Safely Managing Dental Unit Waterlines
Due in part to headline-making infection control breaches involving dental treatment water, patients and the profession are placing increased scrutiny on dental waterline asepsis.
Due in part to headline-making infection control breaches involving dental treatment water, patients and the profession are placing increased scrutiny on dental waterline asepsis. The provision of safe care demands that offices follow recommended infection prevention protocols, and managing dental unit waterlines (DUWLs) is a foundational element of any successful program. Due to intermittent water flow through long, complex and narrow-bore tubing systems, DUWLs encourage, and even amplify, the formation of waterline biofilms that may contain pathogens, including Pseudomonas aeruginosa, nontuberculous mycobacteria, and Legionella species that can be released into treatment water.
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Create a Protocol
A dental waterline management protocol should be included in every facility’s written safety program and should contain relevant laws and formal recommendations, along with specific information regarding the equipment used, procedures performed, and the germicidal products and processes employed in DUWL maintenance. Instructions for use for all equipment and products should be available and followed. The protocol must stipulate regular DUWL testing to ensure compliance with water standards. If surgical care is provided, written and physical methods for complying with the sterile irrigation standards must be available. Patient records should document sterile fluids used for surgery.
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Materials Needed
Waterline cleaners and germicides fall under two main categories. Shock treatment products are used to remove established, attached DUWL biofilms. (Note: These products are caustic and clinicians should avoid contact with skin or mucosal tissues.) Low-level germicides are used to reduce planktonic biofilm and retard its attachment and growth. These agents should be continuously present within the dental water system, and are safe for patient treatment.
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Shock Treatment
Shock treatment is recommended prior to beginning a regimen of daily DUWL management with a low-level maintenance product or other system, as well as periodically to remove accumulated biofilm. Shocking recommendations are important because biofilms should be removed prior to implementing daily or automatic, system-based waterline management programs. In addition, DUWL biofilms have the potential to build up when an office uses a daily, low-level germicide that is safe for patient care. While some manufacturers suggest a time interval for periodic shocking, many do not. If no shock interval is recommended, the most reliable method for determining the need for shock treatments is to test output water.
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Variety of Options
Practices can also choose independent water reservoirs that isolate dental units from municipal water systems and provide immediate access to dental waterlines for intermittent- or continuously present cleaners or germicides. Manufacturers now offer equipment with separate water bottles due to the well-established criteria for water maintenance. Automated germicide metering or slow-release devices, which may include filtration technology that can be used with independent reservoirs or municipal water connections, are another option for DUWL management.
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Importance of Biofilm Removal
Distillers, reverse osmosis, and microfiltration devices can remove microorganisms from procedural water entering the dental unit, but do not limit the growth of biofilm after water enters the DUWL or reservoirs. These devices and processes may also produce water with high bacterial counts due to hidden and undetected biofilms. Strict protocol for preventing biofilm contamination in the devices or in stored water supplies must be followed. Studies show that samples of treated dental water may contain higher CFU/ml than tap water due to the residual levels of chlorine, more rapid water flow, and larger plumbing size of tap-water lines. Because water filters trap particulates, chemicals, and organisms, filters are potential sources of water contamination and must be regularly maintained. In addition, dental units may contain hidden or difficult-to-access filters that cultivate bacteria and fungi.
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Stay Safe
Ensuring safe treatment water requires investing in a DUWL management system, using it correctly and consistently, and assessing the results through testing. Commercial options for maintaining waterlines are abundant, so there is an appropriate solution for every clinical setting. In light of the increasing scrutiny on DUWL asepsis, it behooves oral health professionals to follow recommended protocols designed to protect patients and practitioners.
