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Prevention and Control Lapse Investigation – Lakeland Family Dentistry and Norwood Family Dentistry Clinics

An investigation by Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health and Peterborough Public Health has found that dental instruments were not being properly cleaned and sterilized in accordance with provincial standards. At this time, we do not have any evidence that disease transmission has occurred.

KFL&A Public Health and Peterborough Public Health sent notification letters to patients of the dental clinics on July 12, 2019. This communication recommends that affected patients seek non-urgent medical assessment and possible testing of hepatitis B, hepatitis C, and HIV.

Frequently asked questions (FAQ) about this IPAC lapse

There are two dental offices affected by this infection prevention and control lapse:

  1. Lakeland Family Dentistry, 12357 Highway 41, Northbrook, Ontario K0H 2G0
  2. Norwood Family Dentistry, 4243 Highway 7, Norwood, Ontario, K0L 2V0

On May 16, 2019 KFL&A Public Health received a complaint about infection prevention and control (IPAC) practices at Lakeland Family Dentistry, 12357 Highway 41, Northbrook, Ontario.

During an inspection completed by KFL&A Public Health on May 21, 2019, there was evidence of improper cleaning and sterilization practices of medical equipment and devices. Consequently, KFL&A Public Health issued an Order under the authority of Section 13 of the Health Protection and Promotion Act to address the deficiencies and close the clinic on May 21, 2019.

At the time of inspection, staff of the Lakelands Family Dentistry clinic indicated that some dental equipment was reprocessed (cleaned and sterilized) at a second dental practice, Norwood Family Dentistry, located at 4243 Highway 7, Norwood, Ontario.

KFL&A Public Health notified Peterborough Public Health and they conducted an inspection on May 22, 2019 upon which evidence was found that medical equipment/devices were not cleaned and sterilized according to provincial standards, Peterborough Public Health issued an Order under the authority of Section 13 of the Health Protection and Promotion Act to address the deficiencies and close the Norwood clinic on May 22, 2019.

Improperly cleaned and improperly sterilized instruments can spread infectious diseases such as hepatitis B, hepatitis C and to a lesser extent, human immunodeficiency virus (HIV).

The risk of disease transmission is believed to be low, however, out of an abundance of caution, Public Health recommends that all patients who had a dental procedure at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 or the Lakeland Family Dentistry facility between February 20, 2018 and May 22, 2019 see their health care provider to discuss their individual risk of infection and consider whether they should be tested for hepatitis B, hepatitis C, and HIV

In Ontario, it is expected that approximately 1% of the general population will test positive for hepatitis C; testing positive for hepatitis C or any other bloodborne infection does not necessarily mean that it is related to exposure at this clinic. Although the rates are low, hepatitis C is the most common bloodborne infection. Rates for hepatitis B and HIV are also very low.

At this time, KFL&A Public Health and Peterborough Public Health are not aware of any cases of hepatitis B, hepatitis C or HIV transmission at the dental clinic. Out of an abundance of caution, Public Health recommends that all patients who had a dental procedure at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 or the Lakeland Family Dentistry facility between February 20, 2018 and May 22, 2019 see their health care provider to discuss their individual risk of infection and consider whether they should be tested.  

What if I attended the Norwood dental clinic before December 15, 2017 and/or the Lakeland dental clinic before February 20, 2018?

  • The Norwood facility demonstrated compliance with the provincial standards for reprocessing (cleaning and sterilization) of dental instruments and infection control practices as of December 15, 2017. If you attended this clinic before to December 15, 2017 no further action needed.
  • The Northbrook clinic demonstrated compliance with the provincial standards as of February 20, 2018. If you attended this clinic before February 20, 2018  no further action is needed.

The dental clinics are cooperating with both KFL&A and Peterborough Public Health to ensure patients who may have been treated at the clinic have the information that they need to make informed personal health decisions.

After consultation with Public Health Ontario and the Royal College of Dental Surgeons of Ontario, and based on a risk assessment, KFL&A Public Health and Peterborough Public Health determined the notification time period would include patients who had been seen at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 and the Lakeland Family Dentistry facility between February 20, 2018 and May 22, 2019.

Affected patients will receive a notification package in the mail. The package includes a patient letter, a letter for your healthcare provider and a partially completed laboratory requisition for blood tests.

Affected patients will receive a notification package by mail. The package includes a patient letter, a letter for a healthcare provider and a partially completed lab testing requisition. Make an appointment with a health care provider and bring the package with you. 

If you did not receive a package by mail and you had dental assessment or treatment at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 or the Lakeland Family Dentistry clinic between February 20, 2018 and May 22, 2019, you can download a copy of the patient information package (PDF). If you require a printed copy of the package contact the Public Health agency in the area where you live.

·        Haliburton Kawartha Pine Ridge Public Health – 1-866-888-4577, ext. 1232

·        Hastings and Prince Edward Counties Public Health – 613-966-5500 or 1-800-267-2803, ext. 349

·        Kingston, Frontenac and Lennox & Addington (KFL&A) Public Health - 613-549-1232

·        Peterborough Public Health (705)743-1000, ext. 401

·        Renfrew County and District Health Unit, (613)735-8653, ext. 555

 

If you are unsure which is your local public health agency, the Government of Ontario has a full listing of locations.  

When you meet with a health care provider, they will discuss your risk of infection, provide counseling about testing and if appropriate, recommend testing.

If you decide to be tested, your health care provider will complete the prefilled blood requisition that was sent with your letter.

Results are usually available within 2 weeks. Contact your health care provider for results and follow up.

Please do not go to a hospital emergency department or urgent care for blood testing; the emergency department and urgent care will redirect you to a primary care provider.

Take the following steps:

  • Book an appointment with a health care provider. If you do not have a health care provider go to a walk-in clinic.
  • Bring the patient information package you received in the mail to your appointment. It includes a partially pre-filled laboratory requisition that a health care provider must sign. You cannot take the requisition to the laboratory without seeing a health care provider. Packages are also available for printing. If you are unable to print, please call your local public health office: 
    • Haliburton Kawartha Pine Ridge Public Health – 1-866-888-4577, ext. 1232
    • Hastings and Prince Edward Counties Public Health – 613-966-5500 or 1-800-267-2803, ext. 349
    • Kingston, Frontenac and Lennox & Addington (KFL&A) Public Health - 613-549-1232
    • Peterborough Public Health (705) 743-1000, ext. 401
    • Renfrew County and District Health Unit, (613)735-8653, ext. 555


  • If you choose to be tested, follow-up with your health care provider to get the results of your bloodwork
  • If you did not receive a package by mail and you were seen for a dental assessment or treatment at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 and/or the Lakeland Family Dentistry clinic between February 20, 2018 and May 21, 2019, you can download a copy of the patient information package(PDF).

This is not an emergency, do not go to the hospital emergency department or urgent care centre for blood testing. You may take the patient information package, including the test requisition to a walk-in clinic.

Call your local public health agency in the area where you live:

  • Haliburton Kawartha Pine Ridge Public Health – 1-866-888-4577, ext. 1232
  • Hastings and Prince Edward Counties Public Health – 613-966-5500 or 1-800-267-2803, ext. 349
  • Kingston, Frontenac and Lennox & Addington (KFL&A) Public Health - 613-549-1232
  • Peterborough Public Health (705)743-1000, ext. 401
  • Renfrew County and District Health Unit, (613)735-8653, ext. 555

Not sure which is your local public Health? Click here.

Depending on the date of your last visit to the dental clinic, you may need to have more testing. Your health care provider will discuss if any further tests are needed.

Based on the results of testing, your health care provider will also discuss any treatment that may be appropriate.

This is not an emergency. Please do not go to a hospital emergency department or urgent care centre for blood testing; the emergency department and urgent care will redirect you to a primary care provider.

Make an appointment with a health care provider for an assessment and possible testing.

While you are waiting for assessment and test results, consider taking the following precautions:

·        Do not share utensils or personal items such as nail clippers, razors, or toothbrushes.

·        Do not share needles or other drug related supplies.

·        Do not share glucose or blood sugar testing equipment with others.

·        Clean up any visible blood from cuts etc.

·        Use condoms during sexual activity.

You should speak with a health care provider for individual advice.

At this time, only patients who received treatment at the Norwood Family Dentistry location between December 15, 2017 and May 22, 2019 or the Lakeland Family Dentistry clinic between February 20, 2018 and May 22, 2019, are asked to see a health care provider.

Yes, we recommend you speak with a health care provider to ensure you are up to date.

Testing is free for Ontario residents. If you are not an Ontario resident or do not have insurance, please call your local public health agency.

  • Haliburton Kawartha Pine Ridge Public Health – 1-866-888-4577, ext. 1232
  • Hastings and Prince Edward Counties Public Health – 613-966-5500 or 1-800-267-2803, ext. 349
  • Kingston, Frontenac and Lennox & Addington (KFL&A) Public Health - 613-549-1232
  • Peterborough Public Health (705)743-1000, ext. 401
  • Renfrew County and District Health Unit, (613)735-8653, ext. 555

 

Not sure which is your local public Health? Click here.

If you test positive for hepatitis B, hepatitis C, or HIV, the result is reported to the local Medical Officer of Health. This is a requirement under the Health Protection and Promotion Act. Local public health agencies will not share your results with anyone else without your permission.

 

Test results will go to the health care provider who ordered the testing.

Test results should arrive within 2 weeks.

Follow up with your health care provider for results.

 

If your test result is positive, your health care provider will advise you about next steps including more testing, treatment, and follow-up.

There are highly effective treatments for these infections.

It is expected that approximately 1% of the people in our community will test positive for hepatitis C; testing positive for hepatitis C or any other bloodborne infection does not necessarily mean that it is related to exposure at these dental clinics.

Yes. Although the risk of infection is believed to be low, you should take the following precautions until to you speak to a health care provider or have received results from testing:

·        Do not share personal items such as nail clippers, razors, or toothbrushes.

·        Do not share needles or other drug related supplies.

·        Do not share glucose or blood sugar testing equipment with others.

·        Clean up any visible blood from cuts etc.

·        Use condoms during sexual activity.

Visit the Peterborough Public Health website and Health Canada for general information about these infections.

Speak with a health care provider.

 

Each clinic site will be allowed to open after inspections have shown the site to be in compliance with recommendations.

No. local public health agencies (health units) are not mandated to routinely inspect offices and clinics run by regulated health professionals (e.g., dentist or physician). In these settings, it is the regulatory college of the health professional, who sets the standards and ensures adherence.

In 2015, the Ontario Public Health Standards and the Health Protection and Promotion Act were changed to require health units to follow up on infection prevention and control complaints in any public setting, including those run by regulated health professionals such as dentists and doctors.

Yes, the Royal College of Dental Surgeons of Ontario (RCDSO), which regulates dental practice in Ontario and the Ministry of Health and Long-Term Care (MOHLTC) has been notified. KFL&A Public Health and Peterborough Public Health also consulted with Public Health Ontario during this investigation.

As members of a self-regulated profession, dentists are accountable to the Royal College of Dental Surgeons of Ontario. They must meet minimum requirements to maintain patient safety, including standards for infection prevention and control. The standards are based on expert guidance provided by Public Health Ontario. KFL&A Public Health and Peterborough Public Health has partnered with the College, and Public Health Ontario to provide local dentists and their staff with up-to-date information about cleaning and sterilizing dental instruments.

Local public health agencies or health units follow provincial protocols that specify how to investigate and follow up on infection prevention and control complaints.

When we receive a complaint, we conduct an inspection to determine if there has been a breach of infection prevention and control practices and if that breach constitutes a health hazard.

Infection prevention and control lapses are disclosed on all local public health agencies websites.

 KFL&A Public Health – www.kflaph.ca/IPACLapse

Peterborough Public Health – www.peterboroughpublichealth.ca/IPACLapse

You can call KFL&A Public Health at (613)549-1232 or Peterborough Public Health at (705)743-1000, ext. 401.

Resources:

IPAC Lapse Report – Lakeland Family Dentistry, Northbrook, ON; Norwood Family Dentistry, Peterborough, ON.

Peterborough Public Health – Infection Control Complaints and Lapse Disclosure

Royal College of Dental Surgeons of Ontario – Infection Prevention and Control in Dentistry

Health Canada – Hepatitis B Fact Sheet

Health Canada – Hepatitis C Fact Sheet

Health Canada – HIV Fact Sheet

Resources for patients:

Patient information package (PDF) – Patients who received treatment at this dental clinic need to print and bring all three documents to their health care provider.

The test requisition is pre-filled, and you must have your health care provider sign it. You cannot take the requisition to the laboratory without seeing a health care provider first.

If you do not have access to a printer, please call Peterborough Public Health at 705-743-1000, ext. 401. Accessible formats can be available.

Resources for health care providers:

Laboratory requisition

Public Health Ontario – Best Practice Document, infection Prevention and Control for Clinical Office Practice (Provincial Infectious Disease Advisory Committee, April 2015)

Ministry of Health and Long-Term Care – Infection prevention and control disclosure protocol

Ministry of Health and Long-Term Care – Infection prevention and control lapse disclosure guidance document

 

Please do not go to a hospital emergency department or urgent care for blood testing. The emergency department and urgent care will redirect you to a primary care provider.

Contact us.