Information for Healthcare Professionals about the IPAC Lapse at Legget Drive Dental

Laboratory requisition for HBV, HCV, and HIV testing

Information below is for Ottawa Health Care Professionals only. If you are not a healthcare provider, please visit OttawaPublicHealth.ca/Lapse for information regarding the Infection Prevention and Control lapse at Legget Drive Dental.

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 Legget Drive Dental located at 201- 555 Legget Drive in Ottawa (hereafter “the clinic”).

IPAC lapse description

Following receipt of a complaint, OPH conducted an IPAC investigation that concluded that patients who received a dental procedure or dental cleaning at the clinic between September 1, 2016, and January 27, 2020, may have been exposed to improperly cleaned and/or sterilized instruments.

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

OPH risk assessment and recommendations for testing

Undergoing a procedure using dental instruments that may have been improperly reprocessed carries a very small risk of acquiring 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 dental procedure or dental cleaning at Legget Drive Dental during September 1, 2016, - January 27, 2020, undergo testing for HBV, HCV, and HIV.

Patient notification

Patients who received a dental procedure or dental cleaning at the clinic were identified by the clinic and were mailed an OPH-approved notification letter by the clinic. The notification letter instructs patients to bring the letter to their health care provider to discuss testing.

The letter advises patients who are certain they did not undergo a dental procedure 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 Legget Drive Dental, 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,
Ottawa Public Health is copied on results, including negative results,
The results can be tracked using the “Public Health Unit Outbreak # OTT-2020-001.”

Please ensure that you complete the “Submitter” portion of the requisition.
Please ensure that your patient completes the “Patient Information” portion of the 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.

Timing of testing

Based on established window periods of HBV, HCV, and HIV, a single test now (i.e., over 6 months after the potential exposure) with a negative result is sufficient to rule out infection.

Interpretation of test results

Hepatitis B*

HBV serological markers				Interpretation and recommended action
HBsAg	anti-HBs	anti-HBc (total)	Anti-HBc IgM	Interpretation and recommended action
Negative	Negative	Negative	N/A	Not infected, not immune. The patient is not infected with hepatitis B and no further testing is required relating to the IPAC lapse. However, the patient is not immune to hepatitis B – consider vaccinating.
Negative	Positive	Negative	N/A	Immune due to vaccination (defined as HBsAb level greater than 10.0mlU/mL)
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

* only performed if Anti-HBs and Anti-HBc (total) are positive AND the requisition indicates that the patient has symptoms

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

Hepatitis C

Anti-HCV	Interpretation and recommended action
Non-reactive	The patient does not have hepatitis C and no further testing is required related to this IPAC lapse.
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 serological markers

HIV serological markers				Interpretation and recommended action
HIV 1/2 Ag/Ab Combo Screen	HIV 1/2 Antibody	HIV 1 P24 Antigen Screen	HIV 1 P24 Antigen Confirmatory	Interpretation and recommended action
Non-Reactive				The patient is negative for HIV and no further testing is required related to the IPAC lapse
Reactive	HIV-1 Positive OR HIV-2 Positive			HIV1 antibodies detected OR HIV2 antibodies detected Confirmed positive HIV result and patient requires referral to HIV specialist for treatment/care
Reactive	HIV-1 Negative	Reactive	Confirmed Reactive	Evidence of HIV-1 infection prior to seroconversion Confirmed positive HIV result with evidence of recent infection and patient requires referral to HIV specialist for treatment/care
Reactive	HIV-1 Indeterminate	Reactive	Confirmed Reactive	HIV-1 antibodies detected Confirmed positive HIV result with waning p24 antigen following recent seroconversion. Required referral to HIV specialist for treatment/care

Patient resources

For more information about this IPAC lapse, patients can:

Contact the Legget Dental Clinic at (613-271-9726)
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:

Visit the CPSO website
Review the PIDAC Infection Prevention and Control for Clinical Office Practice guidance document
Review the PIDAC Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices In All Health Care Setting guidance document
Complete Public Health Ontario’s IPAC Core Competencies online course
Visit the OPH healthcare professional website about IPAC
Contact OPH at (613) 580-6744 and select the option “I am a healthcare professional”

To ensure timely access to new Ottawa Public Health resources, healthcare providers can:

Complete this registration form:

To receive urgent/emergent OPH memos, tick the box for “Emergency Notifications”
To receive OPH’s healthcare provider monthly e-newsletter, tick the box for “Physicians Update”

OPH wants to know more of 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.