Remediating Failures

Identifying When Remediation is Needed

When bacterial levels in the waterlines exceed 500 CFU/mL then remediation is required. Remediating waterlines is not uncommon. In a recent JADA publication 40% of dental personnel reported having failed a waterline test. However, there are additional circumstances when dental waterline remediation may be necessary, so it is important to bring awareness to the following:

• Installation of new equipment or maintenance/repair of existing
• After lengthy office closure – if dental waterlines have not been used for an extended period of time, stagnant water remains in the lines. The design of the small tubing becomes a breeding ground for bacteria, increasing the bacterial load.
• Boil water advisory – this can impact practices that use municipal water with or without independent water bottles. This advisory would apply to dental handpieces, ultrasonic scalers, air/water syringes, and any other equipment that utilizes public water.

If Your Waterline Test Failed...Take Action

What is the difference between a shock (periodic) and continuous (maintenance) waterline treatment? Periodic treatments are used to quickly bring high bacterial counts down to the EPA standard of less than 500 CFU/mL and are NOT safe for use during patient treatment. Whereas, maintenance treatments are delivered in the form of waterline maintenance tablets, liquids, cartridges or straws which assist in maintaining bacterial levels at or below the EPA standards. Maintenance waterline treatments ARE safe for use during patient care.

A recent survey reported that approximately 50% of dental offices shock and retest their DUWLs and 38% place a service call to their local product representatives after two failed waterline tests. Let's look at current HuFriedyGroup DUWL treatment products for both dental waterline shock and maintenance.

Shock (periodic) Treatment - Liquid Ultra Solution

Liquid Ultra Solution is a powerful shock treatment for independent bottle systems. Liquid Ultra Solution is the only product on the market that is registered with the EPA with a "biofilm bacteria kill" claim, which prevents the formation of biofilm as well as removing existing biofilm from waterlines. This pink solution allows users visualize when the solution is drawn into water lines and flushed out. This product requires a three consecutive night protocol.

Shock (Periodic) Treatment - VistaTab Dental Waterline Cleaner Tablets

VistaTab Dental Waterline Cleaner Tablets are for use with independent water bottles. Once these antimicrobial tablets are added to water, they will dissolve and turn the water blue. These tablets will clean and control microbial contaminants in the dental waterlines. The protocol for use can be completed in about 15 minutes.

Maintenance Treatment – DentaPure Cartridges

DentaPure Cartridges provide continuous water treatment for 365 days or 240L of water usage. Non-allergenic elemental iodine is used to maintain bacterial levels ≤200 CFU/mL. Cartridges can be installed into dental units that are plumbed directly into the municipal water system or with independent water bottles.

If there are questions or additional support is needed with your waterline management program, I encourage you to reach out your selected product manufacturer, they are the experts with their product and they are there to help you.

Successful Remediation, Now What?

Once the waterlines have been remediated, what can offices do to ensure that the water in the dental lines remain at a safe level?

• Test waterlines every three months or per state/local guidance and remediate as necessary
• Use waterline maintenance treatments to maintain safe bacterial levels
• Be aware of local boil water advisories if applicable to your practice
• Do not use water heaters on dental units or warm water in independent water bottles; 68°F promotes bacterial growth
• Eliminate dead legs on dental units
• Flush dental lines for 20-30 seconds between each patient per CDC guidance and additionally per specific product instructions

Simply talking about testing and remediation protocols isn't enough; it needs to be established, documented, and shared with the entire dental staff. In our final blog of the series we will be primarily focusing on creating a water management protocol, continuing education, and highlighting the GreenLight Dental Compliance Center by HuFriedyGroup. At the end of this four-part series it is our goal that you understand; the who, what, why, how, and when of dental waterline maintenance.

Don't Wait for a Second Failure – Implement a remediation and maintenance plan now.