Extraordinary times for the dental industry: Adapting to rigorous new IPAC standards

Posted Jan 9th, 2020 in the wire

Julian Perez, Vice President, Risk Management & Compliance, dentalcorp


The dental profession is going through an extraordinary period of change; technology is rapidly advancing, research is expanding in a variety of new directions, regulations are being revised, and expectations about what a visit to the dentist means are evolving.  Change is exciting, but it can also be stressful. Over the past few years, the media, regulatory bodies, and the general public have taken a greater interest in Infection Prevention and Control (IPAC).

Starting in Ontario, a string of clinic closures and class action lawsuits caused practitioners across Canada to obsess about how to promote patient safety while avoiding unwanted scrutiny.  Changes that started in Ontario in 2016 have continued to this day. In the last four months of this year, at least four dental offices in Ontario and Alberta have been shut down due to IPAC lapses. In each case, notifications have been sent to thousands of patients advising them that, despite the low risk, they should get tested for HIV and Hepatitis.

Although there have been no high-profile clinic closures in this province (to date), in June, the College of Dental Surgeons of Saskatchewan adopted a new Standard: Infection Prevention and Control Standards in the Oral Healthcare Facility.  Complying with this standard is a must, although it may not be easy. Adherence to the CDSS’ detailed 68-page standard requires training, consumable costs, teamwork, discipline and most of all a culture of safety and compliance. The adoption of this new Standard is a reminder that dentistry is a healing art and oral health professionals have a “duty to cause no harm to their patients, and to provide a safe working environment for all … personnel in their practice.”

Where to start

Successful implementation of a complex and detailed standard requires breaking it down into a checklist which can be used to perform a self-audit. One example of what such a check list might look like is Ontario Public Health’s “IPAC Checklist for Dental Practice.” Regardless of how you decide to design your checklist, the goal is to convert the standard into a list of tasks and processes that can be managed and monitored. The following items are useful starting points when undergoing an IPAC review.

  • Ensure there are written processes in place that meet CDSS standards and guidelines;
  • Use the CDSS Standards to develop office-specific processes in your practice;
  • Implement training to bring all staff up to speed with the new Standard;
  • Ensure there is one-directional flow of instrument reprocessing;
  • Ensure all reprocessed items are logged so that they are traceable to the patient;
  • Perform daily biological monitoring for every sterilizer; and
  • Complete an equipment capacity report to ensure the number of autoclaves is sufficient to provide efficiency in the reprocessing area.
In addition to these tasks, reminders must be set so that once the practice has achieved compliance, it does not allow IPAC to fall off the radar. For example, annual waterline testing is required and the date for that should be marked on the calendar on January 1st. Likewise, periodic IPAC audits and IPAC training should be scheduled throughout the year. IPAC has to become part of the routine of the practice. It needs to become second nature.

Staying compliant through practice growth

Anytime a significant change occurs in the clinic, whether it be the introduction of new equipment, the addition of personnel, or otherwise, consideration should be given to how that change may interact with the existing IPAC processes and protocols. A new hire may require IPAC training early on so that they quickly learn the ropes. The manufacturer's instructions for use (MIFU) of all new dental equipment should be reviewed for any special IPAC related considerations. Renovations must be carried out in a way that is in line with the CDSS new standards, etc.

If your dental practice is growing or has aspirations to grow, the impact of that growth on the existing IPAC regimen and infrastructure must be taken into account. For example, the reprocessing capacity of an existing steri-centre may not suffice for the volume of instruments introduced by a specialist moving into a new operatory. When your clinic and staff are expanding, principal dentists should: 
  • Ask yourself if there is enough space in the reprocessing area to accommodate adding more equipment and an increased flow of instruments. Consider renovating or reorganizing your clinic’s space to allow for efficient equipment capacity. This makes it much easier for staff to comply with current IPAC regulations and ensure that reprocessing is never a bottleneck.
  • Involve staff and clinicians in the planning process of IPAC-oriented renovations. This is key to ensuring their buy-in and commitment.
  • Consider implementing traceability software. Traceability by a computerized system is a useful way to track patient-specific packages more efficiently and recall the history of the sterilization process. This significantly reduces the risk to a dentist/clinic and helps to decrease labour time of the dental team.
  • Consider hiring a dedicated steri-tech. By having a dedicated resource for instrument reprocessing, you will free up time for dental hygienists and dental assistants to maintain a steady flow of patient care. The economic benefit of hiring someone to manage sterilization tends to outweigh the increased labour expenditure. 

The oral health professionals in Saskatchewan have a long tradition of providing high quality, compassionate care to the public.  As professionals with a unique body of knowledge and skills, you should embrace the new Standards for Infection Control and maintain the strong reputation your profession enjoys. At the most basic level, IPAC is about creating a safe and effective environment for oral health professionals to deliver quality care for all in Saskatchewan. Posed that way, we can all embrace this integral part of running a successful dental clinic.

As previously published in the College of Dental Surgeons of Saskatchewan's 2019 Winter Newsletter. 


About the Author 

Julian Perez is the Vice President of Compliance & Risk Management at dentalcorp and is responsible for the development, implementation, and oversight of company-wide standards, programs, and systems to support practices in the delivery of optimal patient care. Julian has a robust legal background having worked for a Wall Street law firm in Manhattan as well as a professional liability program providing malpractice defense to over 10,000 dentists. Julian holds a bachelor’s degree from Yale University and a juris doctorate from Columbia University’s School of Law.

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