Safe-water-delivery-in-the-dental-hygiene-operatory-rdh-magazine

Safe water delivery Advances in water line infection control aid the hygienist's role in safety By Karen Siebert, RDH, MA Hygienists have not always thought of dental unit water line (DUWL) infection control as our responsibility, but it is just as crucial to patient and practitioner safety as cleaning and disinfecting a countertop With new choices in water line disinfection products, choosing wisely can more than maintain a safe level of colony-forming units (CFUs) Figure 1: Life cycle of biofilm Courtesy of Biolennia Laboratories (Toronto, ONT Canada) Historically, water lines have not been a topic of discussion among hygienists As champions of personal protection equipment, surface disinfection, and instrument care, water lines fell under equipment maintenance the quick "have to's" at the end of the day to keep the unit running, not critical infection control Trusting that the little tablet dropped in the water bottle was all we needed to assure a fresh water supply, we didn't put much more thought into the issue Today there is an abundance of evidence that it takes more than one step to maintain a healthy water supply "Drop in and forget" is no longer an option The maze of tiny tubes that connect water to the delivery point have been shown to be an ideal environment for biofilm growth, linking DUWL safety directly into the chain of asepsis As hygienists, we need to place DUWL health right up there with visible surfaces A daily, weekly, and monthly routine should be followed to ensure safe water delivery Consider reading these articles   Cleaning or disinfection: What's right for the suction lines? Elimination of contaminants in waterlines may be guesswork, but several options help  Legionnaires’ disease and dental unit water Hygienists have exciting choices with a new generation of DUWL products that offer a good "bang for the buck." Sustainable products compatible with the health of the environment and humans are now options, exposing patient, practitioner, and environment to fewer chemicals One of hygiene's favorite oral rinses, 0.12% chlorhexidine gluconate is also an environmentallyand human-friendly germicide that has a long history of successful biofilm removal in dental unit water lines With the original report of contaminated water bottles 50 years ago, chlorhexidine gluconate was the first germicide used to address the issue Well documented as safe for patients and the environment, 0.12% chlorhexidine gluconate is proven to kill P aeruginosa This new generation of products with a chlorhexidine base has uses beyond DUWL treatment It can be used as an initial shock treatment or for weekly or daily line maintenance to effectively remove biofilm from lines During the clinical day, chlorhexidine DUWL treatments can also be used as an irrigant Combining multiple benefits into one product simplifies a previously puzzling topic in infection control As hygienists, we know the safety and benefits of chlorhexidine gluconate Products approved for intraoral use reduce worry about chemical exposure to harsh biofilm disruptors in line cleaners, and have the potential to enhance treatment outcomes when used as an irrigant Why is this so important? Since 1963 when the first report of contaminated water bottles appeared, evidence has been compounding that patients and practitioners exposed to treatment water with greater than 500 CFU/ml are at risk for several gram-negative bacterial and fungal related illnesses Immunocompromised patients are especially susceptible to these infective organisms Mainstream media has picked up on this topic, most recently reporting the death of an 82-year-old Italian woman from L pneumophila pneumonia linked to dental unit water lines (Ricci, ML, et al., 2012) Figure 2: New DUWL Tubing Courtesy of Biolennia Laboratories (Toronto, ONT Canada) Patients are not the only ones at risk practitioners are exposed to aerosols produced by high-speed handpieces and ultrasonic scalers Proper personal protective equipment does not eliminate exposure entirely, still posing the risk of infectious microorganism aspiration Proper DUWL care reduces microorganisms present in aerosols produced from high-speed and ultrasonic handpieces (IADR Loma Linda University, 1999) Several studies have shown antibodies to Legionella present in dental healthcare workers exposed to DUWL aerosols (O'Donnell, et al., 2011) This underscores the importance of reducing inhaled microorganism counts from treatment water aerosol Figure 3: Three weeks of biofilm growth Treatment water tested at >500,000 CFU's Courtesy of Biolennia Laboratories (Toronto, ONT Canada) Based on the studies since 1963, both the CDC and EPA have weighed in on the topic, setting standards for safe levels of treatment water The 2003 CDC Guidelines for Infection Control in Dental Health Care Settings states, "Use water that meets EPA regulatory standards for drinking water for routine dental treatment water output." The EPA has set the standard for drinking water at < 500 CFU/ml (colony-forming units per milliliter) In 1996 the ADA challenged practitioners to set a goal of