Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Pu b Ii (Health
OntarioSante
pub i.queOntario
IPAC Lapses and
Reprocessing of Instruments/Equipment in
Dental Settings
Dr. Sonica Singhal, Scientist, Oral Health, PHO
Ms. Donna Moore, IPACSpecialist, PHO
November 29, 2017
At Mississauga Convention Centre, for Peel Public Health
Disclosure
Presenters:
• Dr. Sonica Singhal and Ms. Donna Moore
• Reiationships with commercial interests:
Grants/Research Support: None
Speakers Bureau/Honoraria: None
Consulting Fees: None
Other: None
PubhcHealthOntano ca
11/29/2017
1
Objec ives
• Roles ana responsibilities of MOHLTC, PHUs and PHO
IPAC lapses: changing landscape
Provide an overview of Core Elements andReprocessing Checklists of Equipment/Devices inDental Practice Settings
Publk+tealthtjntanc ca
Royal College of Dental Surgeons of Ontario(RCDSO)
• The RCDSO is the statutory governing body fordentists in Ontario that protects the public's right toquality oral health services by providing leadershipand education to the dental profession in regulation
Regulators must earn and maintain the trust anaconfiaence of the public that they are working intheir best interests
Needs to provide assurance to the public thatpractitioners are competent and that the public issafe
http//www.rcdso.org/whoweare/missronandvalues
4
11/29/2017
2
Role of RC 5 I AC lapses in dental offices
• Responsibility for oversight and licensing of dentists
• Investigate as part of QA and complaints process
Can assess member's practice as necessary
To notifv facility or member-specific complaint asap;may conduct joint investigation inspection with PHU
5
Ministry of Health and Long erm Care (MOHLTC)
• Patient-focused, sustainable publicly funded healthsystem
Stewardship is the ministry's mission and mandate
• Develops legislation, regulations, standards, policies,and direct: res
http'; /www.hcalth.gcv.cn.r.a/en/corn man/Ill' n.su y/defau lt.aspx 6
11/29/2017
3
On ario blic ealth Standards (OPHS)
The OPHS establish the minimum requirements forfundamenta public health programs and services tobe delivered bV Ontario's 36 boards of health, whichinclude assessment and surveillance, healthpromotion and policy development, disease andinjury prevention, and health protection.
http://www. hea It h .gov. 0n. cal en/ p rol p rogra msl pu b Iieh ea It hi 0ph _sta nda rd sl
7
Role of the MOHL C in IPAC lapses in dental offices
• rio direct role; would not inspect offices on a routinebasis
Investigation, including inspections implemented bvthe BOH through the 36 Pi: Us; can be involved to co-ordinate when more than one PHU involved
8
11/29/2017
4
Public ~ eal ni 5 and Boards of Health
• 36 public health units in Ontario
• Overseen bV PPHD of the IVIOHLTC
• Wide range of services provided:Routine Inspections (e.g. food, water, personal services settings)
Immunizations
Den "I p rogra HIS
Reproductive, child, and youth programming
Outbreak management and complaint investigation
Role of PH s/BOH in IPAC lapses in denta offices
• The BOH receives complaint regarding a potentialIPAC lapse
• The BOh shall contact the regulatory College andundertake a I steps included in the IPAC PracticesComplaint orotocol
The BOi: s'-'cd assess the complain
• The 8011 shall investigate the complaint
• Ir C;::'~E of apse, prepare initial report and make itpubliclv ava i able
The 501: sha i complete a follow-up and prepare afinal report and make it publici.' available 10
11/29/2017
5
PA La s Disclos re Guida ce oc ment• On October 14,201\ the MOHLTC updated the
OPHS and related protocols to incorporaterequirements for PAC lapse disclosure.
If an IPAC lapse has been identified in certainsettings, the board of health shall post an Initialand a Final Report online in accordance with theInfection Prevention and Control Lapse DisclosureGuidance Document, 2015 (or as current).
http://www. hea Ith.gov.on ca/en/pro/progra ms/pu blichea Ith/oph_sta nda rds/docs/gu i
da nce/ipac_la pse_d isclosu re_gd. pdf
Defnition of a apseInfection Preventionand Control LapseDisclosure GuidanceDocument
• A lapse is defined as a ., based on current IPAC standard of care
documents from the Provincial Infectious DiseasesAdvisory Committee (PIDACL Public Health Ontario(PHD); or the Ministry of Health and Long-Term Care("the rninistrv"). where availab e, that the
to the premises' clients,attendees or staff
12
11/29/2017
6
ublic Health On ario (PHO)
• We provide scientific and technical advice andsupport to clients working in government, publichealth, health care, and related sectors
Our clients include:• Ontario's Chief IVledicai Officer of Health
• lViinistry of Health ano Long-Term Care and other ministries
• local public health units
• health system providers and organizations
https/ /www.publichealthontario.ca/en/ About/Pages/M ission Visio n-a nd-Values.aspx
13
Role of P 0 in IPAC lapses in dental offices
• No direct role in inspections
Provision of scientific and technical advice to supportPHU lapse irvestigations
May provide field support to PHUs to i "form riskassessment process
Laboratory coordination of samples ano furthertesting (genetic sequer ci 19)
14
11/29/2017
7
P,)bll(He.;ltllOntJnC,(d
PAC Lapses: C anging Landscape
In the News
IPAC apses Specific to Dental Settings
11/29/2017
8
irst case of CV rar smission i a den al setting (CDC)
2013: an He I case i a ental ell 'c Oklahoma State Department of
Public Health -Dental Healthcare-Associated Transmission of Hepatitis (, Final Reportof Public HealtbJr:!'.I~stigatioQ_and Response, 2013
~e e I as e
a~ a risk f r
•
•CV ra s is .iorConclusion
This report documents the first p ersc-n-to-p er soo HCV trensrnissicn event in a dental setting.
Contaminated medication via's used (In more than on-=,patient was the likely mode oftransmi,;si(l(l, J::'i~,ssibly invc+vir-g pr-ope.f(ll suspensions. Br·:)ad~ninB state-level HCV surveillance
programs, rec~.gnjzing dental encounters as a risk fe,f" HLV transmission, and increased stateand Iedera' coVer:::~ightof ('I..Jtpatient oral surgical pradices are futuro>:, ster's tc..(('<'l:,;do:-" tc reduce
the risk (If HCV trens-ni ssion ~vent,:, in oral healthcar>:? ,:,etti~s.
PubhcHealthOntario ca
2016: M. Abscessus Outbreak in pediatric clinic Georgia
• Between Jan 2014-Jan 2016, a Practice performed1,386 pulpotomies
e 20 cases: confirmed (n = 11) or probable (n 9)
Median age 7 years (range = 3-11 )
Median incubatior period 65 days (rc.ngedays)
~,IIseverely ill, requiring -ospitalizatio,'l 17 parentsrequired surgica excision and 10 received outpatientintravenous antibiotics by P CC line
Peralta G, Iobm D'Angelo M, Pathan: (I ('1 (11 Notes t.on. th:' Fwlu f./I~'(ofJ(J(tel/un) uilsct'')2>uS Infections r~rl1ong
Patlerlb of a Pediatti; Dentistry Practice Gt"orgld,2015 M:vi\\'R_ Motb Mar-tal VI."kly Re-p )016:6S:3SS--3S6, DC)I
htt fl jjrJ_x,dSJ ic()rgj1Q .1_55Jl2!m_rr1_w~ me" §~na5
=-8-164
PubllcHealthOntano ca
11/29/2017
9
2016: M. abscess us 0 tbreakChi re s' Dental Group, California
Pulpotomies between Feb. and Aug. 2016 withexposure to contaminated waterlines
• As of July, 2017 total case count 73 cases; 22confirmed, 5~ probable; age range 2 LO 11 years
• Clinical presentation slowlv progressive oral cellulitis
72 of 73 cases have ecuired hospitalization and 1\1antibiotics
PubltcHealthOntano ca
Transmission of blood-borne pathogens in US dental health care settings:2016 update.Cleveland JL, Gray SK) Harte JA) Robison VA) Moorman AC, Gooch BF.
• BACKGROUi\JD: During the past decade) investigators havereported transmissions of blood-borne pathogens (BBPs) indental settings
Authors describe these transmissions and examine the lapses ininfection prevention available information
r E "(iDS: Authors reviewed the literature from 2003 through2015 to identify reports of the transmission of BBPs in dentalsettings and related lapses in infection prevention efforts, aswell as to identify reports of known or suspected health care-associated BBP infections submitted by state health
departments to the Centers for Disease Control and Prevention.
JA_n][)~f}tAsso~. 2016Sep;147(9).729 38 doi: 1O.1016/jddaJ.2016.03.020. Epub 2016 May 24
PubhcHealthOntano Col
11/29/2017
10
Cleveland et al. Review
ES lTS: 3 published reports oescribed transmissionof hepatitis B virus and hepatitis C virus
• In 2 reports, the investigators described single-transmission events [from 1 patient to another] inoutpatient oral surgery practices
•
• Third report described the possib e transmissio l ofhepatitis B virus to 3 patients and 2 dental health carepersonnel in (3 large dental clinic
• Examples of lapses included the failure to heat-sterilizehand pieces between patients, a lack of t 'a ining forvolunteers on BBPs, and the use of a combination of
McCarthy et al: Compliance with recommended infection controlproced res among Canadian den ists: Results of a nationalsurvey
. ,, i es: The objective of this study was to investigatecompliance with recorr mended infection control (IC)practices by dentists in Canada in 1995
: /1, mailed survey of c s ratified random sample ofdentists (N = 6444L with 3 follow-up attempts. vveightedanalyses included multiple logistic regression to identifvHie best predictors of "excellent" compliance (18 items)
5 ' ts: The adjusted response rate was 66.4%
McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377 38~
PubhcHealthOntano ca
11/29/2017
11
Com iance elements
• Respondents reported use of an Ie manual (52%)
Post-exposure protocol (L11%)
Biologic monitoring of heat-sterilizers Pl%)
Hepatitis B immunization of der tists (9" %: of these72% had post-immunization screening; naturalimmunity 3%) all hygienists (78%), ano all other clinicalstaff (70%)
• Hand washing (before treating patients 76%, after de-gloving 63%); always wearing gloves (95%); changinggloves after each patient (97%)
McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377 384
PubhcHealthOntario ca
Compliance elements (cont'd)
• Masks (82%)
Protective eyewear (82%)
• Puncture-proof container for sharps (94%)
Recapping neeales with scoop technique/device (60%)
FI ishing waterlines (55%)
Heat-sterilizing hand pieces (94%)after each patient 77%)
McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377-384
PubhcHealthOntano ce
11/29/2017
12
Predic ors of Comp iance
• Attending continuing educatior about IC (~10 hours,odds ratio [OR] = 6.3; 6-10 hours, OR = 3,3)
Treating 20 to 29 patients per daV (OR ::c 2.8)
Being women (OR = 2.7)
Population of city in which practice is located(>500,000, OR::: 2.5).
PublicHealthOntano ca
Institute for Safe Medication PracticesA 'iUP.l _I,' OI~1 I. JI r
I:l!Im.!: ~ &mImm. lIifJ!!!Im ~ fJIJ!WJ!!!IjJ :ili!rf ~ UIQ
e ernb e 0,2010• Of over SAOO HCV\/Ssurveyed, nearly 1% admitted tosometimes or always eus! gas 'inge for more I a
e p01 i nt after onlv changing the needle
• 6% of respondents admitted to sometimes or always~. g v· g e-oose] . < g e- se: f~C s f r _ eatle ts
• 1S% of respondents reportedt, r-,-, er a mr I" i -
PubhcHealthOntano ca
11/29/2017
13
Santeopubliq pntario
Ms. Donna Moore, IPAC .Specialist, PHO
October 18, 2017
__ Wellington D ff .u ertn G Iue ph Public Health_ ____:_:;_:_-
Reprocessing Cycle Complex Process
11/29/2017
14
paulding's Classifica ion for Den a Se ings
Category Definition Processing
RCDSO. Guidelines Infection Prevention and Control In the Dental Office. lebr uarv 2010
PubhcHealthOntano ca
NEW Check is for Reprocessing of Dental/MedicaEquipmen /Devices in Den al Practice Settings -201
.. .._.,.,;.,... .... J~_"_. ..... " •..• '-, ..... '''''_'':'''H''''',:O''_'-,,,,.,,-; ,..,-,,," '_'''-'' .- .. '-'." "'~...... ,..~"",
. ., . .,- .,-..:. ~ ,,,":'''', , •• ,", ••.• " ..... h -." ..... _'"'".,, .,',," .•~•.•
11/29/2017
15
nderstanding the Risk
Must be compliant with the relevant Act or regulation (e,g, Occupational Health and Safety Act),
Immediate health hazard exists, Stop practice and correct immediately, The act orfailure to actimmediately may lead to the transmission 01 infection or risk of illness or injury, Practices thatcannot be corrected immediately must be stopped until the health hazard isobserved to have beereliminated, An Order may be warranted/ issued,
Signifies practices that must be corrected, Timelinesforcomplianceor agreement on alternateprocess determined duringinspection,
Provide information regarding best practices, mandatory legislated practice requirements etc,Inform and Educate II/EI: .. ., .
This may also Include just-ir-tims education,
Checklist for Reprocessing of Dental/Medical Equipment/Devices In Dental Practice Settings 20]7
PublicHealthOntano ca
Table of Contents
• Section 1: Policies and Procedures
• Section2: Education and Training
• Section 3: Single Use Items
• Section 4: Phvsical Space
• Section 5: Personal Protective Equipment
Section 6: Cleaning of Sern: Critical &: Critical l)e'/ices
• Section 7: Sterilization
Section 8: Storage
Section 9: Other Considerations
Section 10: Record Keeping
PubhcHealthOntano ca
11/29/2017
16
ection : Policies and Procedures
r Devices are not purchased if not able to reprocess
! Reprocessing based on current recognized standards
Recall of improperly reprocessed
Scheduled preventative maintenance of equipment. withwritten docu mentation
. Quality monitoring and documentation of thereprocessing processes
r Single-use medial equlpment/deviccs.
l Process for removing faulty devices
PubhcHealthOntano ca
Section : Education and Training
Staff assigned to reprocessing tasks:
Complete formal education and training inreprocessing - theoretical and practical components
Trained to c; level that is required for the volume and complexity of theequipment to be reprocessed
Receive device-specific reprocessing instructions fromhe device manufacturer's representative
Trained upon hire, and at least annua Iy and whene lernew equipment or processes are introduced
PubhcHealthOntano ca
11/29/2017
17
ectio 3: ing e Use Items
Single-use items including needles are not reprocessed
(e.g., syringe needles, prophylaxis cups and brushes;and certain orthodontic brackets.)
Prophylaxis angles, high-volume suction tips and
air/water svringe tips are availab e in single-use or 'e-usable forms SinCIe-use medical
equipmentl devices areusu.lly lab.lled by them.nuf.durer with this
symbol:
PubhcHealthOntano ca
Section 4: Physical Space
Designated area that is phvsicallv separate from direct
care areas and from where clean, disinfected or sterileitems are handled or stored
One-way work fiow from dirty to clean to preventcross-conta m ination
Sink sufficient in SiZ.E and depth tor decor.tarr.ir.a 1:'')'1 In
the reprocessir g area
Cleanable. non-porous counter space 1:0 handle thevolume of work
PubhcHealthOntano ca
11/29/2017
18
ection : Physical Space
Dedicated hand hygiene sink and/or ABHR in thereprocessing area
• Puncture-resistant sharps container at point-of-use.tN D/OR snarps are transported to t W .eprocessingarea in a covereo container or cassette.
• Eyewash station within a 10 second wa Ik (16 to 17metres [55 feet]) of the reprocessing area,
Regular schedule for environmental cleaning in thereprocessing area
PubllcHealthOntano ca
Section 4: Physical Space
One-wayII ork tl(111
/
CSf\ SPE 1112 14 User Handbook 101 Medical Device Replocesslng in Community Health Care Setting', 2014
PublicHealthOntano ce
-- 1//
11/29/2017
19
ior 6: Cleaning of Semi-critica an CriticaDen a /medical Equipment/De ices
Contaminated devices are kept separate from cleanitems
Gross soil (e.g., blood, sputum) is removed immediately
(cleaning cannot be done immediately, device is keptmoist
Devices are cleaned manually with an enzymaticsolution or mechanical cleaning
Detergem or enzymatic cleaning solution is discarded asper the fVllFU
PubhcHealthOntano ca
Section 6: Cleaning of Semi-critica and CriticalDental/medical Equipment/Devices
Brushes are inspected & changed when dirty. Sterilizeor disposed of at the end of the day
Reusable cleaning items (e.g. brushes) are discarded ifworn or damaged
Ultrasonic washers and or washer/dismtectors, testedfor efficacy at least weeklv or according to r /IIF J-documented PM
Dental/medical equipment/devices are dried prior tosterilization (e.g. with lint-free cloth]
Pubhc:HealthOntano ca
11/29/2017
20
Steri rza ion: Definition
TI~e leve of reprocessing required when processingcritica medical equipment/devices
• Ste cilization results in the destruction of ali forms of'nicrobial life including bacteria, viruses, spo es andf rngi
Equiprnent/devices must be cleaned .horoughlv beforeeffective sterilization can take place
PIDAC Gest Practices for Cleaning, DISinfection and Sterilization In All Health Care Settings, 2013
PubhcHealthOntano ca
Section 7: Sterilization
Critical instruments/items are either disposable orsterilized using an approved sterilization process
Items are packaged according to the both packagingand aevice MIFU's
Each package is labelled with date processed, sterilizerused, load nurnoer and the HCP1sinitials
nternal Chemical indicators (CI) are placedappropriately in each package if not part of the pouch
PubhcHealthOntano ca
11/29/2017
21
C emica ndicators
• Respond with a chemical orphysical change to one or moreparameters within the sterilizationchamber-
........ _
t; e 'I al n icators (lass'
II
~ I,/1/
4 iUsed for every package
• Placed on outside of package
• Tape only gives visual proof thatcorrect temperature achievedsometime during cycle
; .-::::,_:., ,-=:-.:",~'E-', .:'-,~', ! ":": '.-1
Internal Chemical Indicator• Class 4, Class 5 or Class 6
• Placed inside each package (if not integrated into the package)
Colour change indicates that the steam reached the LD21deof
package
Does not indicate that the package is sterile
Before stet ilization" 18t6 ....... ,1I,I'U",ltII1I!r'
• 3M ('lImpl! Art'
Colo! Slr~mChemirallndirJlilr 'I rip~""~rl IKIHI'I 1001O'H!U s-t .. !:,
.... ).'.,,'" .... -11'
, ':J"'r.., -~~-------• .H'ompl)'" AN'
Colo, Sleam Chemiralindirallir Strips_ 00109 lot 2001-04 '" ,""" ~
After stet ilization
11/29/2017
22
ypes 0 5 erilizersThe tab e-top model is the most frequently used steamsterilizer in community health care settings.
ra lit! DOs lace e t Sterilizers
.,- ~,...,
h'T~"-~:L.-"
'~JJ,.. ,~u!,· ,~ .<, ,l·1 t ,
'\ " .......... ,"- I ,__. _ ...... B _
\I""",-httij":_r
'-I .... - l>"IIj', "I' '"''''~~'''·"""fW'm'",,""'~''>Cl''' .. ..,.,~]l .....(]~r.~:" rp,","'''-
,,'11.] t~ tll"'lt:f '" ol~t iol~e:1
C;)
f) ,'-' l"~, ..--_ r--(o
PI (41III
PI
CSA SPE 1112-14 User Handbook for Medical Device Reprocessing in Community Healthcare Setting
PubhcHealthOntano ca
Types of Sterilizers
Pre-vacuum Sterilizers
~ Air is removed from the chamber by drawing a vacuum
Remove the air from the chamber more quickly andefficiently than gravity alone
Operate at a highe temperature; e.g., J32° ': (27,) of.)
Sterilizing exposure time is tvpicallv shorter thanfor gravitv cycles
PubhcHealthOntano ca
11/29/2017
23
ype 0 erilizers
ea P. se- css re-Flush
• Cassette-type steam sterilizer
Stearn flushes and pressure pulses are used to removeair from the cha rnbe r.
• Uses steam under pressure rather than vac rum
• Pre-set cycles
• Most SPPF have a removable cassette acts as thechamber
• Cannot mix oads (e.g., unwrapped & wrapped)Photo courtesy of SCICan
PubhcHealthOntano ca
Section 7: Sterilization
Sterilizer mechanical displav, printout or USB ischecked, verified and signed for each cycle bv theperson sterilizing medica devices .• **If your sterilizer does not have a printer
Plan to replace it And meanwhile:
During each cycle, check and record the elapsed sterilization time andsterilization temperature during the sterilization exposure phase.
Shown on the display
Use a Class 5 chemical indicator strip (integrator) in each package thatyou sterilize.
•.• ,- ...• ,•• ,.:...~..... ""...''''' ~ i!..:i
"'SPE 111214 (SA User Handbook fOI Medical Device Reprocessing In Communuv Hpdlth Settings, 2014
PubhcHealthOntano ca
11/29/2017
24
ec 7: S erilization
Items in the processed load should not be releaseduntil t e results of the 81 test are available• There 2re contingency plans (i.e., recall policy and procedure)
in the event of reprocessing failures.
Ster iiizer is tested with a biological indicator (81) eac iGoy tne ster i izer is used.
A colour change of the indicator indicatesthe spores are growing - i.e., thesterilization process failed .
• No colour change indicates the sporeshave been destroyed
Biological Indicator
PubfrcHealthOntano ca
ection 7: Sterilization
Items ore placed in the sterilizer according to sterilizerMIFU's
Image courtesy of SciCan
PublicHealthOntano ca
' ..... '
11/29/2017
25
ec i 7: erilization
ze re ui e ar ., i ed for ~ a .
Records 2re kept to document that all sterilizationpa rarnete rs were met
Ster i ized items are not used until the Cl(s) ore checked
Items are allowed to dry before removing from sterilizer
If failed (I is identified, contents of package arereprocessed
Sterile packages are inspected for integrity
PubhcHealthOntano ce
Section 8: Storage
Sterile items are stored in their sterile packaging untiltime of use
Packaged, sterilized instn. ments are storea securely
in 2 manner that keeps them clean, dry arid preventscontamination
The shelf life of a sterile package is event-relatedrather than time-related - differs from R(DSOguidelines
52
11/29/2017
26
ectio 9: er Considerations (Alerts & Recal s)
There is a process for receiving and disseminatingdental/rnedical equipment/device alerts and recallsoriginating from manufacturers oragencies.
surlino ... •-", .......r."..tJc"' ....."""'.l><l"_ ........~~~:.~.t....,-~,
!'" ;;~", -, • -.,;~. • ••• _- ... " .;;~, '0'. .,,:., •
""""'-"1
PubllcHealthOntarro ca
eprocessing Checklist ighlights
All references to High Level Disinfection (HLD) have beenremoved
Rationale
Semi-critical items are cleaned followed by sterilization
The l1ajor'ty of se 'ni-critica i ems rsed in dentistrv areavailable in ~eat-tolerant or disposable alternatives
Avoid the use of heat-sensitive semi-critical items thatmust be processed with liquid chemical germicides
RCDSO. Guidellnellnfection Prevention end Control III tile Dental Ottice. iebruary 2010
PubhcHealthOntano ca
11/29/2017
27
Section 0: Record eeping
A written log of all sterility assurance test results ismaintained
Samph: St~dlildllun L<)9 Shl'el
(yd ..
81 R.. u.11I
(_oolto'_i r- .. u f.lI! InI11.11
, P,'f _
R..,IJltl
(y~l.. TIm" hmp' lOold
IMI"l (·C."F) (o..,,,nl.
PubllCHealthOntarlO ce
FAQ's
A dental office's practice is to load sterilization poucheswith all the instruments needed for one procedure,often exceeding 5 instruments per pouch.
s there a imit to the number of instru merits per pouch?
Paper-plastic sterilization pouches may be used for small,lightweight, low-profile items (e.g., one or tVIIO clamps) andshould allow adequate air removal, steam penetration andevacuation to all surfaces. The pouch size should be adequate tocontain the instruments ensuring these do not touch the pouchseams.
PubhcHealthOnlano ca
11/29/2017
28
FAQ'sIt is not practical for offices to hold equipment until the BiologicalIndicator (BI) has passed as this usually takes 24 - 48 hours. Do wehave to hold equipment until the BI passes? What do we have to doto use equipment if \Ale don't hold it until the BI is read?
• If holding back the precessed lo ad is not possible, evaluation and
documentation of a process challenge device (PCD) containing a Class 5 or 6
chemical indicator and checking, verifying and documenting the specific cycle
physical parameters may be used to justify the release of routine loads .
• If a sterilized package must be released prior to knowing the BI results for the
day, a Class 5 or Class 6 indicator would be required as the internal CI in each
package to be released. In this situation, evaluate the internal CI (Class 5 or
Class 6) and check, verify and document the specific cycle physical parameter
to Justify the release of the routine package.
PubhcHealthOntano Col
FAQ's
A setting is currently cleaning and reprocessinginstruments at the end of the day only. What isrecornmended regarding the de.ay in cleaning devicesand instruments?
It is recommended that instruments be cleaned as soon aspossible 2fter use so that organic rnaterial will not dry on them.If there will be a delay in reprocessing, the instruments shouldbe soaked in an approved instrument soaking solution.
PubhcHealthOntano Col
11/29/2017
29
are Ele en sheck ist Highlights
• Section 4 - Dental Unit V\/aterlines and Water Quality
Section 5 - Handpieces
• Section 6 - Suction
• Section 1:l - Dental Radiography
PubhcHealthOntano ca
Section 4: Dental Unit Water lines & Water Quality
Staff have received training regarding water quality,biofilm formation, water treatment methods andappropriate maintenance protocols for water de ivervsystem
VVaterline f· eaters are not used
All waterlines are purged at the beginning of eachworkday
Closed or other water delivery systems: IVIIFU'srelated to dental units and equipment are followed fordaily and weekly l1&inLenance
PubllcHealthOntano ca
11/29/2017
30
Sec ion 4. De al nit Wa er lines & Wa er Quality
MIFU regarding testing, maintenance and preventativemaintenance of 'ires, anti-retraction valves and otheraccessories ore followed
Handpiece, uslng water coolant are run for 20 to 30seconds after patient/client care
Sterile water or steri e saline is used when irrigatingopen surgical sites and whenever bone is cut duringinvasive surgical procedures
PublrcHealthOntano COl
Water Quality
• Water quality*
• Drinking water standard: :::;500 cfus/ml
• Untreated dental unit water can produce 1,000,000cfus/ml or more over time
lvlicroorga ~liSITlS include:BacteriaLegionella sppPseudomonas spp
• Non-tubercula Mycobacteria spp• Fungi
ProtozoaCDC GUidelines for Infection Control in Dental Health-Care Setttrlgs 2003 MMWR 2003:52 pp 3031
PubhcHealthOntano Col
11/29/2017
31
Sec ion 5: D nDevices
andpieces & Othe n raoral
Devices that cor tact mucous membranes and areattached to the air or waterlines of the dental unitshould be activated to discharge air and water for arninirnurr of 20 to 30 seconds after each patient/clier tuse
PubhcHealthOntano ca
Section 6: Suction Lines
Suction lines are purged between patients/clients byaspirating water or an appropriate cleaning solution
Suction lines are flushed out with an enzymatic cleaneror appropriate clea ning solution at least once per week
PubllcHealthOntano ca
11/29/2017
32
UI en / evices Used ForSectio 1. e a IPatient Care
Semi-critical items must undergo cleaning followed bysterillzati between patient uses
Heat stable se i-cri icc. items are s erilized: heatsensitive semi-critical items are replaced by heat stable ordisposable items
All critical items are either SINGI E P/i,TIENTUSE(disposable) or sterilized between uses
PubllcHealrhOntano ca
Section 12: Dental Radiography
Film packet - remove blood or excess saliva, place incontainer for transport
Film packet disinfected with an appropriate low-leveldisinfectant before opening to deve op
Digital radicgraphv sensors protected with barriersAfter barrier removal, sensors are cleaned of gross debris and saliva and
disinfected with a low-level disinfectant or as per manufacturer'sinstruction
PubhcHeallhOntarlo ca
11/29/2017
33
Summary
PHO Checklist Reprocessing in Dental Practice Settings
PHO Checklist Core Herner.ts in Dental PracticeSettings
• Adapted to a igr. with the dental practice setting
Both checklist are living documents
• Will be reviewed and revised as the e /idence changes
Questions?
PubhcHealthOntano ca
Disclaimer
PHO has developed this Checklist for Reprocessing ofDental/Medical Equipment/Devices in Dental Practice Settings andits content, based on the Provincial Infectious Disease AdvisoryCommittee's infection Prevention and Control for Clinical OfficePractice, June 2013. This document is intended to support areview or audit of Reprocessing of Dental/MedicalEquipment/Devices in Dental Practice Settings and does notreplace best clinical practices 01- legislative requirements.
PHO is not responsible for any losses or damages arising from theuse of this document or its contents, including for any purposes toinform any decision or determination, clinical or otherwise,regarding inspections, findings, outcomes or recommendations.
PubhcHealthOntano ca
11/29/2017
34
Resources from P 0
PIDAC documentshttp://www. p u bl iehea Ithonta rio. ea/en/BrowseByTo pie/I nfeetio usDiseases/P I
DAC/Pages/~IDA~ Doeuments.aspx
Resources
• Reprocessing in the Community On-line Modules
http://www.publichealthontario.ea/en/LearningAndDevelopment/Onlin
e Lea rn ing/I nfeeti 0 usDisea ses/R e p ro eess ing/Pages/ d efa u It aspx
• IPAC Core Competencieshttpl/www.publlchealthontarlo.ea/en/LearningAndDeveloprnent/Onlin
eLea rn ingLl nfeeti ous Disea ses/I PACCore/Pages/ d efa u Itaspx
IPAC Lapse Webpagehttp://www pu bl ichea Ith 0 nta ri 0 .ea/en/BrowseByTop ie/I PAC/Pages/I PACLapses.aspx
69
References
PIDAC: Infection Prevention and Control for Clinical OfficePractice, 2013http://www.publichealthontario.ca/e n/ eRe pository/I PAC CIin ica IOffice Practice 2013.pdf
PIDAC: Updated guidance on the use of rnultidose vials, 2015http://www.publichealthontario.ca/e n/Browse ByTo pic/I nfectiousDiseases/P IDAC/Pages/I nfecti 0 n- Preventio n-a nd-Contro 1- for-CIin ica I-Office- Practice- Multi dose- Via Is.aspx
PIDJlL Cleaning, disinfection and sterilization in al! healthcaresettings, 2013https ://www.publichealthontario.ca/en/ eReposito ry/P IDAC Cleaning Disinfection and Sterilization 2013.pdf
70
11/29/2017
35
efere ces
Canadian Standards Association. CAN/CSA-Z314 3-14 Effective Sterilization in
Health Care Facilities by the Steam Process. Rexdale, Ont.: Canadian StandardsAssociation; 2014
Canadian Standards Association CAf\I/CSA-Z314 0-13 Medical Device
Reprocessing - General requirements. Rexdaie, Ont : Canadian StandardsAssociation; 2013
Canadian Standards Association. CAN/SPE 1112-14 User Handbook for Medical
Device Reprocessing in Community Health Care Settings. Mississauga, OntCanadian Standards Association; 2014
Canadian Standards Association. CAN/CSA Z314.8-14 Decontamination of
Reusable Medical Devices. Z314.8-14 CC, editor. Mississauga, Ont.: CanadianStandards Association; 2014
PublicHealthOntano ca
Tools and Resources
• Standards (e.g., CSA)
• Guidelines (e.g., PIDAC documents, appendices withsample checklists and Audits)
• 'PAC-Canada Audit Tool Kit
Partnerships, Net\tlorking and Communication withIPAC professionals and organizations
11/29/2017
36
Acknowledgemen s
M rking Group
• Dr. Michael Gardner, Royal Col ege of Dental Surgeonsof Ontario (RCDSO)
L f. Chris Swayze, RCDSO
• Guilia Galloro, College of Dentai Hygienist of Ontario(COHO)
• Robert Farinaccia, COHO
Janu Sritharan, Ministry of Health and Long-term Care(MOHLTC)
Melissa Helferty, MOHLTC
PubhcHealthOntano ca
Acknowledgements
vorklng Group representing Public Health Ontario
• Sandra Callery
• Barb Catt
• Dr. Sonica Singhal
[no lvlaureen Cividino
e Laurie Rodnick
Anne Augustin
Donna \/Ioore
• Virginia Tirilis
PubhcHealthOntano ca
11/29/2017
37
Ack ow edgements
f10rking Group
Dr. Michael Gardner, Royal College of Dental Surgeonsof Ontario (RCDSO)
ur. Chris Swayze, RCDSO
Guilia Galloro, College of Dental Hygienis: of Ontario(CDHO)
• Robert Farinaccia, CDHO
Janu Sritharan, Ministrv of Health and Long-term Core(fVlOHLTC)
• Melissa Helferty, MOHLTC
PubhcHealthOntano COl
For More Information About This Presentation, Contact:
Dr. Maureen Cividinoma ureen. civid [email protected]
Donna MooreDon [email protected]
Public Health Ontario keeps Ontarians safe arid healthy.Find out more at PublicHealthOntario ca
~tr OntarioI.ijfft{,tOllW.lthhqtf(ll'P~ ,III! 'fO~
19rtK,Ik"'lltft1_~.Pfomo~.""tl.!.I!Ifr
11/29/2017
38
Refere cesOntario Agency for Health Protection and Promotion (Public Health Ontario).Provincial Infectious Diseases Advisory Committee. Best practices for cleaning,disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto,ON. Queen's Printer for Ontario; May 2013
Canadian Standards Association CAN/CSA-Z3lt1 3 1 Ii Effective Sterilization inHealth Care Facilities by the Steam Process. Rexdale, Ont.: Canadian StandardsAssociation; 2014
Canadian Standards Association. CAN/CSA Z314 0-13 Medical DeviceReprocessing· General requirements Rexdale, Ont.: Canadian StandardsAssociation; 2013
Canadian Standards Association. CAN/SPE 1112-14 User Handbook for MedicalDevice Reprocessing in Community Health Care Settings. Mississauga, Ont.:Canadian Standards Association; 2014
Canadian Standards Association. CAN/CSA Z314.8-14 Decontamination ofReusable Medical Devices. Z314.8-14 CC, editor. Mississauga, Ont.: Canadian
I~. ~ 1 , .'1 ••PubhcHealthOntano ca
11/29/2017
39