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

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

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:

  • 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.

 

Additional resources on our website

 

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