A game of arm wrestling opposes Quebec dentists and their professional order, which wants to thoroughly review the standards for sterilization as of 2023. Some dentists fear being forced to relocate, or being pushed into retirement due to the major investments required to continue their work. Faced with this outcry, the Order of Dentists took a step back on Wednesday, conceding that it had to postpone the start of its ambitious project.
Since the beginning of the consultations launched by this order a month ago on the new guidelines concerning the control of infections and [le] reprocessing of medical devices” — a project whose implementation was scheduled for 2023 and which was to be completed before 2024 — the rag is burning between the Order of Dentists of Quebec (ODQ) and its 5,500 members. Negotiations are multiplying between the ODQ and its various professional associations, in particular the Association of Dental Surgeons of Quebec (ACDQ), which describes this project as “exaggerated” and “useless”.
According to an assessment made by the ACDQ, these new standards would increase the expenses of the 2,500 dental clinics in Quebec by 75 to 100 million dollars per year. “It would downright push dentists to move, or to undertake renovations so expensive that some are thinking of retirement rather than considering such investments”, underlines the Dr Carl Tremblay, president of the ACDQ.
An online survey conducted by this association among 500 dental clinics reveals that these new standards could force 80% of them to undertake major renovations.
A delayed project
Asked Wednesday about the outcry raised by this draft revision of the standards of practice, the president of the ODQ, Guy Lafrance, insisted on the “advisory” nature of this operation and confirmed that the 2023 deadline should be postponed. “We will have to review that, be realistic, we will take the time to listen to people,” he said, without setting a date.
The Order says it does not act on complaints, as was the case in Ontario, or on incidents that occurred in clinics. There was none, “not to my knowledge,” says Mr. Lafrance. Rather, it is the concern to harmonize Quebec standards with those of the rest of Canada that guides this reform, concluded in Ontario in 2019 and in Saskatchewan in 2017. profession, defends the president of the ODQ. We aim to do this in collaboration, and in a constructive dialogue. »
A major project
The plan to overhaul the Order of Dentists has several components to better prevent and limit infections, including the mandatory development in each clinic of “medical device reprocessing units”, similar to those in hospitals. It aims to improve the traceability of instruments by introducing labeling for each of them at each sterilization.
Already equipped with “Stericentres” to ensure the asepsis of their instruments, the clinics insert the disinfected instruments into sterile envelopes, stored in cupboards or closed drawers in the surgery rooms.
However, the new standards require that a room be reserved for the sterilization and storage of all sterilized equipment. Many clinics would have to purchase more sophisticated sterilizers.
“I have nine surgery rooms, which means a lot of instruments that will be stored in a separate room. It means a constant back and forth,” says the president of the ACDQ.
Another irritant, the sterilizers, tested once a month, will have to be subjected to daily biological tests, lasting 40 minutes. A procedure that will cost thousands of dollars more per clinic per year in time and tests, according to Carl Tremblay. “We are already understaffed. People will have to be hired to do these tasks. »
The ACDQ wonders what this project is all about, since no contamination incident has been reported, even in the midst of a pandemic. “There have not been horror stories like in Ontario, where Public Health had to close three clinics, and where there is no inspection. Here, we are subject to regular inspections by the Order,” says Mr. Tremblay.
Concerned dentists
“During my entire career, I have never had a failure with a single autoclave. For me, this project is unthinkable. I have no space, I am bound by a five-year lease, and my only assistant is already overwhelmed, ”laments a Montreal dentist, who requested anonymity and who fears having to leave the profession. “It’s mainly the big sterilization device companies that will fill their pockets. »
The Dentists owners of Quebec (DPQ), which has 425 members, is also concerned about this project. “Requiring traceability in a four-room clinic is crazy. We are not a hospital managing thousands of instruments distributed in dozens of operating rooms,” emphasizes Pierre Millette, vice-president of government relations at DPQ.
If the Order goes ahead with this project, DPQ demands that a grandfather clause be granted to existing clinics, or that Quebec assume the costs of these major changes. “We don’t want to pass the bill on to the patients. Many are already going without dental care because of the cost. It is obviously access to care that is at stake, says Mr. Millette. In Rivière-du-Loup, there is an eight-month wait for an appointment. People sometimes have to go to Quebec. »