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    4 things you NEED to know about waterline disinfection

    Contaminated waterlines are a frightening proposition, but they're easily mitigated with these proactive steps.

    It’s easy to take something as omnipresent as water for granted, but clean as it may look, danger can lurk just under the surface. Without proper cleaning and disinfection, microorganisms can collect in the dental unit waterline forming biofilm — a layer of microorganisms or bacteria — that can become dislodged and enter the water stream. If that happens, then really bad things can transpire.

    For instance, consider infections that occurred at two separate children’s dental clinics — Georgia in 2015 and California in 2016. Both cases caused Mycobacterium abscessus infections in dozens of children. Fortunately such outbreaks are rare, but there are a few things dental practices can do to keep themselves — and their patients — safe.

    Read more: How clean are the dental unit waterlines in your office?

    The importance of testing

    A key component of any waterline safety program is regular testing.

    “Dirty waterlines and clean waterlines, unfortunately, look exactly alike,” says Peggy Spitzer, a dental hygienist and clinical education manager for Certol International. “We cannot see inside the tubing, we cannot see the biofilm forming.”

    “I don’t think many offices are aware they need waterline disinfection,” adds Karen Daw, an infection control consultant and former clinic health and safety director for The Ohio State University College of Dentistry. “This is why water should be tested. I understand why many assume if the water is distilled or comes from a treated public water source then it must be safe, right? However, water travels into units, some with warmers (bacteria love warm water, by the way), then through very narrow tubing before it exits the handpiece or air/water syringe. And water sits in those lines, sometimes overnight, sometimes over the weekend or even a holiday break. Add low flow rate and voila: You have bacteria soup. Let that sit long enough and you could end up with harmful biofilm.”

    How to test

    While testing is critical, there’s no regulatory guideline on when or how to do it. Rather, it’s placed in the hands of manufacturers to ensure their specific equipment meets safety guidelines.

    “How do you know if you are delivering water of acceptable quality unless you monitor?” asks Dr. Marie Fluent, DDS, former educational consultant for the Organization for Safety, Asepsis and Prevention (OSAP). “And that’s a big question. Since the CDC does not provide the specific recommendations for monitoring your water, clinicians must rely on the manufacturer of the dental unit and the manufacturer of the waterline maintenance products for recommendations. However, unless you test your dental unit water, how do you know if you have a problem?”

    There are two main ways of testing dental unit waterlines: an in-office testing kit and a mail-in service.

    Dental waterline disinfection“There are advantages and disadvantages to both,” Dr. Fluent says. “With an in-office variety, the results are available more quickly because it’s done in your own facility immediately after acquiring the water sample. However, the in-office tests may be a little bit less accurate than the mail-in variety. There is evidence to suggest the in-office methods underestimate water contamination, and this may be due to several factors: variations in room temperature and a lack of neutralization (or stabilization powder) in the test sample. The powder stabilizes the bacteria present in the test tube. Thus, when filling the test tubes, it is important to fill slowly and carefully to maintain the powder.”

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    “Whatever product is being used to maintain the waterlines, follow the manufacturer’s instructions for use (IFU) on whether testing is recommended,” Daw adds. “Once tested, follow the manufacturer’s recommendations for frequency of testing to ensure the water remains at the EPA recommendation for safe levels of heterotrophic bacteria, or 500 CFU/mL (colony forming units per milliliter). Testing can be done in-house or via a mail-in service. In-office water testing is great for immediate pass-fail test results. A mail-in service provides the practice with third-party verification.”

    There are no specific recommendations on when to use one method versus the other.

    “We are sort of in the infancy of dental unit waterline testing, maintenance and monitoring,” Dr. Fluent says. “As years pass by, more detailed recommendations will most likely be provided. At this point in time, either testing method is appropriate. But as time goes on, I believe we are going to see more detailed recommendations, and possibly regulations, for dental unit waterline testing.”

    Another consideration is where the water is tested. If a problem is discovered, how does the practice know whether the contaminated water originates within the dental unit or at the water’s source?

    “Water should be tested coming out of your dental unit (air water syringe, handpieces, scalers and any other devices attached to water) as well as the source water,” Dr. Fluent says. “And that will help you determine, if there is contamination, where it does occur.”

    “Test kits are available and not too hard to use,” Spitzer adds. “They need to be used at baseline (starting point) before any treatments and on a regular basis thereafter to confirm treatment is working.”

    Up next: Shocking the system

    Robert Elsenpeter
    Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author ...

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