Dr. Lyne Giroux, Sudbury Ontario
Public Health Sudbury & Districts Infection Prevention and Control Lapse (IPAC) Report
Patients affected by this infection prevention and control lapse were mailed the following three items for reference and follow up:
- Patient notification letter (PDF)
- Fact sheet on blood-borne infections—hepatitis B, hepatitis C, and HIV (PDF)
- Laboratory requisition form (PDF)
Initial Report
Premise or facility under investigation:
From June 21, 2006, to June 30, 2010
Dr. Lyne Giroux
885 Regent St., Suite 300
Sudbury, ON P3E 5M4
From March 5, 2018, to January 24, 2020
Dr. Lyne Giroux
336 Pine St., Suite 400
Sudbury, ON P3C 1X8
Type of premise or facility:
- Medical dermatology clinic
Date the Board of Health became aware of the infection prevention and control lapse:
- March 12, 2020
Date the infection prevention and control lapse was linked to the premise or facility:
- April 8, 2020
Date of posting the Initial Report:
- May 22, 2020
Source of the infection prevention and control lapse information:
- Letter received from Dr. Lyne Giroux by email on March 12, 2020.
Summary description of the infection prevention and control lapse:
From June 21, 2006, to June 30, 2010, and from March 5, 2018, to January 24, 2020, syringes were reused to withdraw additional doses of local anaesthetic from multi-dose vials for the same patient.
This practice could result in contamination of the multi-dose vials with blood borne pathogens. The multi-dose vials containing anaesthetic could then be used to fill other syringes for use on other patients resulting in the risk of transmission of blood-borne pathogens.
The use of previously used contaminated needles or syringes to access multi-dose vials is considered an infection prevention and control lapse.
The guidance on the use of multi-dose vials in Infection Prevention and Control for Clinical Office Practice (2015, PDF) is clear that when using multi-dose vials the provider must never re-enter with a used needle or used syringe.
The specific circumstances in this incident were reviewed by Public Health Ontario at the request of Public Health Sudbury & Districts in order to inform the agency’s risk assessment and determination of whether an infection prevention and control lapse occurred. Public Health Sudbury & Districts’ findings and actions are in line with the findings of Public Health Ontario.
Infection prevention and control lapse investigation
Did the infection prevention and control lapse involve a member of a regulatory college?
- Yes
If yes, was the issue referred to the regulatory college?
- Yes
Were other stakeholders notified?
- Yes (Ministry of Health, Public Health Ontario, all Ontario local public health agencies, public health entities across Canada)
Concise description of the corrective measures required:
The use of multi-dose vials for injectable medications and vaccines increases the risk of transmission of blood-borne pathogens and bacterial contamination of the vial and should be avoided. Patient safety should be prioritized over cost when choosing between multi-dose and single-use medication vials.
- All needles are single patient use only.
- All syringes are single patient use only.
- Never re-enter a vial with a used needle OR used syringe.
If multi-dose vials are selected for use, the following recommendations must be followed each time it is used:
- Once medication is drawn up, the needle should be immediately withdrawn from the vial. A needle should never be left in a vial to be attached to a new syringe.
- Use a multi-dose vial for a single patient whenever possible and mark the vial with the patient’s name.
- Mark the multi-dose vial with the date it was first used and ensure that it is discarded at the appropriate time.
- Adhere to aseptic technique when accessing multi-dose vials. Multi-dose vials should be accessed on a surface that is clean and where no dirty, used or potentially contaminated equipment is placed or stored. Scrub the access diaphragm of vials using friction and 70% alcohol. Allow to dry before inserting a new needle and new syringe into the vial.
- Discard the multi-dose vial immediately if sterility is questioned or compromised or if the vial is not marked with the patient’s name and original entry date.
- Review the product leaflet for recommended duration of use after entry of the multi-dose vial. Discard opened multi-dose vials according to the manufacturer’s instructions or within 28 days, whichever is shorter.
Public Health Sudbury & Districts was informed by Dr. Lyne Giroux that on January 28, 2020, nursing staff were educated at a meeting on the guidelines for the use of multi-dose vials as outlined in Infection Prevention and Control for Clinical Office Practice (2015). All the multi-dose vials that were in use were removed and discarded as of January 28, 2020.
Please provide further details or steps:
Potentially exposed patients were identified by cross referencing clinic patient lists for the identified time periods against procedures that would have required local anaesthetic. These patients are being notified of the incident and advised of testing options. This was accomplished by regular mail on May 21, 202o through a package (letter, resources, and laboratory requisition) from the physician or owner of the dermatology clinic. This package was reviewed and approved by Public Health Sudbury & Districts’ Medical Officer of Health.
Date any order(s) or directive(s) were issued to the owners or operators: (if applicable)
- Not applicable
If you have questions, please contact:
Cynthia Peacock-Rocca, Manager
roccac@phsd.ca
705.522.9200, ext. 279
Final Report
Date of Final Report posting:
- Not applicable
Brief description of corrective measures taken:
Public Health Sudbury & Districts was informed by Dr. Lyne Giroux that on January 28, 2020, nursing staff were educated at a meeting on the guidelines for the use of multi-dose vials as outlined in Infection Prevention and Control for Clinical Office Practice (2015). All the multi-dose vials that were in use were removed and discarded as of January 28, 2020.
Date all corrective measures were confirmed to have been completed:
The clinic advised Public Health Sudbury & Districts on March 12, 2020, that corrective measures were completed by January 28, 2020. This was confirmed by Public Health Sudbury & Districts on March 13, 2020.
This item was last modified on June 29, 2020