Infection Prevention and Control Lapse at Main Street Family Medical Centre

Following a complaint on April 24, 2018, an inspection of the Main Street Family Medical Centre at 1251 Stittsville Main Street was conducted by Ottawa Public Health (OPH). During the investigation, OPH determined that equipment used for some minor surgical procedures was not being properly cleaned.     

On April 25, 2018, OPH required the clinic to stop performing all minor surgical procedures until further notice. There is no ongoing risk to patients being treated at the clinic. OPH is not aware of any cases of infection associated with this clinic at this time.

OPH worked with the clinic and the Ministry of Health and Long Term Care (MOHLTC) to identify at-risk patients. On July 17, 2018 the Main Street Family Medical Centre sent a notification letter to at-risk patients with further actions. 

What happened?

Who is at risk?

What do I do if I’m at risk?

What tests does Ottawa Public Health recommend for those at risk?

What if I test positive for hepatitis B, hepatitis C or HIV?

What is Ottawa Public Health doing about this lapse?

I can’t find the information I need on this website

Additional resources on our website

What happened?

What is an infection prevention and control lapse (IPAC) lapse?
Best practices for infection prevention and control (IPAC) keep clinics safe for clients. An IPAC lapse occurs when a best practice is not followed and this results in a risk of infection to clients.

An example of a best practice is proper cleaning of re-usable medical instruments. When there is a lapse in a cleaning process, the risk of a client being exposed to an infection goes up. 

What is Ottawa Public Health (OPH) investigating at the Main Street Family Medical Centre at 1251 Stittsville Main Street?  

Ottawa Public Health (OPH) investigates clinics on a complaint-basis. OPH received a complaint about the clinic on April 24, 2018. OPH began an investigation right away. The investigation found a lapse in the cleaning and sterilization of medical equipment. Patients who underwent some minor surgical procedures at the clinic between December 2003 and April 2018 may be at risk of infection.

View the complete IPAC Lapse Report.

Why is OPH involved in investigating this medical clinic? 
OPH received a complaint about this clinic on April 24, 2018. Ottawa Public Health (OPH) investigates clinics on a complaint-basis. OPH does not routinely inspect medical clinics. Medical doctors are a self-regulated profession. They are responsible for upholding IPAC standards in their own practice.

The Ontario Public Health Standards under the Health Protection and Promotion Act (HPPA) mandate health units to investigate complaints about potential infection prevention and control (IPAC) lapses. Three protocols under the Standards detail investigation and response requirements: Infection Prevention and Control Protocol, 2018, the Infection Prevention and Control Complaint Protocol, 2018 and Infection Prevention and Control Disclosure Protocol, 2018.

I have seen several doctors at this medical clinic. Does this involve all of the doctors at the clinic? 
Your risk of getting an infection related to this IPAC lapse depends on the procedure you had, not the doctor who treated you.  If you are worried about possible risk of infection, please discuss it with your primary care provider to make decisions about testing.

Who is at risk?

I had a minor surgical procedure done at this clinic between December 2003 and April 2018. What is my risk of developing an illness? 

OPH worked with Public Health Ontario to assess the risk of infection to patients. Public Health Ontario found there is a low risk of transmission of Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV). Although the risk is low, OPH recommends that patients who had a minor surgical procedure done at this clinic be tested as a precaution. OPH is working with the clinic and the Ministry of Health and Long Term Care (MOHLTC) to identify patients. Once this list is finalized, the Main Street Family Medical Centre will be sending patients letters with further action.
What type of minor surgical procedures make a patient at risk? 
Based on the investigation, not all procedures make a patient at risk. Some procedures may have used improperly cleaned medical instruments.

Procedures of concern include:

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

Certain procedures used proper IPAC practices. These procedures are not considered to have put patients at risk. The following procedures are not a cause for concern: 

  • Other 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)

The risk is specific to this clinic. Procedures done by one of the clinic’s physicians in other clinical settings are not a cause for concern. This includes other hospitals, emergency rooms, or other clinics. 

How many patients are affected by this investigation? 
About 4,600 patients may need testing. This testing is for Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV). Although the risk is low, OPH recommends that patients who had a minor surgical procedure done at this clinic be tested as a precaution. These patients will be notified by mail.
What if I didn’t get a letter but I had a procedure at this clinic and want to get tested? 

Based on the investigation, not all surgical procedures make a patient at risk of infection with a blood-borne virus (i.e., hepatitis B, hepatitis C, or HIV. Certain procedures used proper IPAC practices. These procedures are not considered to pose a risk. The following procedures are not a cause for concern:

  • Other 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)

Some procedures may have used improperly cleaned medical instruments. Procedures of concern include:

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

If you believe you had a procedure of concern at this clinic and have not received a letter, see your primary care provider to discuss testing. If you would like to be included in our investigation, please contact us with your name, date of birth, and health card number. This information will allow us to have access to your test results for the purposes of evaluating whether the infection control lapse at this clinic resulted in any hepatitis B, hepatitis C or HIV infections.

If you test positive, OPH will contact you to offer you additional testing that may help determine if transmission occurred as a result of this infection control lapse.   

I am already vaccinated for hepatitis B, should I still see my doctor?
If you received the full series of hepatitis B vaccine before having a procedure at this clinic, you should be protected against hepatitis B. You not will be protected against hepatitis C or HIV. OPH recommends testing for all 3 infections. The test will also show if you are immune to hepatitis B.
Is OPH aware of any cases of infection after a surgical procedure performed at this clinic?
 At this time, OPH is not aware of any cases of infection associated with this clinic.
Why weren’t at-risk patients notified earlier?

Ottawa Public Health completed several steps between April 24, 2018 and July 17, 2018 in order to identify and notify at-risk patients. This complex process can be broken down into 4 high-level steps:

1) Eliminate any ongoing risk to the public. OPH identified that the cleaning and disinfection of reusable medical instruments was inadequate at the clinic on April 24, 2018. The very next day, OPH required the clinic to cease performing all minor surgical procedures until further notice.

2) Assess the risk of infection. Ottawa Public Health consulted Public Health Ontario (PHO) to complete a formal risk assessment, based on the specific types of procedures done at the clinic and the specific deficiencies in infection prevention and control (IPAC) practices. Public Health Ontario estimated a low risk of hepatitis B, hepatitis C, and to a lesser extent, HIV infection, and advised that at-risk patients be notified of their risk of these infection. Public health Ontario provided their final risk assessment report to OPH on May 18, 2018.

3) Identify at-risk patients. OPH worked with the Main Street Family Medical Centre to identify what minor surgical procedures were performed using reusable medical equipment that may have been improperly cleaned and sterilized. Then, OPH worked with the Ontario Health Insurance Plan (OHIP) to identify patients who had the specific procedures of concern based on physician OHIP billing codes. On June 28, 2018, OPH received the list of at-risk patients from OHIP. OPH determined that approximately 4,600 patients had a procedure of concern, among about 90,000 patients seen at the clinic since 2003. This accounts for approximately 5% of all patients seen at the clinic during that time period.

4) Notify at-risk patients. OPH helped draft and approved the letter to notify at-risk patients. On July 17, 2018, the notification letter was mailed by the Main Street Family Medical Centre. OPH also worked with the clinic’s physicians and the Public Health Ontario Laboratory (PHOL) to provide pre-filled laboratory requisitions to the 4,600 at-risk patients with the notification letter.  This laboratory requisition allows patients to go straight to a laboratory and have testing done, rather than have to first wait to see a physician to get a lab requisition. 

Is it possible that I received a letter in error?

Ottawa Public Health and the Ontario Health Insurance Plan (OHIP) used billing codes to identify patients who had a procedure of concern at the Main Street Family Medical Centre between December 2003 and April 25 2018. Despite our greatest efforts, it is possible that some residents may receive a letter from the Main Street Family Medical Centre in error. 

If you are certain that you did not undergo a medical procedure of concern at the Main Street Family Medical Centre during this period of time, and believe that you received a letter in error, you may ignore it. 

I received a letter for a family member who now deceased? What do I do?

The clinic has taken measures to ensure that letters were not sent to deceased patients. Despite their best efforts, it is possible that some deceased patients may have received a letter. No further action is required if the patient is deceased.

Hepatitis B, hepatitis C and HIV are diseases that must be reported to Public Health by law under the Health Protection and Promotion Act. If the deceased person had tested positive for any of these diseases prior to their death, the health unit would already know about it.  

What do I do if I’m at risk?

I was a patient at this clinic and had a surgical procedure there. What do I do now?

OPH worked with the Ontario Health Insurance Plan (OHIP) to identify patients who had the specific procedures of concern based on billing codes. Letters were sent by the clinic to at-risk patients on July 17, 2018. The letter explains the infection control lapse, recommends that you get tested for hepatitis B, hepatitis C, and HIV, and provides information on how to get tested. A laboratory requisition is included with the letter and can be taken directly to a lab.

If you want to discuss testing before going to the laboratory, you can make an appointment with a physician at the Main Street Family Health Centre. If you prefer to discuss testing with a primary care provider (family physician, nurse practitioner, or walk-in clinic) not linked with the Main Street Family Health Centre, or to have your test results sent to a provider outside this clinic, you need to make an appointment to see that provider first. They need to fill out the laboratory requisition found here. Please do not go to a hospital emergency department for blood testing; the emergency department will redirect you to a primary care provider. 

I have visited this clinic but I have never had any surgical procedures done at this location. Should I get tested?
No. If you are certain that you did not have a medical procedure at this clinic, you do not need to get tested.

If you are uncertain about having had a procedure at this clinic, speak to your primary healthcare provider about your risk and possible testing.  

I underwent a minor surgical procedure at this clinic during the time period identified by OPH. Should I take any precautions right now? 
Even though the risk of infection is low, OPH recommends testing for hepatitis B, hepatitis C, and HIV as a precaution.

Until you know for sure that you are not infected with hepatitis B, hepatitis C or HIV, you can reduce the risk of spreading these infections to others by:

  • avoiding sharing clippers, razors, and toothbrushes,
  • using condoms during sex.
What about other people in my household? Should they get tested too? 
The priority is for you to be tested for hepatitis B, hepatitis C, and HIV. If you test positive, your primary care provider will discuss who else may also need to be tested. This may include sexual partners, household members, and drug-sharing partners.
Can I get vaccinated against these diseases if I think I was exposed?
Getting vaccinated now will not help prevent infection from a minor surgical procedure you had in April 2018 or before.

Only hepatitis B can be prevented with a vaccine. Consider getting the hepatitis B vaccine if:

  • you are at high-risk for infection 
  • you are traveling to countries where hepatitis B is common 

Hepatitis B vaccine is publicly funded in Ontario for the following high-risk persons:

  • Children <7 years old whose families have immigrated from countries of high prevalence for Hepatitis B Virus (HBV) and who may be exposed to HBV carriers through their extended families (3 doses)
  • Household and sexual contacts of chronic carriers and acute cases (3 doses)
  • History of a sexually transmitted disease (3 doses)
  • Infants born to HBV-positive carrier mothers:
  • Premature infants weighing <2,000 grams at birth (4 doses)
  • Premature infants weighing ≥2,000 grams at birth and full/post term infants (3 doses
  • Intravenous drug use (3 doses)
  • Liver disease (chronic), including hepatitis C (3 doses)
  • Awaiting liver transplants (2nd and 3rd doses only)
  • Men who have sex with men (3 doses)
  • Multiple sex partners (3 doses)
  • Needle stick injuries in a non-health care setting (3 doses)
  • On renal dialysis or those with diseases requiring frequent receipt of blood products (e.g., haemophilia) (2nd and 3rd doses only)
My doctor was at the medical clinic that is being investigated. Do I need to go back to that clinic if I want to talk to a doctor about getting tested?
No, you are not required to go back to the Main Street Family Medical Centre. You can discuss testing with a primary care provider including:
  • A family physician,
  • Nurse practitioner or
  • Walk-in clinic.

For help finding a walk-in clinic, please visit the Ontario.ca website.

What mental health supports are available to me?

We understand that this investigation can affect residents physically and emotionally.

During times of stress, there are steps you can take to help promote positive mental health. This includes:

  • Follow a normal routine as much as possible
  • Eat healthy meals. Be careful not to skip meals or to overeat.
  • Exercise and stay active
  • Help other people in your community as a volunteer. Stay busy.
  • Accept help from family, friends, co-workers, or clergy. Talk about your feelings with them.

Ottawa Public Health would like to remind you that help is always available to support your mental health.

Ottawa residents and families can access community mental health resources available in Ottawa from the following agencies: 

  • The Distress Centre answers calls 24 hours a day, seven days a week, with crisis line specialists providing confidential support. Callers can reach the Centre at 613-238-3311.
  • The Mental Health Crisis Line answers calls for people ages 16 or older 24 hours a day, seven days a week. Callers can reach the line at 613-722-6914. 
  • Tel-Aide Outaouais offers French-language mental health telephone support from 8 a.m. to midnight every day. Ottawa residents can call 613-741-6433 and Gatineau residents can contact 819-775-3223.
  • The Kids Help Phone (1-800-668-6868) provides confidential 24/7 phone and web counselling for children ages 20 and under. 
  • The Youth Services Bureau (YSB) provides youth and family counselling, crisis support, a 24/7 crisis line at 613-260-2360, walk-in counseling and an online crisis chat service for youth at chat.ysb.ca.
  • The Walk-In Counselling Clinics provide free, confidential single session counseling sessions throughout Ottawa
  • Ottawa Public Health Information at 613-580-6744 (TTY 613-580-9656).
  • 211 connects callers to community, social, government and health service information in Ottawa 24 hours a day, seven days a week. The service is free, confidential and multilingual.

What tests does Ottawa Public Health recommend for those at risk?

How do I get tested?

If you are a patient who has had a procedure of concern, you will receive a letter and a laboratory requisition. This requisition will be pre-filled by a clinic physician. You can take the letter and laboratory requisition directly to any laboratory to have your blood drawn for testing. The results will go to the Main Street Family Medical Centre. If you wish to discuss testing before going to the laboratory, you can make an appointment with the Main Street Family Medical Centre.

The testing is free for Ontario residents. If you are not an Ontario resident, see a healthcare provider to discuss testing.

For help finding a laboratory, please visit the Ontario Association of Medical Laboratories website.

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

Other testing options

You may choose to see a provider not associated with the Main Street Family Medical Centre to discuss testing. This can be a family physician, nurse practitioner or walk-in clinic. You may also request that your test results be sent to your chosen provider. If this is your preferred option, you will need to make an appointment with your provider in place of the process listed above.

The primary care provider will need to fill out this laboratory requisition. Use of this laboratory requisition ensures that the correct tests are ordered and that Ottawa Public Health will receive a copy of the results.

For help finding a walk-in clinic, please visit the Ontario.ca website.

Lab requisition to be filled by your healthcare provider

When will results from my blood test be ready? How will I get my results?
Test results are sent back to the healthcare provider who ordered the test. Contact the healthcare provider who ordered the tests to obtain the results.
 What if I want my test results to go to another physician?

If you prefer to have your laboratory testing results sent to a primary care provider (family physician, nurse practitioner, or walk-in clinic) not linked with the Main Street Family Medical Centre, you need to make an appointment to see that provider first. They need to fill out the laboratory requisition found here: www.OttawaPublicHealth.ca/HCP-lapse.

Please do not go to a hospital emergency department for blood testing; the emergency department will redirect you to a primary care provider. For help finding a walk-in clinic, please visit: www.ontario.ca/locations/health/

It is important to note that under the Regulated Health Professions Act, patients cannot order medical tests on their own behalf or on behalf of a licensed healthcare provider (e.g., by changing the name of the physician on the laboratory requisition). Only a licensed healthcare provider can order these medical tests.

Who will pay for the tests? 
The tests are free for Ontario residents as they are covered by the Ontario Health Insurance Plan (OHIP).  If you are not an Ontario resident, see a healthcare provider to discuss testing.
I am not an Ontario resident. What do I do? 
Make an appointment to see a primary care provider to discuss your risk and options for testing. A primary care provider may include:
  • A family physician,
  • Nurse practitioner or
  • Walk-in clinic
Do I need follow-up testing? 

Follow-up testing depends on when you were tested relative to when you had the procedure in question. Speak to your healthcare provider about your need for repeat testing.

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. 

What if I test positive for hepatitis B, hepatitis C or HIV?

What if my result is positive? 
If you test positive for hepatitis B or C, or HIV, your doctor will discuss the results with you and determine the most appropriate course of action.
What if my result is positive – how will I know how I was infected?

Testing will help you know if you are infected, so you can receive treatment and take precautions to avoid infecting others. Please be aware that these tests are not meant to determine where, when or how you became infected with hepatitis B, hepatitis C or HIV.

If you test positive, Ottawa Public Health will offer you further testing that may help determine if you became infected as a result of this infection prevention and control lapse.

Where can I learn more about hepatitis B, hepatitis C or HIV? 

What is Ottawa Public Health doing about this lapse?

When did OPH start investigating this clinic?
OPH received the complaint on April 24, 2018, and initiated the investigation immediately. On April 25, 2018 OPH required the clinic owner and medical staff at the clinic to stop performing all minor surgical procedures immediately.
Are minor surgical procedures currently being performed at this clinic?

On April 25, 2018, OPH required the clinic to stop performing all minor surgical procedures until further notice. The clinic is working with Ottawa Public Health and the College of Physicians and Surgeons of Ontario to be able to offer those procedures safely in the future.

With the help of Ottawa Public Health and the College of Physicians and Surgeons of Ontario, the clinic is able to resume all minor surgical procedures, except suturing (putting in stitches) as of July 12, 2018.

These infection control issues sound serious. Why is the clinic still operating? 
OPH’s primary concern is to protect the health of the public. When a risk was identified, OPH required the clinic to stop certain procedures. The clinic must meet IPAC standards before resuming these procedures.

The clinic is cooperating with Ottawa Public Health, the College of Physicians and Surgeons of Ontario, and the Ontario Ministry of Health and Long-Term Care. The clinic must ensure that appropriate measures are taken to allow surgical procures to resume safely.

At this time, OPH does not have concerns about the procedures currently being conducted at the clinic.

Are other health agencies involved in the investigation? 
Yes, the College of Physicians and Surgeons of Ontario ­(CPSO), which regulates physician practice in Ontario. OPH also consulted with Public Health Ontario on this investigation. The Ontario Ministry of Health and Long-Term Care is also involved in this investigation.
How can I know this type of infection control issue isn’t happening at other medical clinics?  
Medical doctors are a self-regulated profession. They are responsible for IPAC standards in their own practice. The College of Physicians and Surgeons of Ontario (CPSO) is their regulatory college.

OPH provides healthcare professionals with IPAC supports and resources

Health units do not routinely inspect medical clinics. Ottawa Public Health (OPH) investigates clinics on a complaint-basis. OPH may also find an IPAC lapse as part of a reportable disease investigation.

Why wasn’t this clinic inspected earlier?

Medical doctors are self-regulated healthcare professionals. What that means is: the same way that medical doctors are responsible for knowing and applying the latest evidence-based guidelines for managing diseases such as diabetes and high blood pressure, they are also responsible for knowing and applying the latest guidelines for infection prevention and control (IPAC) in their practice. The regulatory college for medical doctors is the College of Physicians and Surgeons of Ontario (CPSO).

Whenever a regulated healthcare professional is involved in an infection prevention and control lapse, the local public health unit is required to notify the relevant regulatory college. In this case, the College of Physicians and Surgeons of Ontario (CPSO) was notified of this lapse in April 2018. The CPSO is conducting its own investigation related to this infection prevention and control lapse; this included a joint inspection of the clinic by OPH and the CPSO.

As per the Ontario Public Health Standards Infection Prevention and Control Disclosure Protocol, 2018, there are three possible triggers for a local public health unit to conduct an infection prevention and control (IPAC) investigation of a medical clinic:

  • An infection prevention and control complaint,
  • A report of a case/outbreak of a reportable disease (e.g., hepatitis B, hepatitis C, HIV) where the only potential source or the most likely source of infection was a medical procedure, or
  • A referral from a regulatory college, another local public health unit, Public Health Ontario, or the Ministry of Health and Long-Term Care.

OPH first received an infection prevention and control complaint about this clinic on April 24, 2018. OPH immediately inspected the clinic, and required the clinic to cease minor surgical procedures of concern on April 25, 2018. There is no ongoing risk to the clinic’s patients related to the IPAC lapse.

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I have more questions and want to talk to a health professional. What do I do?
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