October 31, 2019
by Elaine Powell, RDH, RDA, dentalcorp Practice Auditor; Jaime Robertson, RDH, dentalcorp Practice Auditor
Imagine you or a family member received a letter from your dentist indicating that, due to an oversight on the practice’s part, you should be tested for bloodborne diseases, such as HIV or Hepatitis C. Now, imagine if the letter was from a practice you owned or worked in.
In July 2017, Public Health Ontario closed the ﬁrst dental practice in Ontario due to an Infection Prevention and Control (IPAC) lapse. Dental ofﬁces had not yet faced this kind of IPAC audit, and the regulatory bodies were caught off guard as well. The Royal College of Dental Surgeons of Ontario (RCDSO) and the College of Dental Hygienists of Ontario (CDHO) were alerted to the fact that regulated health professionals had been involved in the delivery of instruments that may not have been reprocessed effectively. Subsequently, patients were sent letters notifying them that they should be tested for speciﬁc bloodborne pathogens. The media was abuzz with print and television clips discussing the risk of dental visits, and the stress and fear the letters caused patients and their families.
What have we learned from this example? That failing to be IPAC compliant can have grave consequences, tarnishing both your practice’s reputation and your ﬁnances.
The answer is that everyone is responsible. We must hold ourselves accountable to a higher standard for risk management. It begins when the appointment is conﬁrmed by administrative personnel and extends to the delivery of clinical interventions by the dentist, dental hygienist and dental assistant.
This means that when you take a position in an ofﬁce, be it an associate or principal dentist, you are responsible for the delivery of properly sterilized instruments. Whether a dental assistant or registered dental hygienist was responsible for reprocessing has no bearing on the dentist’s ultimate accountability. While you may put your faith in your staff, you must also ensure that the instruments that end up on your tray are ﬁt for use. Dentists should be active participants in the ofﬁce’s IPAC program. They should understand the full life-cycle of their instruments and ensure that the appropriate processes and safeguards have been put in place. Some questions you may want to ask are:
• Has the ofﬁce reduced its IPAC program to writing?
• When was the last time staff were updated on IPAC requirements?
• Do we process instruments according to the provincial standards or guidelines?
• How many autoclaves are there in the clinic and are the sterilized packages labelled and logged?
• How often do staff receive training in IPAC best-practices?
When we look at this from a risk management standpoint, we know that the dentist will be the ﬁrst to face legal action, but this may also extend to dental hygienists, dental assistants, denturists and any staff in the reprocessing area. From an employer standpoint, the education in IPAC must be provided and logged to ensure that all staff in the dental ofﬁce receive regular education and are aware of all policies required to meet the standards and guidelines in each province.
Regulatory bodies are continuously reviewing IPAC guidelines and implementing new standards of practice or guidelines to meet the changes. If the regulatory body chooses to make the document a standard, then disciplinary action could occur in the event a complaint was launched.
Infection prevention and control is no longer a process that is left to one individual to complete; rather, it’s a coordinated team effort in each practice. This requires excellent communication among all the people employed within the clinic. It can be hard work to customize a comprehensive IPAC manual speciﬁc to the practice, but it must be done. The adequacy of the IPAC program must be conﬁrmed and veriﬁed by each dentist practicing in that location. The principal dentist has a special obligation to instill the right culture of safety and accountability for all team members. Developing—and subsequently revising—the IPAC manual provides team members the opportunity to identify their role within the practice and to have a stake in its success.
About The Author
Elaine and Jaime are registered dental hygienists who work closely together as practice auditors on dentalcorp’s Compliance team. Together they bring over 60 years of oral health care experience in clinical, regulatory, and educational capacities. They are passionate about infection prevention control and assisting practices in providing safe and effective patient care.