Public health is encouraging women who received certain procedures at a local health clinic to get tested for HIV and hepatitis B and C after finding the clinic was not following approved sterilization procedures.
About 1,200 patients from the Riverview Medical Group Upper Level clinic in Fergus were sent letters on March 11 informing them they may be at risk of the blood-borne infections.
The College of Physicians and Surgeons of Ontario “is investigating the physicians involved in the infection control breach to determine whether any further action is required,” college spokesperson Kathryn Clarke stated in an email to the Advertiser.
However, public health officials say there are to date no confirmed cases of infection tied to the clinic.
On March 14 Wellington-Dufferin-Guelph Public Health (WDGPH) announced patients who had an intrauterine device (IUD) inserted or an endometrial biopsy at the Fergus clinic between 2005 (when the clinic opened) and Feb. 8 of this year were at an “extremely low risk of infectious diseases from a lapse in infection control practices.”
On Feb. 5 public health received an inspection control complaint from a patient against a physician at Riverview Medical Group Upper Level.
“They were the ones who noticed that they thought that the instruments were kept in a place that they didn’t think was typical,” WDGPH medical officer of health Dr. Nicola Mercer told the Advertiser.
She explained public health doesn’t have authority to inspect regulated health care professionals under normal circumstances.
“We only go into an office if there’s a complaint,” she said. “That’s why we received a complaint and on the next business day we went in to do an inspection – both a public health inspector and a nurse went in to do a complete inspection.
“So we don’t look just at whatever the complaint was about, we actually go in and do a thorough inspection … of the office.”
When contacted by the Advertiser a clinic staff member declined to comment, stating only that all questions should be directed to Mercer.
Public Health Ontario participated in the clinic investigation, along with WDGPH.
It was discovered that Riverview Medical Group Upper Level was not following published best practices, including documents from the College of Physicians and Surgeons of Ontario about cleaning, disinfecting and sterilizing reusable medical equipment.
“When you reuse medical instruments there are multiple steps that have to be followed when you’re washing the instruments, disinfecting them and followed by sterilization – and if you make any errors along the way of any of those little steps in following both the manufacturer’s guidelines as well as the best practice documents then those little errors add up to a risk to an individual patient,” Mercer said.
“So that’s why we felt it was important, even though we know the risk is exceedingly small, that out of an abundance of caution for those particular patients we wanted to make sure that they were aware.”
The infractions were inconsistent and “small” items so it took some time for infection control experts from Public Health Ontario to determine a risk factor, Mercer explained.
The instrument in question is called a tenaculum, a type of forceps. It is used at the clinic only during the insertion of IUDs and endometrial biopsies, both of which are invasive procedures that puncture skin. That is why blood-borne infections are a concern.
“Blood-borne infections … [such as HIV and hepatitis B and C] are caused when somebody who has an infection can transmit it to somebody else if all of the cleaning steps were not perhaps followed perfectly, so those are the three that we’re looking for,” Mercer said.
She reiterated that women who received letters are encouraged to be tested for HIV and hepatitis B and C, but no cases have yet been reported.
“In fact we haven’t noticed any increased number of cases of disease within the community either, so neither directly tied to the clinic nor in general,” Mercer said.
Once patients are tested Mercer said public health will follow up with any positive cases and try to ensure primary care providers have the results from negative tests.
Riverview Medical Group Upper Level is now following best practices and the required guidelines when cleaning and sterilizing reusable instruments, Mercer said.
“There is no infection control concerns at Riverview Medical Group since (Feb. 9) and current patients and future patients are at no risk of … blood-borne infection,” she said.
Public health will do one more inspection at the practice and if the Riverview Medical Group passes, the health unit will have no further involvement unless there is a future complaint.
Anyone with questions or concerns can contact the public health information line at 519-823-4920 and a public health nurse will be available to answer questions.
