FI Jan 19

A par tnered publication with Dental Sales Pro • www.dentalsalespro.com

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January 2019

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FOR DENTAL SALES PROFESSIONALS

Editorial Staff Editor Laura Thill lthill@sharemovingmedia.com Managing Editor Graham Garrison ggarrison@sharemovingmedia.com Founder Brian Taylor btaylor@sharemovingmedia.com Senior Director of Business Development Diana Partin dpartin@sharemovingmedia.com

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JANUARY 2019

Biotec Custom Steri-Centers: Sterility assurance for any size practice First Impressions

The look and feel of the reception area is important, but keeping it free of germs and infection is critical to the health of patients and staff.

Safe Water, Safe Patients

Growing attention to the hazards of contaminated dental unit water has led more dental clinicians to take the necessary steps to protect their patients.

Director of Business Development Jamie Falasz, RDH jfalasz@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Circulation Wai Bun Cheung wcheung@sharemovingmedia.com Associate Editor Alan Cherry acherry@sharemovingmedia.com

First Impressions Digital Edition is published monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5257 Fax: 770/236-8023 www.firstimpressionsmag.com First Impressions (ISSN 1548-4165) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved.

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First Impressions

January 2019

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INFECTION CONTROL

BY HOWARD SORENSON, VICE PRESIDENT OF SALES, PORTER ROYAL SALES GROUP

Biotec Custom Steri-Centers: Sterility assurance for any size practice Sterility assurance depends on good design of the space des-

ignated for instrument processing.

First and foremost, steri-centers must be designed to comply with OSHA and CDC standards. In addition, a well-designed steri-center facilitates organization, efficient processing of dental instruments and the quick turnover of dental instrument setups.

In many cases, traditional straight-line steri-centers work very well. But older, U-shaped centers, which do double duty as supply storage areas, do not! That said, the use of modular dental cabinetry and some custom-built modules can make any size or shape of space become a functional efficient steri-center. And with the growth of larger group practices and DSO-type facilities, many practices require a mega-sized steri-center to accommodate

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the flow of staff and trays. A well-designed steri-center should incorporate the systemized processing of instruments, the use of cassettes, and protocols for color coding of instruments, handling biohazardous materials, cleaning instruments and storing sterile instrument setups.

Some points to consider when designing a steri-center include: • Is the current steri-center in need of a face lift?

• How many procedures does the dental practice perform each day?

• What is the current protocol for procedure setups?

(Using instrument cassettes not only saves time, but will reduce the amount of space required.)

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• How does the practice currently process its handpieces?

• Do the material setup tubs match the practice’s instrument setups?

• How does the practice dispose of biohazardous materials?

It’s important to determine where to bring contaminated instruments into the steri-center, as well as where to leave sterile, ready-for-use instruments. In addition, it’s important to measure the space and identify electrical outlets, as well as where plumbing and lighting will go. (If necessary, is it possible to move any of these utilities?)

The large group practice The large practice presents a unique set of challenges for a private practitioner. Given the magnitude of instruments that require processing, and the movement of staff entering and exiting the sterilization

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center, the space must be well designed to maximize efficiency and guarantee efficacy.

In one particular case, for instance, Biotech, Inc. created a steri-center with two entries: a pass-through from the hallway outside the space at one end for receiving contaminated trays, and a pass-through at the other end of the steri-center for the sterile trays to be picked up for use with the next patients. This design greatly minimized the staff traffic in and out of the work space.

Another possible bottleneck is having a single sink in these large practice stericenters. Having a double sink with two faucets, multiple Hydrim type washers, and ultrasonic cleaners needs to be considered to prevent one area of the instrument processing from slowing down the recycle time.

Sufficiently analyzing the work flow and procedures completed at the practice, as well as consulting with the staff that does the instrument processing, help ensure the final steri-center design is best suited to each particular practice.

A well designed steri-center should incorporate the systemized processing of instruments, the use of cassettes, and protocols for color coding of instruments, handling biohazardous materials, cleaning instruments and storing sterile instrument setups.

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INFECTION CONTROL

BY LAURA THILL

First Impressions The look and feel of the reception area is important, but keeping it free of germs and infection is critical to the health of patients and staff.

The dental reception area is the initial point of reference for patients, who expect a clean, welcoming environment that attests to the professionalism of the practice. Anything less may make them think twice about returning, according to Lean Keefer, RDH, BS, MSM, director of clinical services and education, Crosstex, A Cantel Medical Company. “We never get a second chance to make that first impression,” she points out.

“The appearance of the reception area reflects the attitude and habits of the dentists and staff,” says Keefer. “It’s critical to make a positive, lasting impression. In addition, the reception area should be designed to optimize patients’ mood and well-being, as well as improve their perception and experience.”

Patients are reported to comment more frequently on their experience in the reception area than on the dental team’s clinical skills, she adds. “Clinical care and staff/patient relationships are key to having patients return, but don’t underestimate the power of how the dental office presents itself to patients.”

Achieving the ideal look and feel of the reception area is only half the battle.

Upper respiratory and seasonal illnesses are easily spread, making it imperative for the dental staff to follow regular infection control protocols. “Upper respiratory and seasonal illnesses can be spread through direct contact with mucous membrane; cross-contamination with clinical contact surfaces; and droplet transmission, including sneezing and coughing, which spreads the pathogens by large particle droplets that carry microorganisms,” says Keefer.

“People with flu can spread it to others up to about six feet away,” she continues. “Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby, or possibly be inhaled into the lungs. Less

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often, a person might get flu by touching a surface or object that has flu virus on it, and then touching their own mouth, nose or eyes.” (https://www.cdc.gov/flu/about/ disease/spread.htm) People often misread their seasonal illnesses, Keefer continues. For instance, a sick person can be contagious before his or her symptoms appear. “If you have a cold, you’re contagious for one or two days before your symptoms develop and for two weeks after you are first exposed to the virus,” she says. “With the flu, people are the most contagious in the first three to four days after symptoms begin. However, it is possible to infect others a day before symptoms start. Children and those with weakened immune systems may pass the virus for longer than seven days.”

First lines of defense The reception area receives heavy traffic, from early morning to evening. If left unattended, it inevitably will become cluttered with waste and carry the potential for cross-contamination, notes Keefer, who recommends daily cleaning and maintenance, with emergency cleanups throughout the day as needed. “The staff shouldn’t ignore details that can differentiate the practice,” she explains. “They should take 10 minutes to sit down and carefully view the reception area through the eyes of a patient.

“Boxes of facial tissues and pump bottles of alcohol-based hand rub should be appropriately placed for patient use in the reception area,” Keefer continues. “Wastebaskets with lids should be positioned for easy access to avoid used tissues being left on tabletops or hidden under chairs.” It’s also important to account for patient demographics when selecting and arranging furniture, she points out. “Given that some patients value their

INFECTION CONTROL privacy and are concerned about other people’s germs, it’s better to arrange small groupings of chairs than line them up along the perimeter of the room.”

Posting respiratory etiquette and hand hygiene signs in the reception area can serve to remind patients to cover their coughs and wash their hands, she says, noting that posters may be downloaded from the following websites: • h ttp://www.health.state.mn.us/divs/idepc/dtopics/ infectioncontrol/cover/ • h ttp://www.health.state.mn.us/handhygiene/how/clean8.pdf

How clean is that surface?

Cold viruses have been shown to survive on surfaces for several days, while flu viruses are capable of being transferred to hands and causing an infection that can survive on hard surfaces for 24 hours.

heavy-duty utility gloves, says Keefer. “PPE must be donned/ doffed appropriately, and hand hygiene should be performed immediately after doffing PPE.” It’s important to take a consistent, organized approach, she says. “Cleaning from high to low, and back to front, helps avoid dust and debris falling back onto the surface,” she explains. “Durable, washable surfaces – including both healthcare grade and those manufactured for commercial use – are easier to clean.

Clean first, then use an appropriate level of sanitizer or disinfectant as indicated, based on the surface being treated. (The friction of cleaning removes most germs, leaving remaining germs to be addressed by the sanitizer or disinfectant.)

“Sanitizing reduces germs on inanimate surfaces to levels considered safe by public health codes or regulations,” says Keefer.

“Disinfecting destroys or inactivates most germs on inanimate objects, with the exception of bacterial spores and prions. It is important to follow the manufacturer’s instructions for use and maintain the safety data sheet binder for any cleaning materials or products used in the office.

The dental staff should follow surface disinfection protocol for housekeeping surfaces using the appropriate chemical/cleaner and process with dwell time. That said, they should be mindful, as strong cleaning solutions used to kill germs can cause respiratory problems.

The staphylococcus aureus bacteria that cause MRSA infections can survive for days to weeks on surfaces. MRSA bacteria can live on surfaces for longer than some other bacteria and viruses because they survive better without moisture. Generally, MRSA bacteria survive for longer on hard surfaces than on soft surfaces.

Germs generally remain active longer on stainless steel, plastic and similar hard surfaces than on fabric and other soft surfaces.

Other factors, such as the amount of virus deposited on a surface and the temperature and humidity of the environment, can also affect how long cold and flu germs stay active outside the body.

The dental staff should follow surface disinfection protocol for housekeeping surfaces using the appropriate chemical/ cleaner and process with dwell time. That said, they should be mindful, as strong cleaning solutions used to kill germs can cause respiratory problems. They should wear appropriate personal protective equipment (PPE) during cleaning and maintenance, including a Level 1 ASTM face mask, safety eye protection and

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Microfiber cloths and flat mop heads are recommended due to their ability to pick up and hold dirt, as well as efficiently absorb liquid, notes Keefer. “The absorbency of microfiber is up to seven times its own weight in liquid, which is great for cleaning spills or glass surfaces, without leaving streaks.” It can be helpful to keep colorcoded, microfiber cloths on hand for each purpose, she adds. “Using machine washable microfiber cloths can help cut the cost of disposable cleaning products, such as paper towels. By folding the microfiber cloth into thirds lengthwise, and then again in half provides, multiple clean surfaces during cleaning and dusting. And, it’s better to spray a cleaning/disinfecting product directly onto the cloth as opposed to the surface to reduce aerosol and respiratory hazards. In addition, she recommends adhering to the following protocols: • Windows, doors, walls and mirrors. All floors, walls, surfaces, cabinets, drawers, and equipment must be capable of being quickly and easily cleaned and disinfected. Using a microfiber cloth, damp wipe vertical surfaces and ledges, paying particular attention to smudges and fingerprints; use a cleaning agent as needed.

• High Touch Surfaces. This includes – but is not limited to – door handles, cabinet knobs, light switches, remote controls, phones and sink faucets, which should be cleaned and disinfected daily with an EPA-approved

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INFECTION CONTROL single-use disposable surface barriers may be used to protect electronics.

• Trash and Recycle Containers. Loose trash should be picked up throughout the day and properly disposed of.

When checking the trash bin for emptying, staff should refrain from reaching into, or pushing on, the trash liner to compress the trash. Rather, they should leave the liner in container, close the top, and twist and tie a knot in the top of the bag. (When disposing of the trash bag, it should be carried away from one’s body.) All surfaces of the trash container should be wiped down with a surface disinfectant wipe and allowed to air dry before replacing it with a new liner.

• Flooring. Carpets should be vacuumed daily using a HEPA filter, low decibel vacuum cleaner. They should be spot cleaned as needed, and cleaned every three months.

The CDC offers a number of resources, including its Summary of Infection PreHard flooring should be cleaned usvention Practices in Dental Settings: Basic Expectation for Safe Care (2016) and ing a broom or dust mop, followed Respiratory Hygiene/Cough Etiquette in Healthcare Settings, which are designed by flat-head mop for light cleaning. to limit the transmission of respiratory pathogens spread by droplet or airborne • Odors. Odors can be particularly ofroutes. The strategies primarily target patients and individuals accompanying fensive to patients and staff. A good patients to the dental setting, who might have undiagnosed transmissible respiraventilation system with charcoal tory infections; however, they apply to everyone – including dental healthcare filters can help minimize unpleasant personnel – with signs of illness, such as cough, congestion, runny nose and/or odors. Cautionary use of disinfecincreased production of respiratory secretions. tant/deodorant sprays is recomAdditional information related to respiratory hygiene/cough etiquette mended, as patients may be allergic can be found in the 2007 Guideline for Isolation Precautions (available or have respiratory concerns. at: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf).

Recommendations for preventing the spread of influenza are available at: Throughout the day, the dental staff http://www.cdc.gov/flu/professionals/infectioncontrol/. should practice proper hand hygiene. disinfectant. If high-touch surfaces become visibly dirty, they should be immediately cleaned and disinfected.

• Furniture. Regular vacuuming of upholstered items can refresh the fabric and keep furniture looking good. The dental staff should spot clean any fabric and use appropriate solutions for vinyl and leather surfaces. They should dust light bulbs and replace burned-out bulbs. Using plug protectors in electrical outlets help keep younger patients’ fingers safe.

• Tables and wood. All wood trim on furniture and tables should be dusted. A mixture of a cup of olive oil and a quarter-cup of white vinegar can nourish the wood and help it retain its shine. Plus, the vinegar is a natural germ killer. In addition, the furniture legs, the front of the

Infection prevention resources

reception desk and other surfaces should be scrubbed.

• Interactive toys. Toys, games and play equipment can be easily wiped clean. It’s helpful to limit toys to those that are washable, with fewer parts and smooth/flat surfaces.

Colorfast, plastic toys can be disinfected using a solution of a ½ cup of bleach per gallon of water. Toys should be soaked for five minutes, then rinsed and air dried.

• Electronic equipment. Televisions, monitors and cords should be wiped with a dry microfiber cloth approved for electronics and no-scratch surfaces. The entire surface of remote controls, keyboards and mouse pads should be wiped. It’s particularly important to address buttons, which are a source of cross contamination. Alternatively,

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Washing hands with soap and water is the best way to get rid of germs. If soap and water are not available, an alcohol-based hand sanitizer (minimum 60 percent) is recommended. The staff should offer respiratory prevention packets (i.e., a disposable surgical mask, facial tissues and cleansing wipes) to all symptomatic patients. And, they should attempt to isolate all patients with suspected illnesses.

Loose items should be kept organized in containers, office policies should be saved in plastic sleeves in a three-ring binder, and magazines and pamphlets should be stored in clear plexiglas holders and wall mounts to keep them orderly. “While studies have shown low fomite contamination of the glossy pages, some offices are removing magazines from the reception area and asking patients to bring their own reading materials and children’s toys to reduce the risk of cross contamination,” says Keefer.

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AIR TECHNIQUES: BY PATTI DIGANGI

Selling Clean Water Guiding a Series of Important Decisions and Actions

Humans can live 3 weeks without food, but only 3 days without water.

Water is indeed essential – clean water without contaminants.

Most of us have all heard about the Flint Michigan water crisis that is still ongoing. It was a series of decisions, none of which may have been harmful by themselves, that together created a disaster.

This kind of disaster could be happening in your clients’ dental unit waterlines (DUWL), unintentional yet very dangerous.

Questions to Ask about Daily Line Cleaner (adapted from Karen Siebert, RDH, MA)

Helping Your Clients Protect Their Patients Water safety is no joke – especially to immunocompromised and immunosuppressed people. More than 50 million Americans experience various types of allergies each year. Allergies are the 6th leading cause of chronic illness in the U.S. Allergic diseases and symptoms occur because of an active immune system. Treatment generally works to suppress the allergic reactions creating immunosuppression.

Maintaining DUWL Safety The need for DUWL safety is not limited to immune-challenged patients. Risk is somewhat inherent due to the size of waterlines.

Heterotrophs are a group of microorganisms like yeast, molds & bacteria that use organic carbon as food as opposed to autotrophs like algae that use sunlight and are found in every type of water.

The CDC and the EPA regulatory standards call for < 500 CFU/ml of heterotrophic bacteria in DUWL. Research shows microbial counts can reach 400,000 CFU/ml within 5 days after installation of a new DUWL.

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Do You Know the Simple Steps to DUWL? OSAP’s DUWL Question and Answer can help understand the simple steps to be taken to reduce risk, which you in turn can explain to your clients.

A simple step, that must become routine, is flushing waterlines. Minimally, several minutes each morning; at least for 20-30 seconds between patients; and at the end of the day for several minutes. This can reduce the number of microbes and remove contaminants between patients. Unfortunately, flushing only reduces the risk temporarily.

Three-Step Process

• Is this product FDA and EPA approved as germicidal and patient compatible?

• Is this product compatible with your equipment?

• Are any ingredients considered hormone disruptors or carcinogens?

• Does the active ingredient kill a wide spectrum of microorganisms?

• What is the recommended contact time for product effectiveness?

• What is the pH of the product?

• Do any of the ingredients affect material bonding capabilities?

• What is the cost per treatment?

• Can this product be used for a shock treatment as well as daily/weekly maintenance?

• Is it time efficient for the staff?

www.firstimpressionsmag.com

There are three critical steps to reduce DUWL risk – test, shock, and maintain.

1. Testing is the only way to know the quality of water. Chairside/in-office monitoring can be considered more of a screening than a test. Laboratory testing, though not mandated, is more reliable, relatively inexpensive, and highly accurate.

2. Shocking is needed when the results of testing shows > 500 CFU/ml. A shock treatment is designed to completely dislodge an established biofilm from the length of DUWL tubing.

3. Maintaining the waterlines daily and weekly continues to slow or prevent new adherence.

Recommending the Right DUWL Products There are so many DUWL cleaning product choices that it can become almost overwhelming to choose. Box 1 has some suggested questions to ask.

The product chosen must be an effective biofilm disruptor. At the same

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Surface Disinfection

time, it needs to be gentle on equipment and have no effect on restorative materials.

Time is money so it needs to be time efficient as well as sustainable with no harsh chemicals or leave a residue.

This means, we must be picky when selecting products.

For example, Monarch Lines Cleaner is a powerful formula that helps attack accumulated deposits in tubing lines without the use of harsh or aggressive chemicals.

This product can be used

AT-M Lines FirstImp 1-19.indd 1

Instrument Cleaning

We take clean water for granted because it has always been there.

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Equipment Maintenance

as shock treatment and for weekly DUWL cleaning for any12/18/2018 type of self-contained water bottle systems. It is pH-neutral which means, it is non-corrosive and gentle to equipment; won’t corrode metals, clog valves, or stain.

2:13:29 PM

Initiating a Series of Decisions Having clean water isn’t something we had to think about growing up. We’ve always expected clean water to be provided so that we can live life and not be worried if we have anything to drink. We take clean water for granted because it has always been there.

A water crisis can happen anywhere – even in dental offices with waterlines. A series of actions or inactions, none of which may have been harmful, together can create a disaster when combined.

This has become very real to this immunocompromised author and all patients. Our moment-by-moment decisions make a difference.

About the author: Patti DiGangi, RDH, BS is an international speaker who is passionate about prevention and working with dental professionals to improve practice profitability. Her own immunocompromised situation makes her passionate about prevention.

Patti is the author of the DentalCodeology™ book series for busy dental professionals. Patti also holds publishing and speaking licenses with the American Dental Association for Current Dental Terminology and SNODENT Diagnostic Coding and recently authored a chapter in the American Dental Association’s CDT 2017 and CDT 2018 Companion entitled “D9000 – D9999 Adjunctive General Services.”

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January 2019

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INFECTION CONTROL

Safe Water, Safe Patients Growing attention to the hazards of contaminated dental unit water has led more dental clinicians to take the necessary steps to protect their patients.

There are no shortcuts to obtaining compliant dental water. Without the right products and protocols, however, dental practices will not be able to meet the acceptable standard for water delivered to patients during non-surgical procedures.

What’s more, even though compliance with water safety standards in the United States has not been required by law, that is changing.

“A dental practice simply will not achieve compliance without effective, EPA-validated products used in accordance with the correct protocols,” says Jerod Mendolia, marketing assistant, Sterisil, Inc. “At Sterisil, our philosophy is embodied in the acronym, PPC: Products + protocols = compliance. We have applied this methodology with great success in various settings, from mid-sized five-chair clinics to Ivy League dental schools.”

New technology is important, he adds. But unless clinicians are educated on the appropriate protocols and develop a conscientious attitude, “we are setting them up for failure.”

A serious business Because dental water is used as an irrigant solution in conjunction with high-speed rotary handpieces, potentially contaminated aerosols and spatter can carry waterborne pathogens through the air, increasing the potential for infections. Unwanted health implications associated with contaminated dental unit coolants range from the exacerbation of existing asthma symptoms due

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to endotoxin exposure to complex bacterial infections, such as Legionnaires’ disease, according to the Organization for Safety and Asepsis Prevention (OSAP).

In recent years, two high-profile cases have linked dental unit water to serious infections, notes Mendolia. The first incident occurred at Dentistry for Children in Jonesboro, Georgia. A second incident occurred at Children’s Dental Group in Anaheim, California. In both cases, Mycobacterium were isolated as the cause of infections in pediatric patients who received a pulpotomy procedure with contaminated dental unit water, he points out.

Although the Centers for Disease Control and Prevention (CDC) has recommended that water delivered to patients during non-surgical dental procedures meet Environmental Protection Agency (EPA) standards for drinking water (<500CFU), some question whether this is sufficient in a clinical environment. “In 1995, the American Dental Association challenged dental unit manufacturers to develop the equipment necessary to deliver effluent handpiece water with <200CFU,” says Mendolia. That standard has since been raised to the <500CFU/ml drinking water standard. “Currently, there are many products on the market validated to deliver levels of disinfection well below 200CFU. I don’t think it is unreasonable to expect dental professionals to meet this higher standard considering the number of products and protocols available with advertised effectiveness claims at ≤10CFU.”

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The right solution For many dental professionals, the importance of delivering safe water during patient treatment is clear. Navigating their options, however, can sometimes be tricky. There are several methods available for treating water, notes Mendolia, and clinicians must stay informed in order to best serve their patients. There are advantages and disadvantages to each.

There are many filter options capable of removing some level of microbial contaminants, but without the presence of a residual disinfectant, filtration alone is insufficient to consistently maintain and prevent microbial growth downstream from the filter, according to Mendolia. For best results, filtration should be paired with an ion exchange-based product for shock and residual disinfection. “Clinicians should steer clear of filtration methods that require water storage in a tank,” he says. “Unless the practice has something like a UV light after the tank, water storage can lead to incubation of existing bacteria in the tank to >500CFU. Most waterline treatment products will have some sort of disclaimer stating for use with potable water. So, contaminated storage tank water would be unsuitable for use with many chemical treatments based on this alone.

“Since the introduction of the independent bottle reservoir, chemical treatments have become a viable and convenient

method for reducing effluent dental water microbes,” he continues. “When dental clinicians follow the instructions for use (IFUs), they can expect good results. However, when using municipal tap water, they must do so with caution. Municipal contaminants like chlorine and copper can interfere with the efficacy of some chemical treatments. The best regimens will always feature both shock and maintenance treatments that are compatible with one another. Whenever possible, clinicians should use distilled water in their bottle reservoirs for the best results.”

In theory, in-office distillers are a viable solution, notes Mendolia. However, they are often associated with water test failures. “The machinery of distilling demands regular cleaning and disinfection to ensure the water purity and microbial viability,” he explains. “Once water has been heated into a gas and condensed back into liquid, it no doubt will be above room temperature. This increases the likelihood you are incubating bacteria as it’s stored. Without a residual disinfectant or some sort of shock treatment prior to introduction to the chair, it’s unlikely the 500CFU drinking water standard will be met, and the practice risks violating the manufacturer’s labeling.

“Don’t get me wrong,” he says. “Distilled water is much better than municipal tap water in just about every way. But physically distilling water is not the most effective method. Deionized

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INFECTION CONTROL water is essentially the same thing, and the process by which it is created does not increase the bacterial content. It is for this reason, all Sterisil systems employ this technology as the final purification step. Now you have a very pure base water to which a residual disinfectant can be introduced, with minimal interference from microbes or chemical contaminates.”

Pre-sterilized water is clean enough for any dental procedure, says Mendolia. “However, once it is introduced into a dental chair, it is unlikely to meet the <500CFU standard,” he points out. “Unless the dentist intends to irrigate with singleuse pipettes or purchase a very expensive sterile water generator, this will not be a viable option.” And, the cost of purchasing sterile water makes this an unaffordable option for many dental practices, he adds.

Mendolia recommends that dental practices use their bottle reservoirs for their intended purpose. “The independent bottle

and protocol’s efficacy, and subsequent tests validate the protocol execution throughout the product’s lifespan (assuming the product did not expire prematurely). If both tests pass, the practice can begin testing every six months. If there is a test failure, the clinician should shock immediately and retest per the waterline treatment manufacturer’s IFU. I personally recommend testing through a third-party lab that specializes in dental water microbes, like Agenics. They offer HPC counts and many other water chemistry metrics that help diagnose problems should they arise.”

Legal precedent Compliance with water safety standards in the United States has not been required by law. But, that’s quickly changing. “Water compliance may not have been the law in 2016, when 73 pediatric patients contracted Mycobacterium infections from contaminated dental water at Children’s Dental Group in Orange County, California,” says Mendolia. However, in 2019, it will become a law in California, he points out, noting that eventually much of the country will likely follow suit.

“What I try to impress on people is that this issue isn’t going away,” he says. “Now that there are legal precedents associated with patient vs. clinicians, and manufacturers vs. clinicians, with regard to this topic, it will be difficult for dental clinicians to prove in court that they are not responsible for any infections related to dental water in their practice, even if they weren’t legally required to take action.”

That said, for some dental professionals, cost will always be an obstacle. “We must focus on the relative cost per liter differences among the various products, relative to their overall need for water,” says Mendolia. “If a large practice intends to confront this problem head on, it would serve them well to go with the option that has the lowest cost per liter. That’s not always the lowest initial cost, but the purchase will pay for itself with time.

Sometimes dental practices just want to get their toes wet, so to speak. “Low cost options like Citrisil tablets are a good place to start, with the same great treatment you get from the higher end products,” he says. But, they’re not as convenient as a long-term solution. “The low-cost options in this category always leave something to be desired when it comes to efficiency and cost per liter.”

As more practitioners are on board with the need for waterline treatment, they are looking for solutions that provide enhanced efficiency and require less staff involvement, notes Mendolia. “We are here to help,” he adds.

“ A dental practice simply will not achieve compliance without effective, EPA-validated products used in accordance with the correct protocols,” says Jerod Mendolia, Sterisil, Inc. reservoir was designed to isolate the dental unit from municipal tap water and provide a conduit through which antimicrobial treatments could be introduced,” he says. “Tap water is not suitable for the dental setting for many reasons, but particularly due to the infinite variability in water chemistry. If clinicians are using residual disinfectants to control microbes in a dental chair, these details matter. Distilled water will always save the dental practice a lot of headaches in the end, trust me.

“Dental practices should always consult with their dental unit manufacturers and their waterline treatment providers about water testing,” Mendolia continues. “Minimum standards for water testing should be followed whenever possible, even though they are recommendations rather than requirements. If the dental practice’s protocols are in line with these standards, it is off to great start.”

A passing water test verifies the absence of bacteria and validates the dental practice’s disinfection efforts, he points out. “According to OSAP, dental practices should be testing within 30 days of introducing a new product or new protocols, and then every 30 days thereafter,” he says. “The initial test validates the product

18

January 2019

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