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
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)
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?
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:
Julie Holt, Supervisor, Infection Prevention & Surveillance
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