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Infection control > #9 Dental Unit Waterline Asepsis > Flashcards

#9 Dental Unit Waterline Asepsis Flashcards

1
Q

What was the History of Dental Unit Waterline ?

A
  • Contamination first reported (1963) by Dr. Blake in Great Britain
  • Hand pieces cooled by separate water reservoir
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2
Q

What was the problem?

A

-Microbes colonize dental water lines forming biofilm leading to contaminated water & aerosols.

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3
Q

What are biofilms?

A
  • Microbial colonies that adhere to solid surfaces in areas where there is sufficient moisture
  • Portions of the biofilm break away, contaminating the water with high levels of bacteria
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4
Q

What are 3 examples of bacteria that can colonize the biofilms?

A

1) Pseudomonas aeruginosa
2) Staphylococcus aureus
3) Legionella species

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5
Q

What are 5 components of the biofilm?

A

1) Seeding dispersal
2) Rolling
2) rippling
3) streaming
4) detaching

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6
Q

What is the Safe Water Drinking Act set level (How much bacteria is present) for MUNICIPAL water ?

A

500 CFU/mL

Colony Forming Units

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7
Q
  • What are the untreated DUQL levels ?

- What is the counts reported within 5 days of installation of new lines?

A
  • 1,000-1,000,000 CFU/mL

- 200,000 CFU/mL

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8
Q

What is the bacterial population explosion every 20 minutes?

A

1 bacteria –> 8 a.m
4096–> 12 noon
134,217,728 –> 5 p.m

(contamination peaks at about 24 hrs)

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9
Q

Where do the bacteria come from?

A

1) The oral cavity
2) The waterlines
3) cross contamination

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10
Q

Where do the majority of microorganisms come from?

A
  • The municipal water system
  • Some come from anti retraction device failure
  • There have been reported cases of cross contamination into the DUWL becomes of..
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11
Q

What is the Anti-Retraction Valve?

A
  • Prevents back flow of fluid from patient into DUWL
  • Failure allows retraction of fluid from patient #1 into the waterline, contaminating lines.
  • Bacteria then delivered to patient #2
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12
Q

What are the characteristics of the DUW?

A
  • Very small diameter 1/16” to 1/8”
  • Very slow flow rate-drips/second
  • Plastic tubing is hydrophobic (biofilm attachment)
  • Tubing provides carbon for the bacteria
  • Large surface area to volume ratio
  • Interior surface is rough
  • Left stagnant for hours
  • Chlorine dissipates over 24 hrs
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13
Q

What are the characteristics of Tap Water?

A
  • -1/2” diameter
  • 5 L/min flow rate= 1000X dental flow
  • Copper is antimicrobial & bacteriostatic
  • Small surface area to volume ratio
  • Interior surface is smooth
  • Line is flushed w/ fresh water often
  • Cholinated at every use
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14
Q

What is the DUWL-Surface colonization?

A
  • Mineralized found in water are deposited on surface tubing
  • Molecules in water help bacteria found in the water to adherer to these surfaces
  • Overtime a micro colony is formed
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15
Q

What is the DUWL-Surface: volume?

A

-As the diameter of the tubing decreases, the surface area covered by biofilm increases. At the same time, the volume of water passing by DECREASES

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16
Q

What is an example of a Biofilm Disease?

A

Legionellosis (Water borne bacteria)

  • Flu-liek symptoms called PONTIAC FEVER
  • Pneumonia

-Two fatal cases in Legionellosis in dentists
(Dentists’ blood tested at 5% higher than vernal population= occupational exposure)

17
Q

-Where can Legionnaries disease be traced?

A
  • Bacteria can be traced to the air-conditioning/cooling system of the hotel
  • Dental offices b/c of the right conditions
18
Q

Legionnaries disease

S/S?

  • When does it develop?
  • How is bacteria carried?
A

-Develops 2-14 days after exposure to Legionella bacteria

  • Headache, muscle pain, chills, fever of 104+
  • Cough, shortness of breath, fatigue, loss of appetite, GI upset.
  • **Affects primarily the lungs
  • Bacteria carried in AEROSOLS of WATER VAPOR, not person-to-person.
  • Environment for growth of Legionella
19
Q

What are the ideal growth conditions for Legionella?

A
  • Stagnation
  • Temp = (95-115)
  • pH = 5-8.5
  • Sediment that tends to promote growth of commensal microflora
  • Algae, flavobacteria, and Pseudomonas, which supply essential nutrients for growth of Legionella or harbor the organism (amoebae, protozoa)
20
Q

What do studies show for L.pneumophilia compared to 8% of general population?

A
  • 23% of dental staff working for > 2 yrs were antibody + for it compared to the 8% general population
  • Exposure to endotoxins found in DUWL has been associated with onset of asthma in a subgroup of dentists
21
Q

What is the Safe Water Drinking Act set level (How much bacteria is present) for Dental water ?

A

200 CFU/mL

Per ADA 1996

22
Q

In 1993 CDC encouraged dentists to __________________ in the air-water syringe valve

A

Install anti-retraction devices

23
Q

Does it make sense to sterilize a hand piece or ultrasonic tip, and run contaminated water through it?

A

No!
But instead:
-Flush water through the lines-temporary effect
-Independent reservoirs
-Chemically treat water (Regular tap water with tablet)

24
Q

What is the Chemical Treatment?

A
  • Chemicals include iodine, chlorine, ozone, chlorhexidine, silver, peroxides, & organic acids
  • May be time-consuming and technique sensitive
  • Potential incompatibility w. the dental equipment
25
Q

What do Independent Reservoirs allow?

A
  • The quality control by individual unit
  • Provides a way to introduce chemical agents if need be
  • Must be properly maintained to be effective
26
Q

What is our procedure at ASDOH?

A
  • 2 Water-Purification/Filtration systems made by STERISIL
  • Some filtered changed quarterly some annually. Filters include UV light filter
  • Water is tested quarterly. 4 DUWL upstairs, 4 downstairs.
  • REPORTS are WATER at 0-5 CFU/mL
27
Q

What is the Maintenance at ASDOH?

A

1) Wash hands
2) Student retrieve bottles from area near the Dispensary
3) Wash hands
4) Change bottle
5) Flush lines

28
Q

What is the Maintenance?

A

1) Consult manufacturer of dental unit for recommendations
2) monitor dental water quality using self-contained TEST KIT
3) Monitor when changing existing equipment
4) Keep RECORDS of monitoring results

Infection control (8 decks)

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