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Infection Prevention & Control Lapse Investigation – Kawartha Endodontics

This is a public notification regarding Kawartha Endodontics.

Patients who received dental treatment between April 2010 and  July 16, 2019 should review the Patient Information Package and FAQ below.

During an inspection completed by Peterborough Public Health on July 15, 2019, evidence was found that medical equipment/devices were not cleaned and sterilized according to provincial infection prevention and control standards and that the relevant record keeping and policies/procedures were incomplete. Consequently, Peterborough Public Health issued an order to close the clinic on July 15, 2019.  Since the time of the inspections and order, staff from the dental clinic worked with Peterborough Public Health to ensure all dental instruments are being cleaned and sterilized according to provincial standards. The clinic was re-opened on July 26, 2019 when they demonstrated full compliance with the provincial infection prevention and control standards.

Peterborough Public Health (PPH) requested Public Health Ontario (PHO) to conduct a risk assessment based on our inspection findings.  PHO concluded that the observed deficiencies  posed a risk of exposure to bloodborne and/or bacterial pathogens.  PHO’s findings support PPH’s intent to notify patients and recommend they consult with their primary health care provider regarding individual risk and bloodborne infection testing.

Frequently asked questions (FAQ) about this IPAC lapse

Kawartha Endodontics, 425 Water Street, Suite 200, Peterborough ON, K9H 3L9

On July 11, 2019, Peterborough Public Health received a complaint about infection prevention and control (IPAC) practices at Kawartha Endodontics, 425 Water Street, Suite 200, Peterborough ON, K9H 3L9.

The office was closed for business on Friday July 12, 2019 so Peterborough Public Health inspected the dental facility on Monday July 15, 2019. At the time of inspection, it was determined based on reasonable and probable grounds that a health hazard existed. Peterborough Public Health found evidence that medical equipment/devices were not reprocessed as per provincial infection prevention and control standards. This included improper sterilization procedures taking place, inconsistent record keeping and incomplete policies and procedures.

To help eliminate the risk while an investigation took place regarding deficiencies found on site, Peterborough Public Health required that the business cease all patient treatment activities.  Peterborough Public Health issued an Order under the authority of Section 13 of the Health Protection and Promotion Act to address the deficiencies and to close the premise.

Improperly cleaned and improperly sterilized instruments can spread infectious diseases such as Hepatitis B, Hepatitis C and human immunodeficiency virus (HIV).

Though risk of disease transmission is believed to be low, Peterborough Public Health recommends patients see their health care provider to discuss their individual risk of infection and the potential benefits of testing for Hepatitis B, Hepatitis C, and HIV.

In Ontario, it is expected that approximately 1% of the people 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, Peterborough Public Health is not aware of any transmission of Hepatitis B, Hepatitis C, or HIV infections associated with this clinic.

Based on a risk assessment conducted by Public Health Ontario, Peterborough Public Health determined there was a risk present and had planned to contact patients directly to notify them. It had been our intention to conduct a two-step notification, beginning with patients who had been seen more recently at the clinic and only proceeding to full notification only if we uncovered evidence of the transmission of infection. However, since the dentist is appealing our Order and the hearing will not take place until January 2020, the decision was made to advise all patients seen before July 16, 2019, through disclosure on our website, and other means at our disposal to consult their health care provider. Patients seen after the clinic re-opened on July 26, 2019 do not need to be tested.  

If you choose to have testing, please download the patient information package. This includes a letter explaining the situation, a letter for your health care provider, and a lab requisition for blood tests.

If you had dental treatment between April, 2010 and July 16, 2019 download the Patient information package .

This includes a letter explaining the situation, a letter for your health care provider, and a lab requisition for blood tests.

On August 27, 2019 and August 29, 2019, the dentist was ordered to provide patient contact information to allow Peterborough Public Health to notify patients of the risk of infection. As the dentist is appealing this Order, Peterborough Public Health has been unable to conduct direct patient notification and therefore had to use other means to reach potentially impacted patients.

When you meet with your 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 lab requisition.

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:

1.     Book an appointment with a health care provider. If you do not have a health care provider go to a walk-in clinic.

2.    Download and print the Patient information package . If you do not have access to a printer, please call Peterborough Public Health (705) 743-1000, ext. 401.

3.    Bring the patient information package with you 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.

4.    Follow-up with your health care provider to get the results of your bloodwork.

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

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

  • To locate your local public health agency 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 dental treatment at Kawartha Endodontics between April, 2010 and July 16, 2019 are asked to see a health care provider. Your health care provider will speak to you about treatment options, if required, and who else may need to be tested.

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.

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

·        To locate your local public health agency click here.

If you test positive for Hepatitis B, Hepatitis C, or HIV, the result is reported to the local Medical Officer of Health and follow-up is conducted. 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.

After the Order to close was issued on July 15, 2019, a follow-up inspection by Peterborough Public Health of Kawartha Endodontics was completed, and the premise was permitted to re-open on July 26, 2019.   At the time of the follow-up inspection, the clinic met the provincial infection prevention and control standards and as result, the closure order was no longer in effect.

No. Local public health agencies are not provincially mandated to routinely inspect offices and clinics run by regulated health professionals (e.g., dentists or physicians). 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 public health to follow up on infection prevention and control complaints in any public setting, including those run by regulated health professionals such as dentists and physicians.

Yes, the Royal College of Dental Surgeons of Ontario (RCDSO), which regulates dental practice in Ontario and the Ministry of Health has been notified. 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. 

Local public health agencies follow provincial protocols and standards 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.

Please call the public health office where you live:

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

To locate your local public health agency click here.

No. We have received reports from Kawartha Endodontics patients who have advised us that Kawartha Endodontics is not cooperating with this effort to provide accurate and timely information to their patients. Regrettably, Dr. Kilislian and her staff have chosen to deny that the lapse occurred, despite the fact that Peterborough Public Health has photographs to document the problems which were corrected and documented, on July 25th. Given these reports, we recommend that Kawartha Endodontics patients not call regarding this matter, and instead, seek any additional information from their referring dentist.

Complaints about the care or treatment received at Kawartha Endodontics should be lodged with the Royal College of Dental Surgeons of Ontario. These can be submitted on their website. Complaints about infection prevention and control practices can be provided to Peterborough Public Health at 705-743-1000, ext. 139.

As PPH has been unable to notify patients directly, we would appreciate assistance from dental offices in reaching people who would benefit from visiting our website and reviewing all of the relevant information and resources. You may use a variety of communication tools including, posting information in your waiting room, posting information on your website, emailing all patients or contacting only those impacted patients directly if you are able to identify them and wish to do so. If you wish to contact patients directly to advise them to visit our website, we have provided a template for a letter that you can customize. This was created in response to a request from dentists and is not a requirement or expectation.   

Resources:

IPAC Lapse Report – Kawartha Endodontics

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.