With 2023 fast approaching, now is a great time to look back at what has happened and think about how it can affect the year to come.
There’s nothing magical that happens when the clock strikes midnight on January 1. However, it is a good time to think about what the coming year will mean for your practice, especially where infection control is concerned. There have been lots of lessons to be learned from the past few years, and the new year might be a good time to reflect on them.
In 2016, infection outbreaks at pediatric dental offices seemed to serve as a wake-up call for all practices about the necessity of testing, treating, and maintaining safe dental unit waterlines. That appeared to be the case, but in March of 2022, another outbreak occurred, reminding us just how easy it is to let one’s guard down. It was so serious, that the Centers for Disease Control and Prevention (CDC) issued an advisory in November.
“The first topic of conversation among infection control experts at this time is the treatment and maintenance of dental unit waterlines (DUWLs),” says Karen Gregory, RN, director of compliance and education for Total Medical Compliance. “I think this latest CDC advisory should be a wake-up call to every dental practice that there must be treatment and maintenance of DUWLs of and testing to ensure the quality of dental unit water.”
These outbreaks have all been associated with children who have received pulpotomies in which the water used for irrigation had high bacterial counts. Both the CDC and the American Dental Association (ADA) have established guidance on water quality, which should be ≤500 colony forming units (CFU)/mL of heterotrophic water bacteria, according to Gregory. However, there seems to be a lack of consistency in processes to meet this standard, she adds.
“I would love to see a higher level of accountability around maintenance and treatment of dental unit water, but I am not sure exactly what that would look like. It is very tragic that children may be impacted for the rest of their lives from a situation that is preventable and because of this, I do believe that’s going to be a continued focus in 2023.”
At times, agencies like the CDC and the Occupational Safety and Health Administration (OSHA) communicate important hazards to the industry. Gregory hopes that 2023 will see an updated communication issued.
“We keep waiting for the publication of the final rule that updates the hazard communication guidance,” Gregory says. “And so that may happen in 2023. There was a conversation about a respiratory protection standard. There was a commitment for a final rule to come out, but I don’t know if that’ll happen or not. Things have kind of settled down, it seems.”
The CDC issued an advisory about waterlines, but Shannon Mills, DDS, a private healthcare consultant and Chair of the American Dental Association Standards Committee for Dental Products’ Subcommittee on Dental Infection Prevention and Control, believes that now is the right time to address the issue even further.
“I suspect we’re going to see additional information about infections resulting from dental unit water,” Dr Mills says. “I believe that the CDC will be updating the recommendations for waterlines, as well as other CDC recommendations, which mostly date that back to 2003.”
The CDC updated its guidelines in 2016, however, this was done mainly to make the guidance easier to implement and more understandable, Dr Mills says, and there were no major changes added.
There is a certain amount of accountability to be placed on manufacturers’ shoulders, Dr Mills adds, including an increased emphasis on the obligations of manufacturers to provide appropriate guidance, he says.
“In the 2003 [CDC] guidelines, manufacturers were called on to provide guidance, and I think the lack of explicitness and the lack of validation is a challenge in that not all the manufacturers are fully meeting,” Dr Mill explains. “Validation can be an extensive process and is fraught with its own risks. But at the same time, I think it’s essential that we do this. We see better attention to this being paid in Europe than in the United States, or it’s just a different approach to things…I think that’s an area where we’ll see increased attention across the spectrum of infection prevention and patient safety.”
And that responsibility isn’t just limited to dental unit water lines. According to Dr Mills, instrument reprocessing is another area where we may see more emphasis, for example.
“Right now, however, the best-documented evidence of illness as a consequence of dental infection prevention practices not being followed is water lines,” he says.
Signs of the Times
A lot of these issues seem to be common and preventable, Dr Mills says. Dental professionals need to clean instruments better and properly dispose of single-use items, he says.
“We don’t have documented evidence of illness due to re-use of single-use, disposable items, but it’s certainly biologically plausible that such things could happen. What will happen in 2023 with infectious diseases? I think it’s very plausible that we’ll see surges—as we are seeing right now with the flu, possibly Covid-19, and certainly RSV. These are respiratory diseases, and we need to take seriously the lessons we learned from COVID about preventing transmission of respiratory diseases and dental practices.”
The lessons learned during the pandemic should not be forgotten. The most important thing is to keep those with respiratory illnesses out of your practice, whether they are patients or staff, Dr Mills cautions. This is a hard lesson to learn because they don’t want to let that employee stay home or they want to place that crown. So, they make their employee come into work, or they accept that patient into their practice to place a crown.
“The next thing you know, half of the practice is sick,” Dr Mills says. “We need to really be more thoughtful about this.”
A New Year, a New Beginning
A new year can bring with it new resolutions. January is a fresh start and is the perfect time to reorganize and take care of some housekeeping. This may include taking inventory of where your practice is in terms of compliance, Gregory says, including a plan for the treatment and maintenance of DUWL, maintenance on sterilizer or washer equipment, and ensuring staff is updated on required bloodborne pathogens training.
“Just stepping back and looking at the culture of compliance in your office is always good,” she says. “I don’t know if it’s called a New Year’s Resolution, but I always see the first of the year as kind of a fresh start. It’s important for the leadership to set the standard that we are going to create a safe practice for both you, as a worker, and for our patients who come to seek care here.”
“I might make a New Year’s Resolution to sit down, block the time to take a hard look at all of your infection prevention practices in your office,” Dr Mills adds. “Look at every single thing. Go down your checklists—the ADA has one, some of the state boards have them, and the CDC has them. Take a look at those checklists, go down line-by-line, and see where you stand. And if you don’t have a dedicated infection prevention supervisor who has a primary or secondary duty in your office for safety and infection prevention, that’s the number 1 New Year’s Resolution. Then have that person do a thorough analysis, a thorough surveillance of all of your practices because if you find things that are deficient, it’s time to fix them. So that’s my 2023 resolution. If you aren’t providing safe care in your practice, you shouldn’t be providing it at all.”
The past 3 years have certainly been eventful. And just when we think that nothing else can happen, something else absolutely does. With 2023 fast approaching, now is a great time to look back at what has happened and think about how it can affect the year to come.