Responding to Infection Prevention and Control (IPAC) Complaints. Monali Varia, MHSc, CIC Peel Public Health November 29, 2017

Transcription

1 Responding to Infection Prevention and Control (IPAC) Complaints Monali Varia, MHSc, CIC Peel Public Health November 29, 2017

2 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

3 Presenter Disclosure Presenter: Monali Varia Relationships with commercial interests: Not applicable

4 Disclosure of Commercial Support No commercial support Mitigating Potential Bias Not applicable

5 Bloodborne pathogen transmission in US dental practices, (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

6 Peel Public Health has responded to 30+ complaints since 2015 Settings include physician offices, dental clinics, diagnostic facilities, specialty clinics IPAC lapses most commonly suboptimal reprocessing practices Other complaints which are referred to appropriate organization e.g., contracted services in long term care

7 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

8 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?

9 A decision to investigate Based on the potential bloodborne illness transmission risks (e.g., associated with use of nonsterile 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

10 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)

11 Example of lapse report on Peel s website

12 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 Canadian Dental Association and Ontario Dental Association Public Health Ontario Checklists for Dental Practice Settings

13 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

14 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)

15 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

16 How does the health unit determine if investigation is complete? What are the triggers to suggest a look back investigation and patient notification?

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19 Example of reprocessing area if renovation is feasible

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22 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

23 Visit the Public Health Ontario site: 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

24 Questions? Region of Peel, Public Health Monali Varia, Manager, Infection Prevention & Surveillance: Julie Holt, Supervisor, Infection Prevention & Surveillance

25 Please use your mobile devices and go to Or Text IPACPEEL901 to once to join

26 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

27 Audience questions (Poll) Given what you ve heard today, what IPAC topic do you need to know more about?