Waterlines: Science

& FCDH Procedures

By: Arye, Yishen, Alexandra, and

Pamela

What’s Important About

DUWLs

• 1/16th to 1/8th inch in diameter

• Large surface to volume ratio (low flow rate)

• Delivers water to handpieces and air/water syringes

• Water sits stagnant in lines overnight and weekends

• Optimal breeding ground for microorganisms

• Plastic hydrophobic surface

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What You Need to Know About Biofilms

• Well organized microbial communities that adhere to wet surfaces

• Communicates via fluid channels to support bacterial growth

• Protective slime layer which makes it difficult to eradicate

Organisms Present in DUWLs

Streptococcus mitisStreptococcus salivariusEnterococciStaphylococcus cohniiStaphylococcus warneri AKlebsiella (Enterobacter) aerogenesBacillus subtilisPseudomonas spp.Streptococcus (Entercoccus) faecalisEnterobacter cloacae

Pseudomonas aeruginosaAlcaligenes faecalisMycobacterium spp.Cladosporium spp.Cephalosporium spp.Aeromonas spp.Legionella pneumophilaAcinetobacter spp.Flavobacterium spp.Moraxella spp.Ralstonia pickettii

Pathogenicity Most Gram-negative species in DUWLs are generally non-pathogenic

Potentially pathogenic microorganisms:

Pseudomonas aeruginosa- causes oral infections

Legionella pneumophila- causes pneumonia

Few cases of cross-infections linked to DUWLs

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Pathogenicity Cont’dChemo patient with

Pseudomonas aeruginosa infection

Patient infected with Legionella pneumophila

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Incidence of Legionnaire’s Disease

In 2012, ABC News reported that an 82-year-old woman dies of Legionnaire’s disease after dental visit.

Sources of Contamination

• Municipal water piped into dental unit

• Suck-back of saliva into line

• Lack of antiretraction valves

• Contamination from independent bottled water systems

• 300 times more amoebae found in DUWLs than in tap water

Laws for Decontaminatio

n of DUWLs

• There are currently no laws that set standards for the quality of water

• 1995- ADA challenged industries to produce systems that reduce bacteria levels

• Cleaner than tap water (500 CFU/ml)

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CDC Recommendations• Flush water lines for:

• 30 seconds at beginning and end of day

• 20-30 seconds after each patient

• Do not use dental unit water for surgical procedures

http://www.ada.org/en/member-center/oral-health-topics/dental-unit-waterlines

ADA Recommendations

• Improve the design of new dental equipment

• Design accessories to adapt to older units

• Take responsibility off HCW

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Goals for Disinfection Practice

• Minimize and prevent biofilm formations

• Improve the safety and quality of dental unit water

• Remove bacteria from tubing surface

• Decrease potential source of cross contaminations

• Easy procedures that can be performed daily

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Quality Improvement Methods

Autoclavable or disposable pathways

Flushing waterlines

Filtration system

Independent reservoirs

Sterile water delivery system

Chemical treatment

Chlorination

Biocides and chemical disinfectants

Peroxide, Ozone UV

http://www.dentalaegis.com/media/20301

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The Waterclave

FCDH Procedure

Remove handpieces, air/water syringes, and ultrasonic scalers

Flush lines:

Beginning of day for 60 seconds

Between patients for 20-30 seconds

At end of day for 60 seconds

Why do we run the waterlines?

May temporarily reduce the level of microbes in the waterlines

Reduces patient-borne microbes that may have entered the handpiece via suck-back

Reduces the build up of biofilms in the DUWLs

Inexpensive and easy to do

The Pink Stuff- PurevacOn Fridays:

Fill bucket with 2 pumps Purevac and water (1 ounce/1 quart)

Suction with low and high-speed suction

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• A powerful cleaning solution that:

• Destroys microorganisms

• Dissolves tough debris

• Keeps evacuation lines open

• Prevents build-up

• Helps system operate properly and efficiently

The BluTab

Inhibits growth of microorganisms in DUWLs

Nontoxic, odorless, tasteless

Has no effect on enamel or bonding

https://www.safcodental.com/catalog/infection-control/waterline-purification/blutab

• Add 10 BluTabs to 19 liters of water (1 tablet / 2 liters H2O)

• Fill individual dental unit water bottles with treated solution

References1. ADA: America’s leading advocate for oral health [Internet].Chicago: American Dental Association; C 1859-

2014. Oral Health Topic Dental Unit Waterlines; April 2012 [cited 2014 November 1]. Available from: http://www.ada.org/en/member-center/oral-health-topics/dental-unit-waterlines

2. Bednarsh HS, Eklund KJ, Mills S. OSAP- Dental Unit Waterlines: Check Your Dental Unit Water IQ [Internet]. American Dental Hygienists’ Association; 1997 [cited 2014 Nov 18];10(9). Available from: http://www.osap.org/?page=Issues_DUWL_7

3. BluTab [Internet]. Safco Dental Supply; 2014 [cited 2014 Nov 19]. Available from: https://www.safcodental.com/catalog/infection-control/waterline-purification/blutab

4. Dallolio L, Scuderi A, Rini M, Valente S, Farruggia P, Sabattini M, Pasquinelli G, Acacci A, Roncarati G, Leoni E. Effect of different disinfection protocols on microbial and biofilm contamination of dental unit waterlines in community dental practices. Environ Res Public Health [Internet]. 2014 Feb 18 [cited 2014 Nov 18]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945585/

5. Garg SK, Mittal S, Kaur P. Dental unit waterline management: historical perspectives and current trends. J Investig Clin Dent [Internet]. 2012 Feb 19 [cited 2014 Nov 18];3(4):247-52.

6. Purevac Evacuation System Cleaner [Internet]. Sultan Healthcare; 2014 [cited 2014 Nov 19]. Available from: http://www.sultanhc.com/sw/swchannel/productcatalogcf_v2/internet/model.asp?ProductMasterID=297561&ParentID=215652&SWID=1

7. Tyagi S, Kulkarni P, Prasad K. Science regarding dental unit waterlines (DUWL): A review. Ann Essences Dent [Internet]. 2010 Jul-Sept [cited 2014 Nov 18];2(3):117-22.

8. Watanabe E., Agostinho AM., Matsumoto W., Ito IY. Dental unit water: bacterial decontamination of old and new dental units by flushing water. International Journal of Dental Hygiene 2008; 6: 56-62.

Live and Let Microbes Die

Our video:

https://www.youtube.com/watch?v=6LpX3bItNI8&feature=youtu.be