Information for Healthcare Professionals about the Infection Prevention and Control Lapse at Main Street Family Medical Centre

Laboratory requisition for HBV, HCV, and HIV testing

Information below is for Ottawa Healthcare Professionals only. If you are not a healthcare provider, please visit OttawaPublicHealth.ca/Lapse for information regarding the Infection Prevention and Control lapse at Main Street Family Medical Centre.   

Ottawa Public Health (OPH) is providing this information as you may be approached by a patient for counselling and testing related to an infection prevention and control (IPAC) lapse at the Main Street Family Medical Centre located at 1251 Stittsville Main Street in Ottawa (hereafter “the clinic”).

IPAC lapse description
Following receipt of a complaint, OPH conducted an IPAC investigation that concluded that patients who received some minor surgical procedures at the clinic between December 2003 and April 2018 may have been exposed to improperly reprocessed instruments.

Procedures that may have involved improperly reprocessed instruments are:

  • Removal of skin tags, moles, and cysts using a blade or scissors
  • Skin biopsies
  • Incision and drainage of an abscess or cyst
  • Removal of ingrown nail
  • Sutures or staples, or their removal
  • Foreign body removal

Procedures that are not a cause for concern include:

  • Injections (e.g., vaccines, vitamin B12, anti-inflammatories/steroids)
  • Blood drawing
  • Removal of warts or skin lesions using liquid nitrogen (freezing) spray or swab
  • Pap test, endometrial (uterus layer) biopsies
  • Swabs (e.g., throat swabs, nose swabs, testing for sexually transmitted infections)

For more information about the IPAC deficiencies identified during Ottawa Public Health’s investigation of this clinic, refer to the lapse report and news release.

OPH risk assessment and recommendations for testing
Undergoing a procedure using medical instruments that may have been improperly reprocessed carries a low risk of transmitting blood-borne infections, such as hepatitis B (HBV) and hepatitis C (HCV), and to a lesser extent, human immunodeficiency virus (HIV). Although the risk of disease transmission is low, as a precaution, Ottawa Public Health recommends that patients who received a minor surgical procedure that may have involved improperly reprocessed instruments at the clinic undergo testing for HBV, HCV, and HIV.
Patient notification
Patients who underwent procedures of concern at the clinic were identified using OHIP billing data and mailed an OPH-approved notification letter by the clinic. Patients who received a notification letter were instructed to either go directly to a laboratory using the laboratory requisitions enclosed with the letter, or bring the letter to their health care provider to discuss testing.

Because OHIP billing data may not accurately identify all at-risk patients, to allow patients to self-identify as potentially at-risk, a news release was also issued.

The letter advises patients who are certain that they did not undergo a medical procedure that may have involved improperly reprocessed instruments at the clinic, and believe that they received the notification letter in error to ignore the patient notification letter. 

Patient testing and laboratory requisition

To order testing for a patient potentially exposed to the IPAC lapse at the Main Street Family Medical Centre, please follow these instructions:

  • Please use this partially prefilled laboratory requisition (PDF)

    • Use of this requisition ensures that:

      • The correct tests are ordered,
      • The tests are performed at the PHOL enabling full tracking,
      • Ottawa Public Health is cc’ed on results, including negative results,
      • The results can be tracked using the “Public Health Unit Outbreak No.”
  • Please ensure that you complete the “Submitter” portion of this requisition.
  • Please ensure that your patient completes the “Patient Information” portion of this requisition.
    • Note that a minimum of two patient identifiers (e.g., name and date of birth) must be recorded, otherwise the specimen may be rejected by the laboratory.
  • If you must use another laboratory requisition instead, please attach the partially prefilled PHOL requisition to it.

Patient pre-test counselling

Although the risk of infection is low, the patient should receive counselling regarding risk reduction until final testing is negative (see Timing of testing below), including discussion to avoid sharing of articles such as clippers, razors, toothbrushes, as well as the use of protective barriers during sexual activity, such as condoms.

Timing of testing 

Date of the most recent procedure

When to test

Over 6 months ago

Once: now (HBV, HCV, HIV)

3-6 months ago

Twice:

  • Now (HBV, HCV, HIV)
  • 6 months after the last procedure (HBV, HCV)

Less than 3 months ago*

Three times:

  • Now (HBV, HCV, HIV)
  • 3 months after the last procedure (HBV, HCV, HIV)
  • 6 months after the last procedure (HBV, HCV)

* Note that Ottawa Public Health required the clinic to cease performing the procedures of concern on April 25, 2018. 

Interpretation of test results

Hepatitis B*  

HBV serological markers

Interpretation and recommended action

HBsAg

anti-HBs

anti-HBc (total)

Anti-HBc IgM

Negative

Negative

Negative

N/A

Not infected, not immune. If more than 6 months have passed since the last procedure (refer to Patient testing and lab requisition), the patient is not infected with hepatitis B and no further testing is required. However, the patient is not immune to hepatitis B – consider vaccinating.

Negative

Positive

Negative

N/A

Immune due to vaccination

Negative

Positive

Positive

N/A

Immune due to previous infection

Positive

Negative

Positive

Positive

Infected – acute

Refer to Primary Care Management of Hepatitis B – Quick Reference Module 4 and counsel as in Module 11

Positive

Negative

Positive

Negative

Infected – chronic infection

Refer to Primary Care Management of Hepatitis B – Quick Reference Module 4 and counsel as in Module 11

Negative

Negative

Positive

Negative

Four possible interpretations – refer to Primary Care Management of Hepatitis B – Quick Reference

* Primary Care Management of Hepatitis B – Quick Reference (HBV-QR) Module 3

Hepatitis C

Anti-HCV

Interpretation and recommended action

Non-reactive

If more than 6 months have passed since the last procedure (refer to Patient testing and lab requisition), the patient does not have hepatitis C and no further testing is required.

Reactive

Either current infection, or previous infection now resolved (either through treatment or spontaneous clearance). Another blood specimen must be submitted to the PHOL to test for the presence of HCV RNA.

HIV

HIV1/HIV2 antibodies

Interpretation and recommended action

Non-reactive

If more than 3 months have passed since the last procedure (refer to Patient testing and lab requisition), the patient does not have HIV and no further testing is required.

Reactive

The PHOL automatically conducts further confirmatory testing on these blood specimens. When confirmatory testing is also reactive, this indicates laboratory evidence of HIV 1 or 2 infection.

Patient resources
For more information about this IPAC lapse, patients can:
  • Contact the Main Street Family Medical Centre clinic at (613) 831-7372
  • Visit the OPH website at www.OttawaPublicHealth.ca/Lapse
  • If they do not have Internet access, they can call OPH at (613) 580-6744 
Healthcare provider resources

For more information about this IPAC lapse, healthcare professionals can contact OPH at (613) 580-6744 and select the option “I am a healthcare professional”.

For more information about IPAC best practices, healthcare professionals can:

  • To ensure timely access to new Ottawa Public Health resources, healthcare providers can:
    • Complete this registration form:
      • To receive urgent/emergent OPH memos (ERMS), tick the box for “Emergency Notifications”
      • To receive OPH’s healthcare provider monthly e-newsletter, tick the box for “Physicians Update”
  • OPH is planning a future CME/CPD session for physicians in conjunction with the University of Ottawa. This event will include education about IPAC in clinical office settings. Sign up for “Physicians Update” to receive more information about when/how to register for this learning opportunity.
  • OPH wants to know more the learning needs of healthcare providers with respect to IPAC in the clinical office setting. Sign up for “Physicians Update” to receive more information about how to participate in this needs assessment.

Additional resources on our website

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