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. 2021 Jul 8;47(7-8):347-352.
doi: 10.14745/ccdr.v47i78a08.

A public health response to a newly diagnosed case of hepatitis C associated with lapse in Infection Prevention and Control practices in a dental setting in Ontario, Canada

Cassandra Johnston  1 , Vidya Sunil  1 , Dorothea Ser  1 , Anne Marie Holt  1 , Gary Garber  2   3 , Liane Macdonald  2   4 , Erik Kristjanson  2 , Tony Mazzulli  2   4   5 , Romy Olsha  2 , David Ryding  2 , Avis Lynn Noseworthy  1
Affiliations

A public health response to a newly diagnosed case of hepatitis C associated with lapse in Infection Prevention and Control practices in a dental setting in Ontario, Canada

Cassandra Johnston et al. Can Commun Dis Rep. .

Abstract

Background: Haliburton, Kawartha, Pine Ridge District Health Unit (HKPRDHU) investigated an exposure in an Ontario operatory dental facility related to a newly diagnosed hepatitis C virus (HCV) infection caused by a virus with an uncommon hepatitis C genotype. Lapses in Infection Prevention and Control (IPAC) and a second epidemiologically-linked case (with the same uncommon hepatitis C genotype) were identified, prompting a broader public health response and outbreak investigation.

Objectives: a) To describe the investigation of a newly diagnosed case of hepatitis C; b) to describe the broader public health response, and c) to address a paucity in the literature related to the risk of disease transmission in dental settings due to IPAC lapses.

Methods: A collaborative approach with two dental practices, public health partners and regulatory bodies was used. An IPAC inspection was completed to determine and mitigate the risk of blood borne infection transmission within the facilities. Appropriate protocols were followed for the IPAC investigation and public health response.

Results: The investigation identified a risk of potential HCV transmission between two cases linked to the same dental facility. There were no other epi-linked cases of HCV identified. Challenges included a lack of adherence to IPAC standards in one of the dental settings and awareness in the dental community regarding HCV transmission, coordination with regulatory bodies and public health experts and low uptake of laboratory testing by patients.

Conclusion: Despite the unique challenges associated with the investigation, HKPRDHU conducted a successful IPAC lapse investigation and public health response. Public health units need to maintain collaborative approaches with regulated health professionals, their regulatory bodies and public health experts.

Keywords: IPAC; dental; hepatitis C; lapse; transmission.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Dental procedure start and end timea of the procedure at the dental Facility Bb a One appointment is missing from Figure 1 due to incomplete documentation related to an appointment that began at 13:00 hours but no end time had been documented b This figure shows the procedure start and end time for each patient seen on the day both potential source case and index case underwent their dental procedure at Facility B in year 0, the day potential transmission may have happened
Figure 2
Figure 2
Number of positive and negative hepatitis C laboratory testing results, by date of dental procedure, at dental Facility B at the time of the initial investigation
Figure 3
Figure 3
Number of positive and negative hepatitis C laboratory results at the 6-month follow-up, by date of dental procedure, at dental Facility B
See this image and copyright information in PMC

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