This document summarizes a presentation on infection prevention and control (IPAC) compliance in the Canadian dental industry. It discusses how dentistry is practiced and regulated across Canada's provinces and territories. IPAC is regulated primarily through provincial dental regulatory authorities, with public health agencies becoming more involved. Compliance is encouraged through education and guidelines rather than formal standards or audits in most areas. Regulators take a balanced approach to encourage compliance through understanding barriers to change rather than an enforcement approach. Maintaining public confidence in dental care through responsible IPAC regulation is seen as the main challenge.

1. Infection Prevention and Control
(IPAC) Compliance in Dentistry
- a Canadian Perspective
OSAP SYMPOSIUM 2012
DR. JOHN O’KEEFE
OTTAWA, CANADA

2. How is dentistry
practiced & regulated in
Canada?
How is IPAC regulated
in Canada?
How is IPAC compliance
encouraged in Canada?
Objectives & Content

3. Big country with small
population
Powers highly devolved
to 10 provinces & 3
territories
Single government payer
for most MD & hospital-
based “medically
necessary” services
95% of dental spending
is in private sector
Dentistry is a $13 billion
sector (7% of total health
spending)
Dental Practice in Canada

4. Most offices are solo or
small # of dentists
Trend towards more
“organization”
10 dental schools, 41
hygiene schools, 42
assisting schools
(Accredited)
Approximately 20,000
dentists, 24,000
hygienists, & 28,000
assistants
Feminization is an
important trend
Organization of the
sector is evolving Dental Practice in Canada (cont’d)

5. Transition to greater
accountability over 30
year period
A provincial & territorial
responsibility
Dentistry, hygiene &
assisting regulation -
separated to greater or
lesser degree
Professional majorities
on Boards that are
“autonomous” to greater
or lesser degree
However, government
powers loom large and
are looming larger
Regulation of dentistry in Canada
(Professional)

6. Mainly Provincial/
Territorial for everyday
practice
Public health agencies
more prominent now
Canadian Standards
Association
WHMIS, PIDAC, Depart
ments of
Labour, Workers’
Insurance
Boards, provincial
equivalents of OHSA
Regulation of Dentistry in Canada
(Workplace Health & Safety)

7. Systems are in transition
Historical reasons for
developments similar to
those in the US
Dental regulators now
“own” the issue
For this presentation I
consulted with 8 Dental
Regulatory Authorities
(DRAs)
This presentation will
present highlights & not
compare jurisdictions in
matters of detail
Alberta is a notable case
– “Vegreville Factor” Regulation of IPAC in Canada

8. DRAs currently play
primary role
Public health agencies
becoming more involved
Regulators of other oral
health care workers may
have important roles
Regulation of IPAC in Canada
(cont’d)

9. Range of stages of
development of
guidelines with more or
less government
“interest”
Education is big part of
strategy
Public pressure
currently seems low –
but “Vegreville Factor” is
on radar screens
DRAs want to be
proactive & balanced
Regulation of IPAC in Canada
(cont’d)

10. Single-use instruments
Frequency of monitoring
with biological
indicators
Cost-benefit questions
“Where’s the evidence?”
Are dental offices like
hospital ORs?
Mandatory reporting to
public health agencies
Subjects that get debated

11. Structures & processes
are in place
No formal outcomes
research published since
1999 (McCarthy et al –
survey in 1995)
“All seems rosy in the
garden at present”
But you never
know…………Vegreville?
Compliance measurement
& encouragement

12. Guidelines but not
standards in most places
Range from audit
through to complaint-
driven, but trend is
towards audit
Education component is
strong – leading to
culture change
People need tools to
facilitate change
Staff knowledge of
processes and
“corrective actions” are
key to change
Compliance encouragement

13. By force?
Encouraging compliance?

14. Given the nature of
dental offices:
Compliance
encouragement is a
balancing act
Things are not
black & white
Encouraging Compliance?

15. Understand human
nature and mould
strategies accordingly
Understand barriers and
drivers of change
Realistic appraisal of
how we compare with
other health care sectors
Politics is art of the
possible
DRAs take their role
very seriously
Compliance encouragement
(as I see it)

16. Responsible regulation
of our sector to maintain
public confidence in
safety and efficacy of
oral health care in
Canada
The major challenge (as I see it)

17. My sincere thanks to:
Dr. David Tobias,
Dr. Peter Stevenson-Moore,
Dr. Darryl Schultz,
Dr. Gordon Thompson,
Dr. Bernie White,
Dr. Marcel Van Woensel,
Dr. Mike Gardiner,
Dr. Ray Wenn,
Dr. Bill MacInnis,
Dr. Kent Orlando,
Mr. Irwin Fefergrad

18. Contact coordinates
jokeefe@cda-adc.ca
613 520-5000
Dr. John P. O’Keefe

19. Discussion
Time
The End