9 Actionable Steps from OSAP to Ensure Dental Water Quality

It can be easy to get lost in the details of OSAP’s 2018 publication regarding dental unit water quality. So we broke down the information to help dental professionals know what to do next.

Let’s explore the 9 actionable steps we saw in Shannon Mills, DDS, Nuala Porteous, BDS, MPH, and Jeff Zawada, Ph.D.’s white paper, Dental Unit Water Quality: Organization for Safety, Asepsis and Prevention White Paper and Recommendations–2018

9 Actionable Steps from OSAP for Dental Water Quality

1. Dental unit water quality is essential for great patient care

While dentistry has seen some horrific cases of dental infection due to unmaintained dental unit waterlines (like the heartbreaking case of pediatric infection in Anaheim, CA), there are still many professionals in the industry that are unaware of the risk associated with untreated waterlines.

Unfortunately, we have had to see the worst-case scenarios for many in dentistry to understand the gravity of waterline-based bacterial infections. It’s up to each team member within a practice to prioritize office-wide safety.

2. Create standard operating procedures (SOP) and assign an Infection Control Coordinator

Consistency is a key element of waterline safety compliance. The development and implementation of Standard Operating Procedures (SOP) in your office will create a concrete process for waterline maintenance that can be followed by all team members. Within your SOP should be guidelines for properly maintaining test results and implementing treatment procedures.

If there is ever a complaint against your office, OSHA, the Department of Health, or the Dental Board will request documentation proving your infection control compliance. In those situations, you always want to show your practice is above board. That is why OSAP and the CDC recommend identifying an Infection Control/Prevention Coordinator who can, among other duties, help ensure that procedural water quality testing records are maintained and available if needed.

If you need help developing an SOP for your office or have questions about how best to test its effectiveness, schedule a quick chat with one of our experts today.

3. Review manufacturer guidelines before starting

In short, make sure to reference manufacturer recommendations for waterline treatment as too often, dental pros are sold one thing when the instructions suggest another. Mills, Porteous, and Zawada explain in the white paper, before beginning any treatment protocol “review instructions for use from the dental unit or device manufacturer for controlling contamination in the water lines and maintaining the quality of dental procedural water.” (p.14)

4. Flush lines at the beginning of the day, between patients, and at the end of the day

While flushing lines alone cannot remove or kill biofilm, this action is important for moving stagnant water, which can be an ideal breeding ground for harmful bacteria. OSAP recommends that dental professionals “flush waterlines for 20-30 seconds at the beginning and end of day and between patients to remove patient material potentially retracted during treatment.” (p.14) Additionally they, “[do] not recommend flushing as a sole means to improve dental procedural water quality.” (p.15) Meaning each dental practice should still be using a shock and treatment solution.

5. Test all dental waterlines regularly

Mills, Porteous, and Zawada explain that if a “dental unit exceeds the action limit for an initial or periodic test, the unit should be treated according to manufacturer IFU, and re-tested immediately after treatment.” (p.17) As a starting point, OSAP recommends that dental offices should begin by testing all waterlines monthly to ensure consistently compliant results. Remember that regardless of if you use one line more than others, it’s essential to test all lines as biofilm can spread between connected lines.

After consistent passing results in a row, your office can move to a quarterly testing cycle. Check out our Complete Guide to Testing Dental Unit Waterlines for more information.

6. Shock all waterlines to enable treatment products to be successful

Shocking, which utilizes a strong solution to break down and kill biofilm build-up, is essential to the process of waterline maintenance. Once shocked, waterlines are brought back to compliant standards and help continuous treatments, like tablets or straws, to work effectively.

For more information on this, we created the Complete Guide to Shocking Dental Unit Waterlines.

7. Do not rely solely on distillers or reverse osmosis devices

While these products can be helpful in maintaining clean water, Mills, Porteous, and Zawada caution that “distillers, reverse osmosis and microfiltration devices that can remove microorganisms from procedural water…do not effectively limit the growth of biofilm in DUWL or reservoirs without addition of germicidal agents or other anti-biofilm treatment.” (p.9) These continuous treatment products cannot and should not be relied upon as the primary means for controlling the growth of bacteria. Instead, we recommend implementing a shock and treatment protocol for effective results.

8. Use sterile water in situations where it is required

As OSAP describes it, “use only sterile solutions for coolant and irrigation supplied by a sterile device for surgical procedures that involve the incision, excision, or reflection of tissue that exposes initially sterile areas of the oral cavity” (p.14) as well as non-surgical tooth extractions, gingival procedures, and non-surgical endodontic procedures.

9. Stay informed

OSAP calls on dental pros to “make a reasonable effort to stay informed about current recommendations on the use of water for dental treatment and on the control of microbial biofilm contamination in DUWLs.” (p.14)

We advise that you work with an infection control consultant, maintain updated CEs, and regularly test your waterlines. It’s also a good idea to partner with a dental water lab (like ProEdge!) to stay on top of the latest options in testing, treating, and shocking.

What is the next step?

While the publication by OSAP provides a robust foundation for waterline maintenance, we recommend taking a look at our Complete Guide to Dental Unit Waterline Maintenance to help your practice determine the next steps.

Should you have any questions along the way, never hesitate to reach out to us. We are here to help you untangle the often complicated world of dental waterline maintenance.