IPAC Newsletter

Winter 2021

2021 Offers a Spark for Reflecting and Rebuilding.

As we flip the calendar page to a brand new 2021, no tears are being shed in the adieu to 2020. I suspect we all share the same New Year resolution and expectations for 2021 … simple, don’t be 2020. You have but one job in 2021, do not be 2020! With every new year comes a reflection of the past year and a spark of new hope for the coming year. Navigating through the rough terrain of 2020, is there even a spark left for 2021? It depends on how it is viewed, is the cup half full or half empty? The half empty approach would reside on the negative connotations of the pandemic, and we all know they were endless from the moment the pandemic struck in March 2020 and the virus making an encore with a second wave that seems to be an even worse performance than the first.

Instead of dwelling on the possibility of being stuck in a half empty cup, let's take the higher road with the cup is half full approach and compartmentalize what we learned professionally and personally.

The foundation of the IPAC program is risk management, a term that dental offices equated to health and safety and not always to IPAC. Dental offices have never dodged IPAC, but it was always something in the background lined up with all the other countless steps we do so easily and so well on a busy day. In many provinces, the pivotal moment for IPAC was in 2017 where public health units and regulatory bodies took a closer look at the practice of IPAC in dentistry to ensure compliance with ‘routine practice’. Many offices had already swept through their IPAC policies and made enhancements to strengthen their IPAC procedures, therefore decreasing the risk level and satisfying the elements of routine practice.

Although in 2017 the reading of the fine print and deciphering of the grey area of written standards seemed like a pain in the neck, I look back and say thank you, thank you 2017 for shaking our IPAC world ahead of time. In this shake-up, dental professionals became more and more knowledgeable in the theory of IPAC and started initiating structure to IPAC. Again, not that we did not follow IPAC, but we did not have it structured as a program. We needed that solid foundation to be prepared for the changes that were to come. I will then label 2017 as the year of IPAC foreshadowing!

I’ll take that half full cup and pour it over to the moment we grasped we needed to step up from routine practice to additional precautions for the pandemic. Additional precautions were but a heading in our IPAC manual (if we even had one) that was glossed over like the Boil Water Advisory section because the chance of these situations unfolding was next to none. Then a true pandemic hit and there was a realization that we were going beyond routine practice now and had to add some layers of protection to even consider opening our doors. Now we were paying attention to the additional precautions section. We acted promptly and effectively, look around your office now at the ‘new normal’. We should not glance in despair but rather in pride that we did it and did it well propelling the message to be heard loud and clear by the public and the minister of health. It was heard so well that in the viruses encore we are now deemed essential in our services (something you and I always knew). Yet another cup is half full view.

Professionally there are many moments of the cup is half full. What about personally? Once we got over the oh woe is me of the layers of PPE and unfamiliar territory, I firmly believe a new level of pride set in. For me, that epiphany was a moment when I was working away getting ready to pick up the ultrasonic, chatting about toothbrush bristle placements, the client’s newborn grandson, and Pinterest fails and I thought oh no I forgot to put my shield on! Panic, how long had I been working without my shield, and no wonder I could see so well.

The shields take some adapting with the fogging, squeezing the forehead and temples, needing to be careful how you turn, etc, etc. Well that same shield that had all these negative attributes, I had on the entire time and did not realize it. At that moment the light bulb came on above my head (covered with a surgical cap of course) confirming I had matured from the woe is me a lesser version of myself. Resounding in my ears was the phrase practice does make perfect, as I had become so used to my shield, I did not even know I had it on. These are our teachable moments, personal triumphs, confirming that we have stepped outside the box and now the outside of the box is the ‘normal’ … who would have thought. To some a face shield issue turned triumphant may seem immature and silly, but I am 100% sure you have had these moments.

In closing, we can not allow 2020 to steal 2021’s thunder!!!! We can not allow 2020 to steal our thunder! 2021 needs to be mentally labeled as the year to reflect, re-analyze, and move forward. Dentistry is navigating this pandemic head-on and in the simplicity of moments like not even knowing your shield is on and no longer being bothered by your shield, is a small but gigantic moment that we are doing more than okay! As these little moments accumulate your cup will not be half full, your cup will ‘spillith over’ in personal growth.

—  Michelle Aubé Simmonds RDH

Legionnaires Risk with DUWL, an Old Issue!

July 1976 at the American Legion Convention at the Bellevue Stratford Hotel in Philadelphia, Legionnaires was named and identified as the cause of an outbreak of severe pneumonia with 200 cases and 29 deaths, linked to the inhalation of aerosolized contaminated water5 7. A milder infection caused by the same type of Legionella bacteria is called Pontiac fever. Rewinding in time, in 1968 in Pontiac Michigan, Pontiac Fever was named and identified as an outbreak of influenza-like illness, identified with people who worked at & visited the city’s health department and had inhaled aerosols from contaminated water5. Legionnaires' disease is an acute bacterial disease, causing death in 5% to 30% of cases6. The Government of Canada’s Legionella site, states the following: “Cases of Legionnaire’s disease may be difficult to detect because very few of the people exposed to the bacteria get infected7. For instance, if 100 people are exposed to Legionella, fewer than 5 of them will get Legionnaire’s disease7. On the other hand, in an epidemic of Pontiac fever, if 100 people are exposed, 95 of them are likely to become ill7.”

Pontiac Fever

  • Milder than legionnaires
  • Influenza like illness
  • No signs of pneumonia
  • Incubation 1-2 days
  • Symptoms onset 72 hours post exposure
  • Most can recover with no antibiotics


  • Pneumonia
  • Requires hospitalization
  • Fatality in 10% of cases
  • Incubation 2-10 days
  • Symptom onset occurs 2-10 days post exposure
  • Requires antibiotics for treatment

On Thursday, October 18, 2018 - at noon the Windsor Essex Health Unit released a statement of active cases of legionella in the surrounding area4. More recently, in 2020 the city of Vancouver health officials had a concern with legionnaires disease calling it a “concerning cluster”. Vancouver health officials state it is common to see 15 cases per year3. In Canada, less than 100 cases are reported each year6. This number may be higher because many infections are not diagnosed or reported. More illness is usually found in the summer and early fall, but it can happen at any time of year6. Detection of legionella is a mandatory reportable disease, according to the Health Protection and Promotion Act, R.S.O., 1990. All clinically diagnosed, probable and confirmed cases must be reported to the Health Unit by the next working day4.

Legionnaires have an incubation period of 19 days and surface as pneumonia symptoms4. It is contracted by two means, via inhalation of aerosolized water droplets containing the bacteria and aspiration of contaminated water. It is not transmissible person to person and the majority of exposures will not render any illness. Elderly, smokers, and immunocompromised people fall at the greatest risk level.

The signs and symptoms are as follows:

  • Cough, fever, and radiographic pneumonia
  • Anorexia, malaise, myalgia, headache, confusion, chills, nausea, diarrhea
  • Similar to pneumonia caused by other pathogens.

The only way to differentiate between pneumonia and Legionnaire’s is to obtain both a sputum culture and a urinary antigen test4. As new respiratory pathogens emerge and looking at, for example, the signs and symptoms of SARS CoV-2, testing is important to rule out which microorganism is the causative agent4. Three key screening questions would be asked to rule out the need for legionnaires testing:

  1. Do you work in the produce department of a grocery store or deliver produce to that department?
  2. Have you stayed at a hotel and showered or went into a hot tub?
  3. Have you had a visit to the dental office?

What do they all have in common? Small water lines with the capability of delivering water through narrow openings.

In 1963 a dentist by the name of Dr. G.C. Blake published the first report of bacterial contamination in a dental water system. Dr. Blake made this discovery when he introduced an air-driven highspeed handpiece that required water to cool the handpiece. The water was in a separate reservoir and he noticed the water became quickly contaminated with bacteria, as to what we refer to now as a biofilm.

He knew there was a problem and he solved the biofilm issue 57 years ago using chemical germicides to reduce the bacterial count in the water reservoir. The timeline needs to be highlighted as 57 years ago DUWL was a hot topic and here we are still discussing it!

Dr. Jean Barbeau in 2000 in the Canadian Dental Association Journal published Waterborne Biofilms and Dentistry: The Changing Face of Infection Control (J Can Dent Assoc 2000; 66:539-41 https://www.cda-adc.ca/jcda/vol-66/issue-10/539.html) alerting dental professionals to realizing, although it is not a day to day discussion, biofilm is real and it elevates the risk of the presence of legionella. Some may state plenty has changed since 2000 and this article is outdated. I wish that was true, as it would mean every dental office in Canada read this article and took it seriously with a dental unit waterline program in every office.

Inside Dentistry published in 2006, an article titled Dental Waterlines: A Decade in Review https://www.aegisdentalnetwork.com/id/2006/04/dental-waterlines-a-decade-in-review. The author, Dr. Shannon Mills plays an active role in the research and data publication on DUWL. He is a leading expert opinion at the OSAP’s yearly conferences on the topic of DUWL. Dr. Mills purposely set out to compare what had unfolded for compliance in a decade specific to the current status of science, technology, and public policy related to DUWL. Scientific evidence accumulated over 3 decades had conclusively demonstrated that water produced by dental units and other dental devices was frequently colonized with high numbers of bacteria. Dr. Mills points out two articles published in the 1980s revealing dental professionals were significantly more likely to carry antibody markers of exposure to Legionella bacteria than the general population. The most likely source of this exposure was the water/aerosol from DUWL and high-speed handpiece.

In Dr. Mills' research, the panelists involved understood improving the quality of water used in dentistry would require changes on the part of clinicians as well as dental manufacturers. Only the manufacturers could create the necessary engineering controls and products to tackle the biofilm issue in the small diameter tubing of DUWL. The ADA White Paper of Feb 1996, specifically included a challenge to both researchers and manufacturers of dental equipment to develop improved equipment to address water quality with a specific timeline for the year 2000. Dental offices cannot move forward on the DUWL.

Today, 21 years later, we are still discussing the topic and public health units are still posting active confirmed cases of Legionaries, however, the movement forward is dental manufacturers listened to the 2000 call out and created viable solutions to attack the biofilm issue and mitigate the risks of Legionnaires.

Recent Blog Articles

Recent Articles

Calling All Dental Professionals, Where Are You? Where Did You Go? An Overview of the Labour Shortage in Dentistry.

Posted: October 19, 2021

For years, dentistry has had an oversaturation of dental professionals. There hasn’t been a dental labour shortage before now. Instead, job postings were few and far between and most jobs surfaced through word of mouth and were immediately filled. Currently, Canada is experiencing a significant labour shortage in dentistry. Dental professionals, where are you?

Read more »

Digital Advertising in Dentistry (2021)

Posted: August 10, 2021

Facebook, Youtube, Instagram, Google and what’s this TikTok everyone’s talking about? In 2021 there’s no shortage of platforms you can reach new potential clients on, but which ones will be the most valuable to your practice and where are your marketing dollars best spent?

Read more »


Product Feature: Aqua Fx

The Shocking Facts About AquaFx

Since one of the discussion articles in this newsletter is legionnaires, it is very suiting to feature a product that is used in countless industries to prevent a legionnaires outbreak, maxill’s AquaFx composed of peracetic acid. Not many people know about the unique qualities of peracetic acid. Peroxyacetic acid (PAA) is a chemical that deserves more attention, or rather, equal attention in dentistry, as it has in other industries. We have all had the misting experience at grocery stores in the produce department walking by the vegetables. The misting delivery system employs small narrow plastic tubes similar to that of DUWL’s and require to be cleaned and disinfected on a regular basis. Many produce maintenance systems utilize peracetic acid.

Peracetic acid has been regularly used as a wastewater and stormwater disinfectant in Europe and Canada for the past 30 years 1. It is used in a concentration of 35% in hospital settings as a sterilant 2. By varying the concentration, it can double as a sterilant and disinfectant. It is the choice chemical for disinfection in the other industries earlier stated and has a long successful history of use in DUWL. It’s popularity is largely in part due to its bio-degradable properties. It dissolves in water as water, oxygen and carbon dioxide. It has a low pH value (2.8) with a higher oxidizing potential than chlorine and chlorine dioxide. As an oxidizer, electrons are quickly transferred destroying the biofilm at a swift rate.

Peroxyacetic Acid

Oxidation in Water Line

Natural Components

Why is this important to the dental office? It translates to a shorter working time for the dental office in not requiring to leave a chemical in the lines over night. Another attractive quality is the testing strips used to confirm the chemical has been completely cleared from the lines.

In a swimming pool or hot tub test strips are used to confirm there are appropriate levels of chemicals in the water. With AquaFx’s test strips, it’s the opposite, a confirmation of no chemicals in order to deliver the cleanest and safest water possible. Aqua Fx is part of the three-step equation in the maintenance of DUWL, Aqua Fx is used in the shocking/disinfecting step, giving a solid punch to any biofilm matrix.

Test Your IPAC Knowledge

Put your IPAC knowledge to the test with our IPAC Quiz!

Multiple Choice

Answer each of the questions below and click the submit button to find out how you did!

1. The characteristics of Legionella include which of the following?

2. The transmission of Legionella occurs via which of the following routes?

3. Pneumonia and Legionnaires have overlapping sings and symptoms. In which testing approaches is Legionaries differentiated?

4. What is Legionella’s incubation period?

5. Which of the following individuals fall at a higher risk for Legionella?

6. Who must participate in improving the quality of water used in dentistry? Select all that apply.

7. Pontiac Fever is a derivative of the SARS CoV-2 virus.

8. On the topic of research and data publication on DUWL and the risk with Legionella, which statement is accurate:

9. A studied showed dental professionals were significantly more likely to carry antibody markers of exposure to Legionella bacteria than the general population.

10. According to Health Protection and Promotion Act, R.S.O., 1990, detection of legionella is a mandatory reportable disease. All clinically diagnosed, probable and confirmed cases must be reported to the Health Unit within which period of time?

Upcoming maxill CE Events

Continuing Education Webinars

The New AAP Periodontal Classification

February 26, 2021

Calculating Staging and Grading. Are you Doing all Three?

Michelle Aube Simmonds RDH

Dental Unit Water Lines (DUWL)

March 25 2021

DUWL Maintenance Program; Do YOU Have One? Identified as a Need since 1963!

Michelle Aube Simmonds RDH

Implant Training For The Dental Staff - Most Current Guidelines

April 29, 2021

Nicol Ross CDA

IPAC Written Polices and Procedures

May 27, 2021

What’s In YOUR IPAC Manual? The Requirements for a Complete IPAC Manual.

Michelle Aube Simmonds RDH

Sterilization Monitoring & Record Keeping

June 24, 2021

The Fine Print of Quality Assurance Sterilization Monitoring.

Michelle Aube Simmonds RDH

Caries Risk Assessment & Fluoride Varnish

July 22, 2021

Caries Risk Management. Best Practice Considerations of Fluoride Varnish.

Michelle Aube Simmonds RDH

maxill U

Its time again to update your offices Health and Safety training. Visit maxill U to access the complete line up of training required to meet the Ministry of Labour standards.


maxill University is an online learning centre that offers convenient training at your fingertips. Train your staff, expand your knowledge and make sure your office is up-to-date with all required small business essentials.

24/7 online access
Student Paced
Approved & Audited Content
Admin Tools
Group Discounts
Quick & Easy Registration

The maxill University - Workplace Health And Safety Training LMS (Learning Management System) can be used to complete courses as an individual or to manage the training of the entire office. As a training manager you have the ability to buy credits, assign them to staff, and track the progress of the entire team.

In addition to workplace health and safety training maxill University will soon be offering PACE certified on-demand CE courses to help you get the credits you require and keep up to date with the latest hot topics.


1.0 Training Unit


1.0 Training Unit

Workplace Violence

1.0 Training Unit

Slips, Trips & Falls

1.0 Training Unit

Health & Safety Awareness

1.0 Training Unit

Office Ergonomics

1.0 Training Unit

Safeguarding YOUR Practice with a Quarterly IPAC Review

The time is here again to re-evaluate your practice. IPAC Platinum will remind you quarterly to perform an ongoing inspection, leave the reminder alert to maxill!!! Its our commitment to keep you going in your IPAC journey. Showing proof that your practice is participating regularly in self reflection to ensure compliance and goal setting is crucial for a full circle IPAC program. Remembering the umbrella to an IPAC Program is the concept of risk management, therefore, the quarterly review serves as an IPAC risk assessment to ‘catch’ any issues before they manifest to a real problem.

Be on the look out for your maxill email communication delivering the quarterly IPAC checklist directly to your mailbox. The next step is to download and print the checklist followed by creating an IPAC quarterly review binder. The format can be physical or digital. Most offices prefer to have both. The physical is simple in the event of an audit and the digital is the back up, should something happen to the paper copy. The famous phrase “if it is not written it did not happen”, retain a copy of the completed review of your practice. Organize the binder with tabs for simple retrieval or viewing should an audit ever unfold and an assessor needs to see the ongoing IPAC maintenance of your office. In most geographical areas, compliance records are retained for 10 years. Decide if your binder will support a year or a series of years. Four reviews will be inserted every year.

Do you need assistance with your quarterly review? If you need support, maxill is here to help with either a virtual or live visit from your local sales representative or one of maxill’s IPAC leaders. In keeping with social distancing rules, we can offer a virtual meeting via Zoom. The quarterly review is also an opportunity to inform maxill of any changes to your products or equipment to be updated in your IPAC manual if you are a maxill IPAC 360 customer. Take the time to use the quarterly review to accomplish the following:

  • The review itself using the provided checklist
  • Report new products and confirm the presence of SDS
  • Obtain missing SDS if applicable
  • Report new equipment and confirm the presence of MIFU
  • Obtain missing MIFU from any new equipment
  • Schedule a team IPAC annual training and record the training to place in your IPAC manual
  • Perform an inventory for expired products and remove from practice
  • Confirm team members have up to date CPR training with proof of certification
  • Confirm team members have up to date WHIMS training with proof of completion
  • Confirm potential immunization changes / updates
  • IPAC leader of the office to review IPAC manual for any required updates
  • IPAC leader to complete the manual review log sheet and list any updates if applicable

It cannot be stated enough that maxill is here to help you accomplish the tasks listed above. Don’t forget your access to the maxill IPAC hotline! Connect with a live IPAC agent for your IPAC questions!

Covid Resources

maxill is pleased to keep its customers connected with the latest data on COVID-19. Please navigate to the maxill COVID Resources page for information to assist you in your best practice decisions.

Join maxill’s IPAC leaders in a short video for the navigation and content of the COVID Resource web page titled Re-Entry Into Practice.

Covid Resources  

Thumbs Up or Thumbs Down Activity

View the following images and decide if there is an IPAC lapse.
For each image below, select the 'Thumbs Up' if there are no IPAC lapses or the 'Thumbs Down' if there is an IPAC lapse.

Image 1


Judging by the hose of the ultrasonic bath going into the sink, and the presence of the ultrasonic bath, this sink is used for soiled instruments and therefore can not be a hand hygiene sink. The hand soap must be removed.


Judging by the hose of the ultrasonic bath going into the sink, and the presence of the ultrasonic bath, this sink is used for soiled instruments and therefore can not be a hand hygiene sink. The hand soap must be removed.

Image 2


The forceps must be in a larger bag in the open position. The label is correct. The Type V inside the bag is correct. The bag is not folded properly at the left end of the image.


The forceps must be in a larger bag in the open position. The label is correct. The Type V inside the bag is correct. The bag is not folded properly at the left end of the image.

Image 3


This is the correct size barrier for this style of chair as it extends past the button controls of the chair.


This is the correct size barrier for this style of chair as it extends past the button controls of the chair.

Word Search


Word List

  • PCD

Cited Resources for IPAC Quarterly:

1 Martin, Laura. Water Online. EPA Investigates Chlorine Alternative. https://www.wateronline.com/doc/epa-investigates-peracetic-acid-as-a-green-alternative-to-chlorine-0001

2 Centre for Disease Control. Peracetic Acid Sterilization. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/peracetic-acid.html

3 Andrew Weichel. 'Concerning' cluster of legionnaires' disease cases detected in New Westminster. https://bc.ctvnews.ca/concerning-cluster-of-legionnaires-disease-cases-detected-in-new-westminster-1.5093476?cache=%2Fget-a-plan-before-withdrawing-from-an-resp-financial-advisers-1.4055455

4 Confirmed Cases of Legionellosis. Windsor Essex Public Health Unit. https://www.wechu.org/updates-alerts/confirmed-cases-legionellosis

5 Legionnaires and Pontiac Fever. https://www.uspharmacist.com/article/legionnaires-disease-and-pontiac-fever

6 Middlesex Health Unit. Legionnaires Fact Sheet. https://www.healthunit.com/legionnaires-disease

7 Government of Canada. What is Legionella? https://www.canada.ca/en/public-health/services/infectious-diseases/legionella.html