IPAC lapse with risk of blood-borne infection at personal service settings
To: Ottawa Physicians and Nurse Practitioners
Date: January 28, 2025
From: Dr. Monir Taha, Associate Medical Officer of Health
Subject: IPAC lapse with risk of blood-borne infection at personal service settings
Ottawa Public Health (OPH) is alerting you to the possibility that that you may be approached by patients for counselling and testing related to an infection prevention and control (IPAC) lapse from two Gorgeous Brows and Lashes personal service setting locations:
- Gorgeous Brows and Lashes, 3900 Innes Rd, Ottawa ON K1W 1K9
- Gorgeous Brows and Lashes, 2210 Bank Street Ottawa, ON K1V 1J5
IPAC lapse description
During a routine inspection and subsequent IPAC investigations at two Gorgeous Brows and Lashes locations, OPH concluded that customers who underwent certain facial procedures at these premises from their openings to December 6, 2024, may have been exposed to improperly reprocessed instruments.
Procedures that may have involved improperly reprocessed instruments are:
- Facial procedures involving a multiuse comedone extractor with lancet, which is used to remove blackheads and treat clogged pores.
Other services that do not involve the use of a comedone extractor are not part of the lapse investigation.
OPH risk assessment and recommendations for testing
Undergoing a procedure involving improperly reprocessed medical instruments carries a risk of transmitting blood-borne infections, such as hepatitis B (HBV) and hepatitis C (HCV), and to a lesser extent, human immunodeficiency virus (HIV). As a precaution, OPH recommends that patients who received facial procedures involving a multiuse comedone extractor with lancet at one of the two locations named above since their openings until December 6, 2024, undergo testing for HBV, HCV, and HIV.
Patient notification
OPH has issued a public service announcement for this lapse to allow patients to self-identify as potentially at risk because the premises’ customer data may not accurately identify all at-risk individuals. The public service announcement instructs the premises’ customers who have had facial procedures involving a multiuse comedone extractor with lancet to discuss testing with their health care providers.
Laboratory testing
The following testing is recommended, based on the timing of last exposure:
Last procedure more than 12 weeks ago:
- Baseline only (now): HIV serology, HCV serology, HBV serology (anti-HBs, anti-HBc), HBsAg
Last procedure 6-12 weeks ago:
- Baseline (now): HIV serology, HCV serology, HBV serology (anti-HBs, anti-HBc), HBsAg, AND
- 12 weeks after last procedure: HIV serology, HCV serology, HBV serology if negative at baseline, HBsAg if not immune at baseline
In order to appropriately manage this IPAC lapse, Ottawa Public Health has obtained a Public Health Ontario Laboratory investigation number (OTT-2025-00001) to identify all laboratory testing associated with this lapse. OPH has a partially pre-populated lab requisition for your convenience.
Alternatively, if using your EMR-generated Public Health Ontario lab requisition, please include the following:
- Investigation number OTT-2025-00001, in the text box within the “Test Indication(s) / Criteria”
- In “Test(s) Requested”: 1) “HIV Screen” and 2) “Only 1 tube of blood is required to perform all tests”
- Selection of hepatitis B and C testing (as above)
*Please note: only 1 tube of blood is required to perform all tests, and a separate HIV requisition is not required if this investigation number is used.
Note that Ottawa Public Health required the premises to correct their deficient practice on December 6, 2024. Customers receiving services after this date would not require testing in response to this IPAC lapse. The indicated timelines would rule out infection from the IPAC lapse exposure but would not rule out more recent infection from any additional and unrelated exposures.
Patient pre-test counselling
Please caution affected patients to avoid sharing personal items such as clippers, razors, and toothbrushes, and encourage the use of protective barriers during sexual activity, such as condoms until final testing is negative (see Laboratory testing above).
Interpretation of test results
See the Appendix for instructions on interpreting test results for HBV, HCV, and HIV. OPH case management will follow up on positive HIV, hepatitis B and hepatitis C results. OPH will not follow up with patients or health care providers on hepatitis B immune status. Please consider immunization of individuals whose results indicate that they are not immune to hepatitis B.
The timelines considered for interpretation are based on the IPAC lapse of interest and may not reflect interpretation of results in the context of more recent (unrelated) exposures the patient may have had.
Reporting requirements
Suspect or confirmed cases of hepatitis B, hepatitis C, and HIV are reportable next business day to Ottawa Public Health. Please fax reporting form (pdf - 90 KB) to 613-580-2831. A generic webform is available for your convenience (this document is currently not in an accessible format).
Patient resources
Health care professional resources
- Publicly Funded Immunization Schedules for Ontario, Ministry of Health
- Primary Care Management of Hepatitis B – Quick Reference (HBV-QR), Public Health Agency of Canada
- Hepatitis C – Diagnostic Serology, Public Health Ontario
For more information about IPAC best practices in healthcare settings:
- Infection Prevention and Control for Clinical Office Practice, CPSO
- PIDAC Infection Prevention and Control for Clinical Office Practice, Public Health Ontario
- PIDAC Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices In All Health Care Settings, Public Health Ontario
- Infection Prevention and Control – Online Learning courses, Public Health Ontario
- Healthcare professional IPAC website, OPH
APPENDIX
Interpretation of test results
Hepatitis B
| HBsAg | anti-HBs | anti-HBc (total) | Anti-HBc IgM | Interpretation and recommended action |
|---|---|---|---|---|
| Negative | Negative | Negative | N/A | Not infected, not immune. If more than 3 months have passed since the last procedure, 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 | Infected – acute
| |
| Positive | Negative | Positive | Negative | Infected – chronic infection |
| Negative | Negative | Positive | Negative | Four possible interpretations – refer to Primary Care Management of Hepatitis B |
| Anti-HCV | Interpretation and recommended action |
|---|---|
| Non-reactive | If >3 months have passed since the last procedure, the patient does not have hepatitis C and no further testing is required. |
| Reactive | Current infection, or previous infection now resolved (either through treatment or spontaneous clearance). HCV RNA testing is required to differentiate between current and resolved infection. In Ontario, when no previous HCV RNA testing has been done, HCV RNA testing occurs automatically following a positive anti-HCV result, and a second specimen is not required. Otherwise, a second specimen will need to be submitted for HCV RNA testing. See Hepatitis C – Diagnostic Serology | Public Health Ontario for details. |
| HIV1/HIV2 antibodies | Interpretation and recommended action |
|---|---|
| Non-reactive | If >6 weeks have passed since the last procedure, the patient does not have HIV infection due to the IPAC lapse exposure (but may still be in the window period of infection from any recent and unrelated exposures to HIV). *Note that if an HIV point-of-care test (POCT) is used, testing must be done at 3 months or later following exposure to rule out HIV infection. |
| Reactive | 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. |