e. crowded and poorly ventilated living space): Those who opt to stay in a shelter are often met with overcrowded areas/rooms/beds, poor ventilated areas and other conditions that result in sickness due to close contact or exposure and air-borne diseases like COVID-19 to be spread due to poor ventilation.Sources:1,3
Substance exposure: There are those who are experiencing homelessness that have experienced substance abuse and experience diseases such as HIV and Hepatitis B and C through using intravenous drugs. Sources: 3
Access to health care facilities: Unfortunately, the relationship between the healthcare system and the homeless population isn’t very positive. Often when those experiencing homelessness are left to choose between using emergency health services or staying infected and possibly infecting others, they choose the latter. Sources: 3
The reality is that individuals experiencing homelessness have limited options to treat and protect themselves from such exposure. Sources: 3 But through IPAC standards and implementation, those experiencing homelessness can have a reduced risk of contracting or spreading infectious diseases through this guide.
Set-Up to Implementation Guide
Assessment: Begin with a thorough risk assessment in homeless shelters, soup kitchens and other services available to those experiencing homelessness, including ventilation, number of accommodations such as beds, showers, bathrooms, etc.
Training: Train and update volunteers and those working at shelters on IPAC standards, guidelines and protocols. Implement regular hand washing to both staff and guests in shelters.
Protective Gear: Ensure volunteers and others working at shelters and other venues wear personal protective gear (PPE) such as gloves, especially when handling food and masks for volunteers and homeless attendees who may be sick.
Environment Cleaning: In soup kitchens, kitchen utensils and cookware need to be properly washed with soap and hot water. Linen and other supplies provided for shelters with beds need to be washed and replaced in case of infectious diseases.
Maintenance
Regular Audits: Conduct frequent IPAC audits to ensure adherence. This helps in early identification of potential issues and allows for immediate corrective action.Sources: 4
Feedback Loop: Create an open communication channel for staff to report concerns or suggest improvements. Front-line insights are invaluable. Sources: 4
Additional Concerns
Emergency Protocols: Having a clear protocol in place for potential breaches in IPAC standards. Swift action can prevent larger issues or outbreak. Sources: 4
Conclusion
The increasing number of people experiencing homelessness in Toronto is alarming and also poses a risk to public health as the homeless population carries an increased risk of infectious diseases through various channels.
While challenging, IPAC standards can be implemented in shelters and other services that serve a significant portion of communities. People who are experiencing homelessness in Toronto, Canada, and other parts of the world cannot be ignored. Following IPAC standards and the step-by-step guide above is a great start to infectious disease prevention and better lives for those experiencing disabilities as they try to get back on their feet.