Infection Prevention and Control Lapse at Legget Drive Dental

Ottawa Public Health (OPH) has investigated an Infection Prevention and Control (IPAC) Lapse at Legget Drive Dental, located at 555 Legget Dr, Suite 201. OPH has determined that dental instruments were not being cleaned and sterilized in accordance with provincial standards. On September 4 2020, Legget Drive Dental sent notification letters to patients of the dental clinic recommending that they seek non-urgent medical assessment from their primary health care provider and possible testing for hepatitis B, hepatitis C, and HIV. Legget Drive Dental has notified all patients who require follow up. There is no ongoing risk to patients being treated at the clinic. 

Investigation details 

Where did this lapse occur? 
This Infection Prevention and Control Lapse occurred at Legget Drive Dental, located at 555 Legget Drive, Suite 201, Kanata, Ontario.
What happened at this dental clinic?

An investigation by Ottawa Public Health (OPH) found that dental instruments were not being cleaned and sterilized in accordance with provincial standards.  At this time, OPH does not have any evidence that disease transmission has occurred.  On September 4 2020, Legget Drive Dental sent notification letters to patients of the dental clinic recommending that they seek non-urgent medical assessment from their primary health care provider and possible testing for hepatitis B, hepatitis C, and HIV.

On November 25, 2019, Ottawa Public Health received and investigated an Infection Prevention and Control (IPAC) complaint concerning Legget Drive Dental. OPH determined that an IPAC lapse had occurred, and corrective measures at the clinic were implemented. Due to the nature of the lapse details outlined in the lapse report (December 13, 2019), patient notification was not required.

On January 13, 2020, Ottawa Public Health received and investigated a second IPAC complaint concerning the Legget Drive Dental Clinic. During the investigation, OPH identified an IPAC lapse and worked with the owner and staff to improve IPAC practices— including cleaning and sterilization of dental equipment— to meet provincial standards. Through the on-site inspections following the second complaint, OPH identified additional issues at the clinic and found inconsistencies in maintaining adequate IPAC best practices. Details regarding the findings of the investigation are outlined in the lapse report.

On January 27, 2020, OPH issued an Order under Section 13 of the Health Protection and Promotion Act (HPPA) to suspend all clinic procedures until further notice.  Since the order, OPH worked with the clinic owner and staff to ensure all dental instruments are being cleaned and sterilized according to provincial standards.  OPH permitted the clinic to re-open on February 3, 2020, when staff demonstrated full compliance with the provincial infection prevention and control standards.

As a result of the findings of the January 13, 2020, investigation, OPH requested a risk assessment from Public Health Ontario to determine whether patients required testing for blood borne infections.  Public Health Ontario indicated that a risk of infection was present and that notifying affected patients may be considered. OPH is not aware of any cases of infection associated with this clinic.

What does this mean for the clinic?  Is it allowed to still be open?

OPH’s primary concern is to protect the health of the public.  When the risk was identified, OPH required the dental clinic to stop practice.  The dental clinic resumed practice after a follow-up inspection by OPH on February 3, 2020, when the clinic met provincial infection prevention and control standards.

 

What do I do if I’m at risk? 

What is the risk?
Improperly cleaned and improperly sterilized dental instruments can spread infectious diseases, such as hepatitis B, hepatitis C and to a lesser extent, human immunodeficiency virus (HIV). Based on the investigation completed by OPH and a risk assessment conducted by Public Health Ontario, OPH has determined there may be a very small risk of transmission of infection.

Who is at risk?

Based on the investigation completed by OPH and a risk assessment conducted by Public Health Ontario, OPH has determined there may be a very small risk of transmission of infection and has contacted all at-risk patients directly by mail to notify them.  Current and previous patients of the Legget Drive Dental Clinic who received dental procedures, including dental cleaning, between September 1, 2016, and January 27, 2020, will have received a patient information letter.  If you have received a letter, please consult with your primary health care provider and bring your letter with you to your appointment.   
Do I need to see my health care provider right away? 
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 health care provider. 

Make an appointment with your health care provider for an assessment and possible testing.

Where and how do I get tested?

DO NOT go to a hospital emergency department or urgent care centre for blood testing.  If you do, you will be redirected to a primary care provider.

To get tested, please take the following steps:

  • Book an appointment with your health care provider to discuss testing (this includes family physician, nurse practitioner, or walk-in-clinic).
  • Bring the patient notification letter you received with you to your appointment.
  • Ottawa Public Health has provided health care providers with information about this lapse and testing instructions. Information for health care providers is available on our website.

What if I went to the clinic but didn’t get a patient notification letter; do I need to get tested?

Only patients who received dental procedures or dental cleaning between September 1, 2016, and January 27, 2020, are potentially at risk of being exposed to hepatitis B, hepatitis C or HIV.  If you are a patient of the clinic and know that you had dental procedures or dental cleaning completed during that timeframe, but did not receive a patient notification letter, please call Ottawa Public Health at 613-580-6744.
Why weren’t at-risk patients notified as soon as the lapse was identified? 

Ottawa Public Health completed several steps between January 27, 2020, and September 4, 2020 to identify and notify at-risk patients. This complex process can be broken down into four high-level steps:

  1. Eliminate any ongoing risk to the public.  OPH identified that the clinic was unable to maintain cleaning and disinfection of reusable dental instruments to provincial infection prevention and control standards at the clinic on January 27, 2020 and required the clinic to stop performing dental procedures and dental cleaning the same day.
  2. Assess the risk of infection. Ottawa Public Health consulted Public Health Ontario 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 indicated that a risk of infection was present and that notifying affected patients may be considered. Public Health Ontario provided their final risk assessment report to OPH on March 6, 2020.
  3. Identify at-risk patients. OPH worked with Legget Drive Dental to identify what dental procedures were performed using dental equipment that may have been improperly cleaned and sterilized. On March 5, 2020, OPH obtained a final list of all patients and procedure codes from Legget Drive Dental for dental procedures done between September 1, 2016 and January 27, 2020. 
  4. Notify at-risk patients. OPH, in conjunction with the Ministry of Health (MOH) and Public Health Ontario (PHO), agreed to delay patient notification at the outset of the COVID-19 pandemic.  This decision was made due to the additional pressure on health care services during the pandemic and the potential risk of exposing patients seeking health care to the COVID-19 virus. In July 2020, OPH re-assessed the current pandemic context and made the decision to proceed with patient notification.  The clinic was notified of this decision July 30, 2020.

OPH helped draft and approve the letter to notify at-risk patients.  On September 4 2020, the notification letter was mailed by Legget Drive Dental.

What about other people in my household; should they get tested too? 

At this time, only patients who received dental procedures at Legget Drive Dental between September 1, 2016 and January 27, 2020 are asked to see their health care provider. Your health care provider will speak to you about getting tested.

I have already been vaccinated against hepatitis B.  Does this matter? 
Yes, we recommend you speak with a health care provider to ensure your vaccinations are complete and to discuss testing needs.
Where can I learn more about hepatitis B, hepatitis C and HIV? 
Hepatitis B

Hepatitis C

HIV

What if my results are positive?

A blood test would confirm if you are infected, so that you can seek treatment.  However, testing cannot tell you where, when, or how you became infected with hepatitis B, hepatitis C, or HIV. 

If your test result is positive, your health care provider will advise you about next steps including more testing, treatment, and follow-up.  

Are the tests confidential?
If you test positive for hepatitis B, hepatitis C or HIV, the result is reported to OPH and a follow-up is conducted.  You may need to provide information about your sexual partners so they can be tested and treated. Your name will be kept confidential and not be given to these partners. This is a requirement under the Health Protection and Promotion Act (HPPA).  Local public health agencies will not share your results with anyone else without your permission.
How will I get my results and how long will it take?
Test results are sent back to the health care provider who ordered the test.  Discuss how you will receive your results during your appointment with your healthcare provider.   
Is this the only blood test I will need?
Your health care provider will discuss with you if any further tests are needed.  
I don’t have a health care provider, what do I do?
This is not an emergency.  Do not go to the hospital emergency department or urgent care centre for blood testing.

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

I am not an Ontario resident.  What do I do?
Make an appointment to see a primary health care provider to discuss your risk and options for testing. 

What is Ottawa Public Health doing about this lapse? 

What is Ottawa Public Health’s role?
Public Health’s role is to respond to complaints regarding infection prevention and control in public settings.  This includes inspection and investigation of premises to determine if there has been a lapse in infection prevention and control practices. 

Public Health must then determine if that lapse constitutes a health hazard and respond accordingly.

Does Public Health routinely inspect dental offices?

No.  Local public health agencies are not provincially mandated to routinely inspect offices and clinics run by regulated health professionals (e.g., dentists, dental hygienists).  The regulatory college of the health professional is the governing body responsible for setting the infection prevention and control standards and ensures adherence.

However, in 2015, the Ontario Public Health Standards and the Health Protection and Promotion Act (HPPA) were changed to require local public health agencies to follow up on any infection prevention and control complaints in public settings, including those run by regulated health professionals.

Have any other health agencies been notified?
OPH has consulted with Public Health Ontario during the investigation and requested that they conduct a risk assessment of the findings.  OPH has also notified the Ontario Ministry of Health about the investigation and subsequent patient contact.
Who else is involved in this investigation?
OPH has contacted both the Royal College of Dental Surgeons of Ontario (RCDSO) and the College of Dental Hygienists of Ontario (CDHO).  In these settings, it is the regulatory college of the health professional that is responsible for setting professional standards and ensuring adherence.

What can I do if I have more questions? 

What if I have more questions?
If your questions have not been answered or you would like to more information:

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