Responding to Infection Prevention

and Control (IPAC) Complaints

Monali Varia, MHSc, CIC

Peel Public Health

November 29, 2017

Objectives

1. Understand the local public health role in responding to

infection prevention and control (IPAC) complaints

2. Identify key contacts and resources to support effective

IPAC practices in the dental practice setting

Presenter Disclosure

• Presenter: Monali Varia

• Relationships with commercial interests:

– Not applicable

Disclosure of Commercial Support

No commercial support

Not applicable

Mitigating Potential Bias

Bloodborne pathogen transmission in US dental practices, 2003-2015 (JADA, 2016)• 3 reports – 6 transmissions of HBV and

1 transmission of HCV; over 7,000 people notified

• Transmission was likely associated with: poor sterilization practices for multi-use devices, contamination of multi-dose vials

• Peel Public Health has responded to 30+ complaints since 2015

– Settings include physician offices, dental clinics, diagnostic facilities, specialty clinics

– IPAC lapses most commonly sub-optimal reprocessing practices

• Other complaints which are referred to appropriate organization

– e.g., contracted services in long term care

The initial call to Public Health

Infection control concerns can be raised by:

• The general public

• Another public health unit or Ministry of Health and

Long-Term Care

• Regulatory college

• Public health investigation of a reportable disease

The initial call….

• Caller expresses concerns with IPAC practices

observed during a recent visit

• Concerns:

– “Unclean office”

– Didn’t see hygienist put on new gloves

– Equipment was lying on an open tray

Were the items sterile?

• Based on the potential bloodborne illness

transmission risks (e.g., associated with use of non-

sterile instruments)

• Public Health mandate

– Health Protection and Promotion Act: mandate to identify and

mitigate health hazards

– Ontario Public Health Standards: IPAC complaints protocol

• Inform Royal College of Dental Surgeons of Ontario

A decision to investigate

What is an IPAC Lapse?

A lapse is defined as a deviation from IPAC standard of

care that has, or may result in infectious disease

transmission to the premises’ clients, attendees or staff

Standard of care is defined through documents from

the Provincial Infectious Diseases Advisory Committee

(PIDAC), Public Health Ontario (PHO), or Ministry of

Health and Long Term Care (MOHLTC)

https://www.peelregion.ca/health/infectioncontrol/

Example of lapse report on Peel’s website

Audit Methods (Resources)

PIDAC• Several guidelines

Procedure/Practice-Specific• Royal College of Dental Surgeons of Ontario (RCDSO). Infection Prevention

& Control in the Dental Office. February 2010.

• Canadian Dental Association and Ontario Dental Association

• Public Health Ontario Checklists for Dental Practice Settings

Conduct a site visit and audit

Commonly identified issues (to date) in Peel dental settings:

• Reprocessing issues for multi-use items– No monitoring and/or documentation of physical parameters,

and chemical and biological indicator results

– No labelling of pouches/packs

• Infrastructure – no one-way workflow for cleaning, disinfecting and/or sterilization

• Lack of available documentation– practice-specific policies and procedures

– manufacturer’s instructions

– autoclave maintenance

Next steps

• Public Health mandate to identify potential health hazards and request corrective actions

• Peel Public Health provides the facility with:

– a formal letter and documentation of recommendations and rationale

– Opportunity to discuss recommendations

– an offer of support and resources re: general IPAC education (e.g., Public Health Ontario learning modules)

When a Public Health Order is Issued

Under the Health Protection and Promotion Act, a Medical Officer of Health may make an order if they have reasonable grounds to believe a health hazard exists. This provides legal authority to enforce corrective measures if required, in regards to the hazard

An Order is revoked once the health hazard is removed

How does the health unit determine if

investigation is complete?

• What are the triggers to suggest a look back investigation

and patient notification?

Example of reprocessing area if renovation is feasible

Opportunities

• Investigations must be a collaborative effort with the

practitioner, regulatory college, PHO/MOHLTC and

local public health

• Participated in follow-up initiatives with the

province, regulatory colleges, universities to help

address existing gaps

• Visit the Public Health Ontario

site: http://www.publichealthontario.ca/en/BrowseByTopic/IPA

C/Pages/default.aspx

�Review your IPAC practices against

current PIDAC best practices and

dental checklist

�Use PHO’s online learning modules

�Call Peel Public Health if you have

questions

Questions?

Region of Peel, Public Health 905-791-7800

Monali Varia, Manager, Infection Prevention & Surveillance:

monali.varia@peelregion.ca

Julie Holt, Supervisor, Infection Prevention & Surveillance

julie.holt@peelregion.ca

Please use your mobile devices and go to

www.pollev.com/ipacpeel901

Or Text IPACPEEL901 to 37607 once to join

Audience questions (Poll)

What is the main challenge you face with

implementing IPAC best practices in your practice

setting?

�Lack of infrastructure (design, resources, etc)

�Competing priorities in busy dental practice

�Keeping current with CSA standards and best practice

documents

�All of the above

Audience questions (Poll)

Given what you’ve heard today, what IPAC

topic do you need to know more about?