PubIi( Sante Health pub i.que Ontario · 2017. 12. 7. · PubIi(Health Ontario Sante pub i.que Ontario IPACLapsesand Reprocessing of Instruments/Equipment in Dental Settings Dr.Sonica

Pu b Ii (Health

OntarioSante

pub i.queOntario

IPAC Lapses and

Reprocessing of Instruments/Equipment in

Dental Settings

Dr. Sonica Singhal, Scientist, Oral Health, PHO

Ms. Donna Moore, IPACSpecialist, PHO

November 29, 2017

At Mississauga Convention Centre, for Peel Public Health

Disclosure

Presenters:

• Dr. Sonica Singhal and Ms. Donna Moore

• Reiationships with commercial interests:

Grants/Research Support: None

Speakers Bureau/Honoraria: None

Consulting Fees: None

Other: None

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Objec ives

• Roles ana responsibilities of MOHLTC, PHUs and PHO

IPAC lapses: changing landscape

Provide an overview of Core Elements andReprocessing Checklists of Equipment/Devices inDental Practice Settings

Publk+tealthtjntanc ca

Royal College of Dental Surgeons of Ontario(RCDSO)

• The RCDSO is the statutory governing body fordentists in Ontario that protects the public's right toquality oral health services by providing leadershipand education to the dental profession in regulation

Regulators must earn and maintain the trust anaconfiaence of the public that they are working intheir best interests

Needs to provide assurance to the public thatpractitioners are competent and that the public issafe

http//www.rcdso.org/whoweare/missronandvalues

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Role of RC 5 I AC lapses in dental offices

• Responsibility for oversight and licensing of dentists

• Investigate as part of QA and complaints process

Can assess member's practice as necessary

To notifv facility or member-specific complaint asap;may conduct joint investigation inspection with PHU

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Ministry of Health and Long erm Care (MOHLTC)

• Patient-focused, sustainable publicly funded healthsystem

Stewardship is the ministry's mission and mandate

• Develops legislation, regulations, standards, policies,and direct: res

http'; /www.hcalth.gcv.cn.r.a/en/corn man/Ill' n.su y/defau lt.aspx 6

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On ario blic ealth Standards (OPHS)

The OPHS establish the minimum requirements forfundamenta public health programs and services tobe delivered bV Ontario's 36 boards of health, whichinclude assessment and surveillance, healthpromotion and policy development, disease andinjury prevention, and health protection.

http://www. hea It h .gov. 0n. cal en/ p rol p rogra msl pu b Iieh ea It hi 0ph _sta nda rd sl

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Role of the MOHL C in IPAC lapses in dental offices

• rio direct role; would not inspect offices on a routinebasis

Investigation, including inspections implemented bvthe BOH through the 36 Pi: Us; can be involved to co-ordinate when more than one PHU involved

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Public ~ eal ni 5 and Boards of Health

• 36 public health units in Ontario

• Overseen bV PPHD of the IVIOHLTC

• Wide range of services provided:Routine Inspections (e.g. food, water, personal services settings)

Immunizations

Den "I p rogra HIS

Reproductive, child, and youth programming

Outbreak management and complaint investigation

Role of PH s/BOH in IPAC lapses in denta offices

• The BOH receives complaint regarding a potentialIPAC lapse

• The BOh shall contact the regulatory College andundertake a I steps included in the IPAC PracticesComplaint orotocol

The BOi: s'-'cd assess the complain

• The 8011 shall investigate the complaint

• Ir C;::'~E of apse, prepare initial report and make itpubliclv ava i able

The 501: sha i complete a follow-up and prepare afinal report and make it publici.' available 10

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PA La s Disclos re Guida ce oc ment• On October 14,201\ the MOHLTC updated the

OPHS and related protocols to incorporaterequirements for PAC lapse disclosure.

If an IPAC lapse has been identified in certainsettings, the board of health shall post an Initialand a Final Report online in accordance with theInfection Prevention and Control Lapse DisclosureGuidance Document, 2015 (or as current).

http://www. hea Ith.gov.on ca/en/pro/progra ms/pu blichea Ith/oph_sta nda rds/docs/gu i

da nce/ipac_la pse_d isclosu re_gd. pdf

Defnition of a apseInfection Preventionand Control LapseDisclosure GuidanceDocument

• A lapse is defined as a ., based on current IPAC standard of care

documents from the Provincial Infectious DiseasesAdvisory Committee (PIDACL Public Health Ontario(PHD); or the Ministry of Health and Long-Term Care("the rninistrv"). where availab e, that the

to the premises' clients,attendees or staff

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ublic Health On ario (PHO)

• We provide scientific and technical advice andsupport to clients working in government, publichealth, health care, and related sectors

Our clients include:• Ontario's Chief IVledicai Officer of Health

• lViinistry of Health ano Long-Term Care and other ministries

• local public health units

• health system providers and organizations

https/ /www.publichealthontario.ca/en/ About/Pages/M ission Visio n-a nd-Values.aspx

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Role of P 0 in IPAC lapses in dental offices

• No direct role in inspections

Provision of scientific and technical advice to supportPHU lapse irvestigations

May provide field support to PHUs to i "form riskassessment process

Laboratory coordination of samples ano furthertesting (genetic sequer ci 19)

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P,)bll(He.;ltllOntJnC,(d

PAC Lapses: C anging Landscape

In the News

IPAC apses Specific to Dental Settings

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irst case of CV rar smission i a den al setting (CDC)

2013: an He I case i a ental ell 'c Oklahoma State Department of

Public Health -Dental Healthcare-Associated Transmission of Hepatitis (, Final Reportof Public HealtbJr:!'.I~stigatioQ_and Response, 2013

~e e I as e

a~ a risk f r

•

•CV ra s is .iorConclusion

This report documents the first p ersc-n-to-p er soo HCV trensrnissicn event in a dental setting.

Contaminated medication via's used (In more than on-=,patient was the likely mode oftransmi,;si(l(l, J::'i~,ssibly invc+vir-g pr-ope.f(ll suspensions. Br·:)ad~ninB state-level HCV surveillance

programs, rec~.gnjzing dental encounters as a risk fe,f" HLV transmission, and increased stateand Iedera' coVer:::~ightof ('I..Jtpatient oral surgical pradices are futuro>:, ster's tc..(('<'l:,;do:-" tc reduce

the risk (If HCV trens-ni ssion ~vent,:, in oral healthcar>:? ,:,etti~s.

PubhcHealthOntario ca

2016: M. Abscessus Outbreak in pediatric clinic Georgia

• Between Jan 2014-Jan 2016, a Practice performed1,386 pulpotomies

e 20 cases: confirmed (n = 11) or probable (n 9)

Median age 7 years (range = 3-11 )

Median incubatior period 65 days (rc.ngedays)

~,IIseverely ill, requiring -ospitalizatio,'l 17 parentsrequired surgica excision and 10 received outpatientintravenous antibiotics by P CC line

Peralta G, Iobm D'Angelo M, Pathan: (I ('1 (11 Notes t.on. th:' Fwlu f./I~'(ofJ(J(tel/un) uilsct'')2>uS Infections r~rl1ong

Patlerlb of a Pediatti; Dentistry Practice Gt"orgld,2015 M:vi\\'R_ Motb Mar-tal VI."kly Re-p )016:6S:3SS--3S6, DC)I

htt fl jjrJ_x,dSJ ic()rgj1Q .1_55Jl2!m_rr1_w~ me" §~na5

=-8-164

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2016: M. abscess us 0 tbreakChi re s' Dental Group, California

Pulpotomies between Feb. and Aug. 2016 withexposure to contaminated waterlines

• As of July, 2017 total case count 73 cases; 22confirmed, 5~ probable; age range 2 LO 11 years

• Clinical presentation slowlv progressive oral cellulitis

72 of 73 cases have ecuired hospitalization and 1\1antibiotics

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Transmission of blood-borne pathogens in US dental health care settings:2016 update.Cleveland JL, Gray SK) Harte JA) Robison VA) Moorman AC, Gooch BF.

• BACKGROUi\JD: During the past decade) investigators havereported transmissions of blood-borne pathogens (BBPs) indental settings

Authors describe these transmissions and examine the lapses ininfection prevention available information

r E "(iDS: Authors reviewed the literature from 2003 through2015 to identify reports of the transmission of BBPs in dentalsettings and related lapses in infection prevention efforts, aswell as to identify reports of known or suspected health care-associated BBP infections submitted by state health

departments to the Centers for Disease Control and Prevention.

JA_n][)~f}tAsso~. 2016Sep;147(9).729 38 doi: 1O.1016/jddaJ.2016.03.020. Epub 2016 May 24

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Cleveland et al. Review

ES lTS: 3 published reports oescribed transmissionof hepatitis B virus and hepatitis C virus

• In 2 reports, the investigators described single-transmission events [from 1 patient to another] inoutpatient oral surgery practices

•

• Third report described the possib e transmissio l ofhepatitis B virus to 3 patients and 2 dental health carepersonnel in (3 large dental clinic

• Examples of lapses included the failure to heat-sterilizehand pieces between patients, a lack of t 'a ining forvolunteers on BBPs, and the use of a combination of

McCarthy et al: Compliance with recommended infection controlproced res among Canadian den ists: Results of a nationalsurvey

. ,, i es: The objective of this study was to investigatecompliance with recorr mended infection control (IC)practices by dentists in Canada in 1995

: /1, mailed survey of c s ratified random sample ofdentists (N = 6444L with 3 follow-up attempts. vveightedanalyses included multiple logistic regression to identifvHie best predictors of "excellent" compliance (18 items)

5 ' ts: The adjusted response rate was 66.4%

McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377 38~


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Com iance elements

• Respondents reported use of an Ie manual (52%)

Post-exposure protocol (L11%)

Biologic monitoring of heat-sterilizers Pl%)

Hepatitis B immunization of der tists (9" %: of these72% had post-immunization screening; naturalimmunity 3%) all hygienists (78%), ano all other clinicalstaff (70%)

• Hand washing (before treating patients 76%, after de-gloving 63%); always wearing gloves (95%); changinggloves after each patient (97%)

McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377 384

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Compliance elements (cont'd)

• Masks (82%)

Protective eyewear (82%)

• Puncture-proof container for sharps (94%)

Recapping neeales with scoop technique/device (60%)

FI ishing waterlines (55%)

Heat-sterilizing hand pieces (94%)after each patient 77%)

McCarthy, Koval APIC 1999 Vol 7, Issue 5 pp 377-384

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Predic ors of Comp iance

• Attending continuing educatior about IC (~10 hours,odds ratio [OR] = 6.3; 6-10 hours, OR = 3,3)

Treating 20 to 29 patients per daV (OR ::c 2.8)

Being women (OR = 2.7)

Population of city in which practice is located(>500,000, OR::: 2.5).

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Institute for Safe Medication PracticesA 'iUP.l _I,' OI~1 I. JI r

I:l!Im.!: ~ &mImm. lIifJ!!!Im ~ fJIJ!WJ!!!IjJ :ili!rf ~ UIQ

e ernb e 0,2010• Of over SAOO HCV\/Ssurveyed, nearly 1% admitted tosometimes or always eus! gas 'inge for more I a

e p01 i nt after onlv changing the needle

• 6% of respondents admitted to sometimes or always~. g v· g e-oose] . < g e- se: f~C s f r _ eatle ts

• 1S% of respondents reportedt, r-,-, er a mr I" i -


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Santeopubliq pntario

Ms. Donna Moore, IPAC .Specialist, PHO

October 18, 2017

__ Wellington D ff .u ertn G Iue ph Public Health_ ____:_:;_:_-

Reprocessing Cycle Complex Process

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paulding's Classifica ion for Den a Se ings

Category Definition Processing

RCDSO. Guidelines Infection Prevention and Control In the Dental Office. lebr uarv 2010


NEW Check is for Reprocessing of Dental/MedicaEquipmen /Devices in Den al Practice Settings -201

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nderstanding the Risk

Must be compliant with the relevant Act or regulation (e,g, Occupational Health and Safety Act),

Immediate health hazard exists, Stop practice and correct immediately, The act orfailure to actimmediately may lead to the transmission 01 infection or risk of illness or injury, Practices thatcannot be corrected immediately must be stopped until the health hazard isobserved to have beereliminated, An Order may be warranted/ issued,

Signifies practices that must be corrected, Timelinesforcomplianceor agreement on alternateprocess determined duringinspection,

Provide information regarding best practices, mandatory legislated practice requirements etc,Inform and Educate II/EI: .. ., .

This may also Include just-ir-tims education,

Checklist for Reprocessing of Dental/Medical Equipment/Devices In Dental Practice Settings 20]7


Table of Contents

• Section 1: Policies and Procedures

• Section2: Education and Training

• Section 3: Single Use Items

• Section 4: Phvsical Space

• Section 5: Personal Protective Equipment

Section 6: Cleaning of Sern: Critical &: Critical l)e'/ices

• Section 7: Sterilization

Section 8: Storage

Section 9: Other Considerations

Section 10: Record Keeping


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ection : Policies and Procedures

r Devices are not purchased if not able to reprocess

! Reprocessing based on current recognized standards

Recall of improperly reprocessed

Scheduled preventative maintenance of equipment. withwritten docu mentation

. Quality monitoring and documentation of thereprocessing processes

r Single-use medial equlpment/deviccs.

l Process for removing faulty devices


Section : Education and Training

Staff assigned to reprocessing tasks:

Complete formal education and training inreprocessing - theoretical and practical components

Trained to c; level that is required for the volume and complexity of theequipment to be reprocessed

Receive device-specific reprocessing instructions fromhe device manufacturer's representative

Trained upon hire, and at least annua Iy and whene lernew equipment or processes are introduced


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ectio 3: ing e Use Items

Single-use items including needles are not reprocessed

(e.g., syringe needles, prophylaxis cups and brushes;and certain orthodontic brackets.)

Prophylaxis angles, high-volume suction tips and

air/water svringe tips are availab e in single-use or 'e-usable forms SinCIe-use medical

equipmentl devices areusu.lly lab.lled by them.nuf.durer with this

symbol:


Section 4: Physical Space

Designated area that is phvsicallv separate from direct

care areas and from where clean, disinfected or sterileitems are handled or stored

One-way work fiow from dirty to clean to preventcross-conta m ination

Sink sufficient in SiZ.E and depth tor decor.tarr.ir.a 1:'')'1 In

the reprocessir g area

Cleanable. non-porous counter space 1:0 handle thevolume of work


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ection : Physical Space

Dedicated hand hygiene sink and/or ABHR in thereprocessing area

• Puncture-resistant sharps container at point-of-use.tN D/OR snarps are transported to t W .eprocessingarea in a covereo container or cassette.

• Eyewash station within a 10 second wa Ik (16 to 17metres [55 feet]) of the reprocessing area,

Regular schedule for environmental cleaning in thereprocessing area


Section 4: Physical Space

One-wayII ork tl(111

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CSf\ SPE 1112 14 User Handbook 101 Medical Device Replocesslng in Community Health Care Setting', 2014

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ior 6: Cleaning of Semi-critica an CriticaDen a /medical Equipment/De ices

Contaminated devices are kept separate from cleanitems

Gross soil (e.g., blood, sputum) is removed immediately

(cleaning cannot be done immediately, device is keptmoist

Devices are cleaned manually with an enzymaticsolution or mechanical cleaning

Detergem or enzymatic cleaning solution is discarded asper the fVllFU


Section 6: Cleaning of Semi-critica and CriticalDental/medical Equipment/Devices

Brushes are inspected & changed when dirty. Sterilizeor disposed of at the end of the day

Reusable cleaning items (e.g. brushes) are discarded ifworn or damaged

Ultrasonic washers and or washer/dismtectors, testedfor efficacy at least weeklv or according to r /IIF J-documented PM

Dental/medical equipment/devices are dried prior tosterilization (e.g. with lint-free cloth]

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Steri rza ion: Definition

TI~e leve of reprocessing required when processingcritica medical equipment/devices

• Ste cilization results in the destruction of ali forms of'nicrobial life including bacteria, viruses, spo es andf rngi

Equiprnent/devices must be cleaned .horoughlv beforeeffective sterilization can take place

PIDAC Gest Practices for Cleaning, DISinfection and Sterilization In All Health Care Settings, 2013


Section 7: Sterilization

Critical instruments/items are either disposable orsterilized using an approved sterilization process

Items are packaged according to the both packagingand aevice MIFU's

Each package is labelled with date processed, sterilizerused, load nurnoer and the HCP1sinitials

nternal Chemical indicators (CI) are placedappropriately in each package if not part of the pouch


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C emica ndicators

• Respond with a chemical orphysical change to one or moreparameters within the sterilizationchamber-

........ _

t; e 'I al n icators (lass'

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4 iUsed for every package

• Placed on outside of package

• Tape only gives visual proof thatcorrect temperature achievedsometime during cycle

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Internal Chemical Indicator• Class 4, Class 5 or Class 6

• Placed inside each package (if not integrated into the package)

Colour change indicates that the steam reached the LD21deof

package

Does not indicate that the package is sterile

Before stet ilization" 18t6 ....... ,1I,I'U",ltII1I!r'

• 3M ('lImpl! Art'

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After stet ilization

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ypes 0 5 erilizersThe tab e-top model is the most frequently used steamsterilizer in community health care settings.

ra lit! DOs lace e t Sterilizers

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CSA SPE 1112-14 User Handbook for Medical Device Reprocessing in Community Healthcare Setting


Types of Sterilizers

Pre-vacuum Sterilizers

~ Air is removed from the chamber by drawing a vacuum

Remove the air from the chamber more quickly andefficiently than gravity alone

Operate at a highe temperature; e.g., J32° ': (27,) of.)

Sterilizing exposure time is tvpicallv shorter thanfor gravitv cycles


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ype 0 erilizers

ea P. se- css re-Flush

• Cassette-type steam sterilizer

Stearn flushes and pressure pulses are used to removeair from the cha rnbe r.

• Uses steam under pressure rather than vac rum

• Pre-set cycles

• Most SPPF have a removable cassette acts as thechamber

• Cannot mix oads (e.g., unwrapped & wrapped)Photo courtesy of SCICan


Section 7: Sterilization

Sterilizer mechanical displav, printout or USB ischecked, verified and signed for each cycle bv theperson sterilizing medica devices .• **If your sterilizer does not have a printer

Plan to replace it And meanwhile:

During each cycle, check and record the elapsed sterilization time andsterilization temperature during the sterilization exposure phase.

Shown on the display

Use a Class 5 chemical indicator strip (integrator) in each package thatyou sterilize.

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"'SPE 111214 (SA User Handbook fOI Medical Device Reprocessing In Communuv Hpdlth Settings, 2014


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ec 7: S erilization

Items in the processed load should not be releaseduntil t e results of the 81 test are available• There 2re contingency plans (i.e., recall policy and procedure)

in the event of reprocessing failures.

Ster iiizer is tested with a biological indicator (81) eac iGoy tne ster i izer is used.

A colour change of the indicator indicatesthe spores are growing - i.e., thesterilization process failed .

• No colour change indicates the sporeshave been destroyed

Biological Indicator

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ection 7: Sterilization

Items ore placed in the sterilizer according to sterilizerMIFU's

Image courtesy of SciCan


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ec i 7: erilization

ze re ui e ar ., i ed for ~ a .

Records 2re kept to document that all sterilizationpa rarnete rs were met

Ster i ized items are not used until the Cl(s) ore checked

Items are allowed to dry before removing from sterilizer

If failed (I is identified, contents of package arereprocessed

Sterile packages are inspected for integrity

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Section 8: Storage

Sterile items are stored in their sterile packaging untiltime of use

Packaged, sterilized instn. ments are storea securely

in 2 manner that keeps them clean, dry arid preventscontamination

The shelf life of a sterile package is event-relatedrather than time-related - differs from R(DSOguidelines

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ectio 9: er Considerations (Alerts & Recal s)

There is a process for receiving and disseminatingdental/rnedical equipment/device alerts and recallsoriginating from manufacturers oragencies.

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eprocessing Checklist ighlights

All references to High Level Disinfection (HLD) have beenremoved

Rationale

Semi-critical items are cleaned followed by sterilization

The l1ajor'ty of se 'ni-critica i ems rsed in dentistrv areavailable in ~eat-tolerant or disposable alternatives

Avoid the use of heat-sensitive semi-critical items thatmust be processed with liquid chemical germicides

RCDSO. Guidellnellnfection Prevention end Control III tile Dental Ottice. iebruary 2010


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Section 0: Record eeping

A written log of all sterility assurance test results ismaintained

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FAQ's

A dental office's practice is to load sterilization poucheswith all the instruments needed for one procedure,often exceeding 5 instruments per pouch.

s there a imit to the number of instru merits per pouch?

Paper-plastic sterilization pouches may be used for small,lightweight, low-profile items (e.g., one or tVIIO clamps) andshould allow adequate air removal, steam penetration andevacuation to all surfaces. The pouch size should be adequate tocontain the instruments ensuring these do not touch the pouchseams.

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FAQ'sIt is not practical for offices to hold equipment until the BiologicalIndicator (BI) has passed as this usually takes 24 - 48 hours. Do wehave to hold equipment until the BI passes? What do we have to doto use equipment if \Ale don't hold it until the BI is read?

• If holding back the precessed lo ad is not possible, evaluation and

documentation of a process challenge device (PCD) containing a Class 5 or 6

chemical indicator and checking, verifying and documenting the specific cycle

physical parameters may be used to justify the release of routine loads .

• If a sterilized package must be released prior to knowing the BI results for the

day, a Class 5 or Class 6 indicator would be required as the internal CI in each

package to be released. In this situation, evaluate the internal CI (Class 5 or

Class 6) and check, verify and document the specific cycle physical parameter

to Justify the release of the routine package.


FAQ's

A setting is currently cleaning and reprocessinginstruments at the end of the day only. What isrecornmended regarding the de.ay in cleaning devicesand instruments?

It is recommended that instruments be cleaned as soon aspossible 2fter use so that organic rnaterial will not dry on them.If there will be a delay in reprocessing, the instruments shouldbe soaked in an approved instrument soaking solution.


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are Ele en sheck ist Highlights

• Section 4 - Dental Unit V\/aterlines and Water Quality

Section 5 - Handpieces

• Section 6 - Suction

• Section 1:l - Dental Radiography


Section 4: Dental Unit Water lines & Water Quality

Staff have received training regarding water quality,biofilm formation, water treatment methods andappropriate maintenance protocols for water de ivervsystem

VVaterline f· eaters are not used

All waterlines are purged at the beginning of eachworkday

Closed or other water delivery systems: IVIIFU'srelated to dental units and equipment are followed fordaily and weekly l1&inLenance


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Sec ion 4. De al nit Wa er lines & Wa er Quality

MIFU regarding testing, maintenance and preventativemaintenance of 'ires, anti-retraction valves and otheraccessories ore followed

Handpiece, uslng water coolant are run for 20 to 30seconds after patient/client care

Sterile water or steri e saline is used when irrigatingopen surgical sites and whenever bone is cut duringinvasive surgical procedures

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Water Quality

• Water quality*

• Drinking water standard: :::;500 cfus/ml

• Untreated dental unit water can produce 1,000,000cfus/ml or more over time

lvlicroorga ~liSITlS include:BacteriaLegionella sppPseudomonas spp

• Non-tubercula Mycobacteria spp• Fungi

ProtozoaCDC GUidelines for Infection Control in Dental Health-Care Setttrlgs 2003 MMWR 2003:52 pp 3031


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Sec ion 5: D nDevices

andpieces & Othe n raoral

Devices that cor tact mucous membranes and areattached to the air or waterlines of the dental unitshould be activated to discharge air and water for arninirnurr of 20 to 30 seconds after each patient/clier tuse


Section 6: Suction Lines

Suction lines are purged between patients/clients byaspirating water or an appropriate cleaning solution

Suction lines are flushed out with an enzymatic cleaneror appropriate clea ning solution at least once per week


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UI en / evices Used ForSectio 1. e a IPatient Care

Semi-critical items must undergo cleaning followed bysterillzati between patient uses

Heat stable se i-cri icc. items are s erilized: heatsensitive semi-critical items are replaced by heat stable ordisposable items

All critical items are either SINGI E P/i,TIENTUSE(disposable) or sterilized between uses

PubllcHealrhOntano ca

Section 12: Dental Radiography

Film packet - remove blood or excess saliva, place incontainer for transport

Film packet disinfected with an appropriate low-leveldisinfectant before opening to deve op

Digital radicgraphv sensors protected with barriersAfter barrier removal, sensors are cleaned of gross debris and saliva and

disinfected with a low-level disinfectant or as per manufacturer'sinstruction

PubhcHeallhOntarlo ca

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Summary

PHO Checklist Reprocessing in Dental Practice Settings

PHO Checklist Core Herner.ts in Dental PracticeSettings

• Adapted to a igr. with the dental practice setting

Both checklist are living documents

• Will be reviewed and revised as the e /idence changes

Questions?


Disclaimer

PHO has developed this Checklist for Reprocessing ofDental/Medical Equipment/Devices in Dental Practice Settings andits content, based on the Provincial Infectious Disease AdvisoryCommittee's infection Prevention and Control for Clinical OfficePractice, June 2013. This document is intended to support areview or audit of Reprocessing of Dental/MedicalEquipment/Devices in Dental Practice Settings and does notreplace best clinical practices 01- legislative requirements.

PHO is not responsible for any losses or damages arising from theuse of this document or its contents, including for any purposes toinform any decision or determination, clinical or otherwise,regarding inspections, findings, outcomes or recommendations.


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Resources from P 0

PIDAC documentshttp://www. p u bl iehea Ithonta rio. ea/en/BrowseByTo pie/I nfeetio usDiseases/P I

DAC/Pages/~IDA~ Doeuments.aspx

Resources

• Reprocessing in the Community On-line Modules

http://www.publichealthontario.ea/en/LearningAndDevelopment/Onlin

e Lea rn ing/I nfeeti 0 usDisea ses/R e p ro eess ing/Pages/ d efa u It aspx

• IPAC Core Competencieshttpl/www.publlchealthontarlo.ea/en/LearningAndDeveloprnent/Onlin

eLea rn ingLl nfeeti ous Disea ses/I PACCore/Pages/ d efa u Itaspx

IPAC Lapse Webpagehttp://www pu bl ichea Ith 0 nta ri 0 .ea/en/BrowseByTop ie/I PAC/Pages/I PACLapses.aspx

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References

PIDAC: Infection Prevention and Control for Clinical OfficePractice, 2013http://www.publichealthontario.ca/e n/ eRe pository/I PAC CIin ica IOffice Practice 2013.pdf

PIDAC: Updated guidance on the use of rnultidose vials, 2015http://www.publichealthontario.ca/e n/Browse ByTo pic/I nfectiousDiseases/P IDAC/Pages/I nfecti 0 n- Preventio n-a nd-Contro 1- for-CIin ica I-Office- Practice- Multi dose- Via Is.aspx

PIDJlL Cleaning, disinfection and sterilization in al! healthcaresettings, 2013https ://www.publichealthontario.ca/en/ eReposito ry/P IDAC Cleaning Disinfection and Sterilization 2013.pdf

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efere ces

Canadian Standards Association. CAN/CSA-Z314 3-14 Effective Sterilization in

Health Care Facilities by the Steam Process. Rexdale, Ont.: Canadian StandardsAssociation; 2014

Canadian Standards Association CAf\I/CSA-Z314 0-13 Medical Device

Reprocessing - General requirements. Rexdaie, Ont : Canadian StandardsAssociation; 2013

Canadian Standards Association. CAN/SPE 1112-14 User Handbook for Medical

Device Reprocessing in Community Health Care Settings. Mississauga, OntCanadian Standards Association; 2014

Canadian Standards Association. CAN/CSA Z314.8-14 Decontamination of

Reusable Medical Devices. Z314.8-14 CC, editor. Mississauga, Ont.: CanadianStandards Association; 2014


Tools and Resources

• Standards (e.g., CSA)

• Guidelines (e.g., PIDAC documents, appendices withsample checklists and Audits)

• 'PAC-Canada Audit Tool Kit

Partnerships, Net\tlorking and Communication withIPAC professionals and organizations

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Acknowledgemen s

M rking Group

• Dr. Michael Gardner, Royal Col ege of Dental Surgeonsof Ontario (RCDSO)

L f. Chris Swayze, RCDSO

• Guilia Galloro, College of Dentai Hygienist of Ontario(COHO)

• Robert Farinaccia, COHO

Janu Sritharan, Ministry of Health and Long-term Care(MOHLTC)

Melissa Helferty, MOHLTC


Acknowledgements

vorklng Group representing Public Health Ontario

• Sandra Callery

• Barb Catt

• Dr. Sonica Singhal

[no lvlaureen Cividino

e Laurie Rodnick

Anne Augustin

Donna \/Ioore

• Virginia Tirilis


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Ack ow edgements

f10rking Group

Dr. Michael Gardner, Royal College of Dental Surgeonsof Ontario (RCDSO)

ur. Chris Swayze, RCDSO

Guilia Galloro, College of Dental Hygienis: of Ontario(CDHO)

• Robert Farinaccia, CDHO

Janu Sritharan, Ministrv of Health and Long-term Core(fVlOHLTC)

• Melissa Helferty, MOHLTC

PubhcHealthOntano COl

For More Information About This Presentation, Contact:

Dr. Maureen Cividinoma ureen. civid [email protected]

Donna MooreDon [email protected]

Public Health Ontario keeps Ontarians safe arid healthy.Find out more at PublicHealthOntario ca

~tr OntarioI.ijfft{,tOllW.lthhqtf(ll'P~ ,III! 'fO~

19rtK,Ik"'lltft1_~.Pfomo~.""tl.!.I!Ifr

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Refere cesOntario Agency for Health Protection and Promotion (Public Health Ontario).Provincial Infectious Diseases Advisory Committee. Best practices for cleaning,disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto,ON. Queen's Printer for Ontario; May 2013

Canadian Standards Association CAN/CSA-Z3lt1 3 1 Ii Effective Sterilization inHealth Care Facilities by the Steam Process. Rexdale, Ont.: Canadian StandardsAssociation; 2014

Canadian Standards Association. CAN/CSA Z314 0-13 Medical DeviceReprocessing· General requirements Rexdale, Ont.: Canadian StandardsAssociation; 2013

Canadian Standards Association. CAN/SPE 1112-14 User Handbook for MedicalDevice Reprocessing in Community Health Care Settings. Mississauga, Ont.:Canadian Standards Association; 2014

Canadian Standards Association. CAN/CSA Z314.8-14 Decontamination ofReusable Medical Devices. Z314.8-14 CC, editor. Mississauga, Ont.: Canadian

I~. ~ 1 , .'1 ••PubhcHealthOntano ca

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Documents

PubIi( Sante Health pub i.que Ontario · 2017. 12. 7. · PubIi(Health Ontario Sante pub i.que Ontario IPACLapsesand Reprocessing of Instruments/Equipment in Dental Settings Dr.Sonica