Transcript Dental Unit Water

Dental Unit Water
“The dirtiest area in dental
surgery.”
www.dentalproducts.net
“The Dirtiest Area in Dental Surgery”
www.dentalproducts.net
Bacterial colonization
of dental water lines
(DUWLs) was first
reported in scientific
literature in 1963.
Conventional DUWLs
expose patients
and staff to harmful
microorganisms in the
office in which you
work.
The “Big Four” agree DUWL’s are a
problem.
These organizations provide the primary opinions
on standards of care in Dentistry.
All of them have issued many statements regarding DUWL
contamination and infection control recommendations.
DUWL Contamination Dynamics
Input: Water quality
Waterline: Biofilm
Output:
Retraction and Backflow
Water Quality
Tap water is a reliable source of contamination.
You have no way of knowing exactly what is in it at
any given time.
Distilled or sterile water is not good enough unless
the reservoir and the DUWL are sterile.
Retraction and Backflow
Oral microflora have been recovered from DUWL’s.
If retraction of patient fluids is not a problem, then
why are there anti-retraction valves built into
the handpieces???
How do you test a handpiece anti-retraction valve?
Eddies of backflow can travel through an open
anti-retraction valve even during positive flow!
Waterline Biofilm
The small diameter and long length of the DUWL
provides a large surface area for the adherence of
microorganisms.
Microorganisms from water and patients combine in
the DUWL and form a biofilm complex similar to
dental plaque.
Bacteria in Biofilms
Bacteria in biofilms tend to be:
-more difficult to culture
(for waterline testing)
-more resistant to control strategies
(antibiotics and
biocides)
than when grown in the laboratory.
Their resilience has been related to
physiology and protection by the EPS
slime matrix that they produce.
Source: http://centerforgenomicsciences.org/research/biofilm.html
Changes in Biofilm Bacteria
Changes which occur in microorganisms incorporated in biofilms:
Become Chronic in Nature
Become Culture Negative
Poor Response to Antibiotics
Greater Potential for Metastasis
http://www.genomenewsnetwork.com
/articles/06_02/biofilms.shtml
Sterilization Destroys Biofilms
Because of the highly resistant effects
of biofilm and its ability to leech
endotoxins and microorganisms
into dental water even after
disinfection,
it is critical to sterilize the entire
pathway to eliminate the risk of
contamination during dental
procedures.
Disinfection is not Sterilization
Disinfection: Destruction of pathogenic and other kinds of microorganisms by
physical or chemical means. *
Sterilization: Use of a physical or chemical procedure to destroy all
microorganisms including substantial numbers of resistant bacterial spores.
*Disinfection does not ensure the degree of safety
associated with sterilization processes.
Disinfection is less lethal than sterilization, because it destroys the majority of recognized pathogenic
microorganisms, but not necessarily all microbial forms (e.g., bacterial spores).
Source:CDC Guidelines for Infection Control in Dental Health-Care Settings -2003
Universal Precautions
Since disinfection does not = sterility,
and dangerous pathogens
have been found in DUWL’s,
the moment that biofilm contaminated
water enters the patient’s mouth,
universal precautions are compromised.
Standard of Care
Most state Dental Boards
consider the
2003 CDC Guidelines for
Infection Control
in Dental Health Care Settings
to be the standard of care
in their communities.
Standard of Care
What does that mean for
Dental Unit Water
compliance in your
office?
CDC Guidelines for Infection
Control in DUWL’s
“Exposing patients or dental health care personnel to water
of uncertain microbiological quality,
despite the lack of documented adverse
health effects,
is inconsistent with generally accepted
infection control principles.”
“Exposing patients …”
According to the CDC:
you are exposing patients if you perform
any of the following procedures:
incision, excision, or reflection of tissue…
biopsy
periodontal surgery
apical surgery
implant surgery
surgical extractions of teeth requiring elevation of mucoperiosteal flap
“…to water of uncertain
microbiological quality …”
According to the CDC:
“Conventional dental units cannot reliably deliver
sterile water…
…because the
water-bearing pathway
cannot be reliably sterilized.”
“… despite the lack of documented
adverse health effects, …”
Since dentistry is typically performed in an
outpatient setting, patients are not
usually monitored for post-treatment
illness.
Although this makes it difficult to establish
an epidemiologic association between
infection and recent exposure to dental
unit water, there are several notable
exceptions.
“… despite the lack of documented
adverse health effects, …”
The death of a California dentist from legionellosis.
“It is likely that aerosols from those dental units were the source
of the fatal Legionella infection."
Atlas RM, et al. Appl Environ Microbiol 1995;61:1208-13.
Two patients with immunodeficiency infected with Pseudomonas
aeruginosa after dental visit.
“Identical strain of microorganism identified in the dental unit waterline."
Martin MW. Br Dent J 1987;163:152-4.
"58 (81.2%) out of 71 patients colonized with Pseudomonas aeruginosa
identified in dental unit waterlines.
“The microorganism could be identified in the patients 7 days after
dental appointment."
Martin MW. Br Dent J 1987;163:152-4.
“… despite the lack of documented
adverse health effects, …”
"The temporal onset of asthma may be associated with occupational
exposure to contaminated dental unit waterlines”.
“Most of the organisms isolated from dental unit waterlines are
Gram-negative bacteria, which contain cell wall endotoxin. A
consequence of endotoxin exposure is the exacerbation of
asthma."
Pankhurst, et al. Prim Dent Care. 2005 Apr;12(2):53-9.
"Dentists had the highest prevalence of L. pneumophila antibodies,
followed by assistants and technicians, when compared with a control group
of non-medical workers, indicating that dental personnel are at an
increased risk of legionella infection."
Reinthaler FF, et al. J Dent Res. 1988 Jun;67(6):942-3.
“… despite the lack of documented
adverse health effects, …”
OSAP Agrees:
“The present lack of epidemiologic evidence
of illness or injury among patients or dental
healthcare workers does not provide a
valid rationale for inaction.”
“… is inconsistent with generally
accepted infection control principles.”
Generally accepted infection control principles
are based on ensuring no cross contamination
and on not introducing new pathogens
as a result of the dental procedure.
Oral microflora have been recovered from DUWL’s
proving cross contamination is possible if not likely.
CDC Recommendations
1. Use water that meets EPA standards.
2. Consult with manufacturer to maintain water quality.
3. Monitoring of water quality
4. Maintenance of the anti-retraction mechanism.
5. Boil water advisories.
6. Eliminate the risk of DHCP non-compliance with disinfectant and water line
monitoring.
What can you do?
How can you incorporate the
recommendations of the CDC into
your practice?
How can you protect your patients
and staff from the dangerous
contaminants found in DUWL’s?
How can you prevent costly
malpractice litigation due to
contamination from your practice?
STERILE DELIVERY
is possible if you choose an
unconventional
delivery system…
AQUASEPT
Sterile Delivery
The AQUASEPT sterile delivery system can be retrofitted onto your
existing unit to enable you to meet
or exceed all of the CDC
recommendations for water used in dental procedures.
AQUASEPT
CDC Recommendations
1. Use water that meets EPA standards.
AQUASEPT lets you use whatever water you want from the
sterilized bottle.
2. Consult with manufacturer to maintain water quality.
AQUASEPT is sterile every time – no consultation needed.
3. Monitoring of water quality.
AQUASEPT allows you to choose the quality of water you are
putting in the sterile bottle.
AQUASEPT
CDC Recommendations
4. Maintenance of the anti-retraction mechanism.
AQUASEPT eliminates reliance on this since the entire pathway is
sterilized between each patient.
5. Boil water advisories.
AQUASEPT prevents work stoppage, accidental patient
exposures and contamination due to boil water advisories.
6. Virtually eliminates the risk of DHCP non-compliance with disinfectant and
water line monitoring.
AQUASEPT only requires proper sterilization technique- no messy
flushing and dangerous chemicals and improper flushing technique.
AQUASEPT
DON’T put your
patients, staff, and practice
at risk!
AQUASEPT
Choose AQUASEPT and operate with the
peace of mind
that sterile delivery brings!
AQUASEPT
Sterile Delivery
It’s the right thing to do!!!