Infection Prevention andControl Update

Dr. Chris Swayze, Manager, ReportsProfessional Conduct and Regulatory Affairs

Infection Prevention andControl Update

1. What changed?

2. Why now?

3. College Guidelines and Public Health

TerminologyReprocessing: The cleaning, disinfecting and/or

sterilization of medical (dental)equipmenUdevices

IPAC: Infection Prevention and Control

PIDAC: Provincial Infectious Diseases AdvisoryCommittees

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What changed?

Background - 2011

In 2011, three of thirty-six public healthunits (PHUs) in Ontario had to managesignificant lapses in infection preventionand control (IPC) in community-basedhealth care facilities.

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Background - 2011CBcnews IOttawa .. , ~ .;. - ......-

ICIiI

Ottawa infection scare leads to endoscopy anxieties

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Background - 2012In 2012, Ontario's Chief Medical Officer ofHealth (CMOH) established the CommunityIn ec ion Preve ltion and Con ro LapsesTask G oup to provide advice on how toimprove IPC practices.

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Background - 2013

Background - ReportSummary of Recommendations

The Task Group made 12 recommendations,organized under five themes.

Recommendations were directed to Public HealthOntario and the Provincial Infectious DiseasesAdvisory Committee (PIDAC).

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Background - ReportSummary of Recommendations

1. Adopt a collaborative process to detect,assess and manaqe elapses.

2. Develop communication Qrocesses andprotocols to be used when managing IPClapses.

ReportSummary of Recommendations

4. All regulatory colleges should establishIPC guidelines and protocols for theirpractices, similar to the to the Guidelines onInfection Control in the Dental Officeissued by the Royal College of DentalSurgeons of Ontario.

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Background - October 2015• Ontario Public Health Standards was updated.

• New requirements for Public Health Units.

• Increased transparency.

• Increased accountability.

IPAC Protocols & Guidelines

• Complaint Protocol (2015)

• Lapse Disclosure Guidance (March 2016)

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Infection Preventionand Control LapseDisclosure GuidanceDocument

Infecuon PI ~\ ennon andControl PracncesComplaint PllltlKn) 2()j"

Th'$ dOCl,.rn~'1~:l. .n s cpport of l~l'n-recuor P'e,tlnllO'] CI' c:1c cnr.or "'anlces c orr-pte.nt "rotocol. 20~8 (0' a'S curr&nt;tnt rnrect oue OIl>8<'1SeS Protocol. 2006 10' as current: 11m:OHi rntect.on P'en.'ntl,)n and ccono: In P.'50nlll 5e',I(&5S,tt''1;JS P'clocol ~008 :or as cur r e nt] unoer me c-na-tcP .. ti c '111;l'th St<'lrda,ds

[;>Ontario £_;:"'Ontario

Public Health Units• 36 Public Health Units (Boards of Health).

• Powers under the Health Protection andPromotion Act (HPPA) - Legal authority.

• Each with a Medical Officer of Health.

• Some variability between Units.

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What changed?Prior to 2016:

• Public Health Units would typically contact the Collegefor advice or provide information about IPAC concerns.

• College did it's own investigation if there werereasonable and probable grounds.

• Collaboration on investigations (joint investigations).

What changed?Prior to 2016:

• Public Health Units rarely investigated dentists.

• Informal process.

• Deferred to the regulated health professionals.

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What changed?Post 2016:

• Formal processes put in place.

• Must follow the IPAC Complaint Protocol.

• Must follow the Lapse Disclosure Guidance Document.

• Must contact the regulatory college and provide anyrelevant information about the member(s).

Inspecting dental offices?

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Resources Public Health OntarioBest Pradk:e. for oHnine.Dbinfectlon and SteriliDtton ofMediCliI Equlpment/Dellkfl

8estPraQic.nfoflrlfilCbofl"'_ntIon and Control~InOnt.ria

Be-st Practn.e s to-En\li'Ofl'Tl~nt~i CI~dn'nifor Preveotlor- and Cont-e:of rotecucns

Routln. PractICII, andAddltlonll Ptetllutions

•

•

Dental specific?

IpacJ,D,c" American

DentalAssociation'·'I,rnE:'I(d',:.

advoca:e fo- .(,,,,1:'

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DENT"l

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Clinical Office Practice - April 2015

Infection Prevention and Control

for Clinical Office Practice

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Infection Prevention and Controlfor Clinical Office Practice

"While this document has been developed inconjunction with the College of Physicians andSurgeons of Ontario and is intended primarilyfor physicians, other health care professionalswho provide clinical services will fi these

idelir e useful, i nu I t se worki 9. denta offices, and offices of other regulatedhealth professionals".

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Checklists for Clinical OfficePractice!! !

Checklist for Infection Preventionand Control (IPAC) Core Elements inClinical Office Practice

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Checklist for Reprocessing ofMedical Equipment/Devices inClinical Office Practice

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Checklists• Issues with the checklists.

• Checklists designed for medical practices.

• Many sections not relevant to dentistry (vaccines).

• Not all Health Units using the PHO checklists (e.g.IPAC Canada 2003, CDC, their own ... ).

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Checklists - PHD• Need for dental specific checklists.

• RCOSO invited to work with PHO along with otherstakeholders (COHO, MOHLTC).

• Checklists are PHO documents.

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New checklISts for IPAC lapses In dental prectoe senlngs

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PHD Tools and Resources• Updated website.

• Frequently asked questions (FAQs).

• FAQs updated regularly as questions arise.

• Checklists will be updated.

• Living documents.

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Tools and Resources atwww.publlchealthontarlo.ca

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RCDSO Guideline

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RCDSO Guideline• Referenced in the Report to the Chief Medical

Officer of Health (September 2013).

RCDSO Guideline• Consistent with the recommendations of PIDAC

and the Canadian Standards Association (CSA).

• Consistent with the PHO documents.

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RCDSO Guideline• Processed in a manner that will maintain sterilityduring storage (i.e. to point of use).

• Ensuring integrity of the packaging.

• Daily operation of every sterilizer must bereviewed and documented.rl8l;·I;Wii

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RCDSO Guideline• A logbook should be kept.

• Clear separation of clean and dirty areas.

• Packaging materials should be designed for thetype of sterilization process being used.

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RCDSO Guideline

• Instruments need to be cleaned anddecontaminated prior to sterilization.

• Gross debris removed prior to ultrasonic cleaning.

• Hinged instruments should be processed openand unlocked .

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RCDSO Guideline

• Sterilization times, temperatures and other operatingparameters recommended by the manufacturer of theequipment used, as well as instructions for correct use ofcontainers, wraps, and chemical or biological indicators,should always be followed.

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RCDSO Guideline

Follow the Guideline and ...

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RCDSO Guideline

• There are some differences between the currentCollege Guideline and some more recent PIDACguidance documents.

• The IPAC principles are the same.

• The differences are not significant.

• The Guideline is being updated.

RCDSO Guideline update• The College's Quality Assurance (QA)

Committee regularly reviews Guidelines andStandards.

• At the May 2017 Council meeting the QACommittee recommended that a working groupbe struck to revise the Guideline.

• Council unanimously approved the Committee'srecommendation.

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RCDSO Guideline update• A working group has been struck, including

representation from the Ministry of Health, PublicHealth Ontario, general dentists, dentalspecialists, IPAC experts, public members andother stakeholders.

RCDSO Guideline update• The working group has met and is in the process

of revising the Guideline.

• A draft will be be circulated to stakeholders,including all dentists in Ontario.

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RCDSO Guideline update

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RCDSO Guideline updateAll instruments and equipment must be capableof being cleaned, disinfected and/or sterilizedaccording to the College's guideline, the mostcurrent standards and guidelines from the:

Canadian Standards Association (CSA)

Public Health Agency of Canada (PHAC)

Provincial Infectious Diseases AdvisoryCommittee (PIDAC)

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Issues in Dental Offices

• Offices closed by public health and postedonline were not following the College'sGuideline.

• Offices where patients were notified werenot following the College's Guideline.

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Issues in Dental Offices• Overfilled autoclave pouches/bags

Issues in Dental Offices• No separation of clean and dirty sides

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Reprocessing Area

Reprocessing Area

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Lab Area

Issues in Dental Offices• No spore testing (biological indicators) - I haveone, but it's in the cupboard ...

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Issues in Dental OfficesInstruments Monitoring and documentation ofsterilization.

• No chemical indicators.

• No documentation of physical parameters (time,pressure, temperature).

• No indicators of sterility.

Issues in Dental Offices• Not maintaining sterility during storage (i.e. to point of use).• Handpieces not sterilized between patients.

burs still in

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Issues in Dental Offices• Single use items being reused.

Issues in Dental Offices• Single use items being reused.

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Issues in Dental Offices• No appropriate sharps container.

Issues in Dental Offices• Location of sharps container.

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Issues in Dental Offices

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How will affect me ...• Will it take more time - yes.

• Will it cost more - yes.

• Is it manageable - yes.

• Is it in the patient's best interest - yes.

• Solutions can be found for your office.

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Summary

• New Public Health Ontario checklists for dentaloffices.

• Follow the College's Guideline.

• The College's Guideline is being revised.

Questions?

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