Infection prevention and control and public health inspections are a hot topic! Dentists are worried about their practices and asking us for help. Here is a quick overview of what you need to know about such inspections.
What legislation governs public health inspections?
The Health Protection and Promotion Act, RSO 1990, c H.7 (“HPPA“) provides the legislative basis on which a public health unit can receive complaints, conduct inspections and issue/enforce orders. For your information, there are 36 public health units across Ontario, each able to investigate complaints within their designated geographic area.
Is a complaint needed?
Yes. There is no protocol in place for a public health unit to do random inspections of dental offices. At present they only inspect in the event of:
- a complaint by the public
- a complaint by a regulatory college (like the RCDSO)
- if the public health unit is made aware of an issue through other sources
What happens after gets a complaint?
Once a complaint is received, the inspector must notify the RCDSO and will work collaboratively with the RCDSO to conduct the inspection. If necessary, other government branches will be notified, such as the Ministry of Labour if, for example, the investigation uncovers issues under the Occupational Health and Safety Act (for more information about your duties under this Act, click here).
What can an inspector do while at the dental practice?
An inspector may enter the premises at “reasonable times” to make inquiries. If you deny entry to the inspector, they may apply to a judge for a warrant to enter and conduct the inspection provided there are reasonable and probable grounds for believing that access is necessary.
Once on the premises, the inspector has the power to do any number of things, including:
- make examinations, investigations, tests and inquiries
- make, take and remove copies, samples or extracts related to examination, investigation, text or inquiry
What are inspectors looking for?
Inspectors are looking for compliance with the RCDSO guidelines, PIDAC’s best practices, and manufacturer’s guidelines (where applicable). Here is a list of some of the infractions that inspectors have found upon entering dental and other offices:
- Protective equipment not available in exam rooms
- Inadequate or expired hand hygiene products (such as alcohol based hand rub)
- Failure to reprocess equipment and devices used in patient care services
- reprocessing and re-using single use devices
- inadequate sterilizer monitoring using spore testing
- dental instruments not reprocessed and stored in packages
- Inappropriate storage of sharps container
- Reusable instruments not stored/handled in a manner protecting them from potential contamination
- Medical office sterilization and recording practices did not follow best practices
- Lack of knowledge of infection prevention and control practices and their location within office
- General cleanliness (stained linens)
- no written schedule for regular environmental cleaning
- cleaning equipment used in reprocessing not thoroughly cleaned and disinfected with a high-level disinfectant between uses or discarded
- dental tools not dried prior to packaging for sterilization
- Dental unit waterlines and attached hand pieces were not being cleaned and disinfected according to manufacturer’s recommendations
What if the inspector finds infractions?
If one or more infractions – also called infection prevention and control (“IPAC“) lapses – are found at the dental practice, then the inspector has powers to make orders to correct those lapses. An order may be made orally, on the spot, if taking the time to put the order in writing will increase the health hazard.
Orders may include:
- asking staff/patients to vacate premises
- doing of specified work (i.e. cleaning, fixing equipment, etc.)
- ensuring equipment (including sterilization equipment) is in good working order
- removal of anything that may be a health hazard
- destruction of anything specified
- closure of the premises or a specific part of the premises until such time as the office becomes compliant with IPAC guidelines
What if I disagree with an order?
Appeals from orders of inspectors lie with the Health Services Appeal and Review Board. However, launching an appeal does not automatically preclude you from having to comply with an inspector’s order unless the Board specifically allows it pending a hearing.
What if I just don’t comply with an order?
- you refuse to comply with an order
- you are not likely to comply with an order
- you cannot be identified or located, or
- you have requested the help of the public health unit to comply with the order
Then, the inspector or medical officer may direct its staff to carry out the order, including posting a public notice about the existence of a health hazard. If this occurs, then you will be responsible for paying for the work required plus legal costs. If you refuse to pay, then the amount will be tacked onto your property tax bill.
Failure to comply is an offence punishable by:
- Individuals: up to $5,000 per day or part of a day the offence is allowed to continue
- Corporations: up to $10,000 per day or part of a day the offence is allowed to continue
Note: directors, managers and officers are automatically liable for corporations under HPPA unless they can prove that they took all reasonable steps to prevent the commission of the offence.
Other remedies available to an inspector if you refuse to comply include obtaining an injunction from the Superior Court of Justice which is an order by the court requiring you to comply. Refusal to comply with a court order may culminate in contempt of court plus imprisonment.
What about publication?
The complainant will be notified
Where an investigation is undertaken due to a complaint, the complainant must be notified of the results of that investigation.
The public will be notified
Where an investigation was undertaken and one or more IPAC lapses were identified and orders made, Each public health unit must publish both the initial report (consisting of findings and orders made) and the final report (consisting of how lapse was corrected).
Currently there are about 10 IPAC lapse reports posted about dental offices across Ontario. Here are links to the IPAC lapse reports, as found on each health unit’s website that may help you decipher what public health will be looking for if they enter your office:
- Guelph Dental Associates
- Upper Middle Dental
- Brantford Oral Surgery
- Jane Rutherford Dental
- Dentistry For You
- OraCare Dental Fort Erie
- OraCare Dental St. Catherines
- Niagara On The Lake Dental
- Tridont Dental Centre
- Tottenham Village Dentistry
Note: IPAC lapse reports are only required to be posted for 12 months. These reports will eventually be taken down (and hence you may find that some links will, in time, become stale).
Patients may be notified
Beyond the IPAC lapse reports, in some instances, the public health unit may advise patients of the lapse, if the lapse has the possibility of affecting them, as was done in the case of Guelph Dental Associates:
The media may pick up the story!
Also, if the media picks up on a closure or IPAC lapse, you may find yourself in the midst of a flurry of negative press, as Guelph Dental Associates has in the past few months:
How do I avoid a complaint in the first place?
If you want to avoid a complaint in the first place, you should do the following:
- follow RCDSO and PIDAC guidelines and best practices documents
- follow manufacturer’s guidelines for machines, especially sterilization
- provide IPAC training to all workers, especially focusing on the ones who are in charge of reprocessing and sterilization
- have a comprehensive written policy that includes IPAC procedures and protocols, WHMIS, sharps, violence, harassment, right to refuse unsafe work, etc.
Please note that the information provided herein should not be considered legal advice and is provided for informational and educational purposes only. If you have any questions about HPPA or public health inspections, need advice about your obligations as an employer under the OHSA, or need help coming up with and implementing a new office policy manual, please contact us – we are your legal dental team.