Public Health Unit Infection Prevention and Control Lapse Report
Initial Report
Premises/Facility Under Investigation
Residence St-Mathieu
Type of Premises/Facility
Retirement Home
Date Board of Health Became Aware of IPAC Lapse
October 2, 2025
Date IPAC lapse was linked to the premise/facility
October 2, 2025
How the IPAC Lapse was Identified
Unrelated complaint investigation
Summary Description of the IPAC Lapse
The investigation revealed that single-use sterile needles were re-used on the same individual.
IPAC Lapse Investigation
Issue referred to regulatory college and/or other stakeholder notified?
Ministry of Long-term Care, Retirement Homes Regulatory Authority and College of Pharmacists
If the Lapse Involved a Member of a Regulatory College, Was the Issue Referred to that Regulatory College?
Yes
Were any Corrective Measures Recommended and/or Implemented?
Yes
Further Details/Steps
- Cease re-use of single use needles.
- Cease recapping of single use needles.
- Obtaining new needles for single use.
- Embed in their IPAC Policies &
Procedures aseptic techniques and
immediate discard of single use needles.
- IPAC training and audits of staff under delegation of a controlled act.
Date any Order(s) or Directive(s) Were Issued to the Owner/Operators
October 3, 2025
Initial Report Comments
Exposed individuals have been notified.
Final Report
Date of Final Report Posting
October 28, 2025
Date Any Order(s) or Directive(s) Were Issued to the Owner/Operator
October 3, 2025
Brief Description of Corrective Measures Taken
- Ceased re-use of single use needles for multiple accesses on the same resident.
- Ceased recapping of single use needles.
- Obtained new needles for single use.
- Has been embedded in their IPAC Policies &
Procedures aseptic techniques and
immediate discard of single use needles.
March 6, 2026:
IPAC training and audits of staff under delegation of a controlled act has been completed by pharmacist.
Date All Corrective Measures Were Confirmed to Have Been Completed
March 6, 2026
If you have any further questions, please contact:
Genevieve Lord
Program Manager / Gestionnaire de programmes
glord@eohu.ca
613-933-1375