Maintaining Dental Unit Waterlines    The waterlines of dental units (DUWLs) are susceptible to biofilm formation especi

Maintaining Dental Unit Waterlines

   The waterlines of dental units (DUWLs) are susceptible to biofilm formation especially because of small diameter of tubing, low water pressure, and prolonged stagnation periods. These environments enable the attachment of microorganisms, multiplication and development of biofilms that are hard to eliminate. Due to the production of aerosols during dental procedures, both patients and staff can be exposed to infectious microorganisms by untreated biofilms (Centers for Disease Control and Prevention [CDC], 2016).

  Pseudomonas aeruginosa, Legionella pneumophila as well as Mycobacterium species are the common pathogens in DUWL biofilms. These opportunistic pathogens can lead to respiratory disease, pneumonia, or systemic infection among patients at risk (Dimensions of Dental Hygiene, 2021).

  Dental waterline management protocol should be written and state the daily flushing protocol, use of antimicrobial agent approved by the EPA and periodic shock therapy to break down biofilm. It should also contain a schedule of monitoring, documentation practices and remedial measures during instances where the water quality surpasses the recommended bacterial threshold (CDC, 2003).

  The importance of regular DUWL testing is that biofilms reform rapidly following treatment. Testing is used to confirm effectiveness of the maintenance practices and compliance with CDC and ADA recommendations of [?]500 CFU/mL of heterotrophic bacteria in patient care water (CDC, 2016).

  Surgical operations in dental practices should be conducted using sterile water or saline via sterile delivery tube instead of using the usual waterlines. This lowers risks of the direct introduction of microorganisms into open surgical sites (CDC, 2003).

  There are two important CDC documents that guide the management of DUWL: the Guidelines on Infection Control in Dental Health-Care Settings (2003) and the Summary of Infection Prevention practices in Dental settings (2016). They both focus on the chemical treatment and regular testing, along with a highly patient adherence to infection prevention requirements.

References

Centers for Disease Control and Prevention. (2003). Guidelines for infection control in dental health-care settings, 2003. MMWR, 52(RR-17), 1–61. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

Centers for Disease Control and Prevention. (2016). Summary of infection prevention practices in dental settings: Basic expectations for safe care. U.S. Department of Health & Human Services. https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/index.html

Dimensions of Dental Hygiene. (2021). Strategies for dental unit waterline management. https://dimensionsofdentalhygiene.com/article/strategies-for-dental-unit-waterline-management