WATERLINES: SCIENCE & FCDH PROCEDURES Group #6: Kenia, Amanda, Jill, and Nina.

WATERLINES: SCIENCE & FCDH

PROCEDURES

Group #6: Kenia,

Amanda, Jill, and Nina

WHAT DO YOU KNOW ABOUT WATERLINES?

• Waterline is a thin, plastic, flexible tube that is 0.5mm-1.0mm in diameter

• A solid surface that is consistently in contact with water, delivering it to handpieces and suctions

• A optimal home for microorganisms to flourish and cause biofilm to form

WHAT’S IMPORTANT TO KNOW ABOUT WATERLINES?

• Comparison of material used in dental unit water lines– Polyurethane

• Used in most dental unit waterlines– N-halamine

• New research shows that N-halamine is a superior material to be used in a dental unit waterline because it inhibits the growth of biofilm

WHAT’S IMPORTANT TO KNOW ABOUT

WATERLINES? CONTINUED

WHAT’S IMPORTANT TO KNOW ABOUT WATERLINES? CONTINUED• CDC, EPA, American Public Health Association,

and American Water Works Association advise that the maximum standard drinkable water should be at 500 CFU/mL or less

• Water sources used in dental unit waterlines come from:

‐ Public city water or distilled water

• The microorganisms in water amplify when going through dental waterline units

WHAT IS THE ACTION OF RUNNING A WATERLINE?• It’s not: The suctioning of

the water • It is : The action of water

flowing through the lines

CLASS QUESTION: WHAT IS BIOFILM?

• Biofilm is a well-organized community of bacteria

• It adheres to surfaces and is imbedded in an extracellular slime layer

• Biofilm can be found in things that we see everyday such as a pets water bowl and pools.

https://www.youtube.com/watch?v=VYGRN9AwZrw

BIOFILM:

BIOFILM CONTINUATION:

Components of a biofilm development: an extracellular slime layer, fluid channels, sessiles, and bacterial communication.

1. Bacteria first adhere to a surface

2. Bacteria communicate with each other and build up to form mushroom shaped communities called a “sessile”.

3. Fluid channels run through the center of the community transporting nutrients and supporting the growth of anaerobic bacteria.

4. Protective slime layer surrounds and protects the community.

CLASS QUESTION: WHAT DOES

RUNNING THE WATERLINES DO?

• Limits the build up of biofilm in the waterlines.• Flushing reduces the microbial count in the

water temporarily• Helps to clean the waterlines of

microorganisms that have entered via suck-back

• This is the most inexpensive way to reduce biofilm in waterlines without needing to purchase additional equipment

WHAT DOES RUNNING THE

WATERLINES DO?

CLASS QUESTION: CAN WATERLINES

CAUSE CROSS CONTAMINATION

OF DISEASES LIKE HIV AND HBV?

CDC States:• The route of transmission of blood-borne viruses is through

intimate contact with blood or other potentially infectious body fluids

• Diseases are not in any type of water source and is highly unlikely, the risk of transmission of HBV and HIV in water is very low

• The risk of contamination from cross-connections of dental operative units is nearly zero

• Backflow prevention devices, when required, should be consistent with this very low degree of hazard

Spread of biofilm is very possible and could harm the patient

WATERLINES AND CROSS

CONTAMINATION OF DISEASES

• Standard of Care: do no harm to patients– Non-maleficence

• Not only do we want to protect the patients, but we want to protect ourselves

• As dental professionals, we will be concerned about biofilms that form in the mouth and within our dental unit waterlines

WHY IS THIS IMPORTANT TO HEALTHCARE PROVIDERS?

• Research shows that Pseudmonas aeruginosa was found in the air/water syringe at it’s highest amount in the beginning of the day prior to being flushed.

IMPORTANCE TO HEALTHCARE PROVIDERS

CONT’:

Pseudomonas aeruginosaPseudomonas cepaciaPseudomonas fluorescensPseudomonas resiculariesPseudomonas posimobilis

Legionella spp

Achromocater xylaxidansKlebsiella pneumonialSerratia marcessensNocardia spp.Streptococcus spp.

• Purge waterlines, this includes first removing handpieces, air-water syringe tips, and ultrasonic tips:– At the beginning of the day– Between each patient: flush waterlines for

20-30 seconds to significantly reduce biofilm– At the end of the day

• Proper disinfection can prevent spread of microorganisms

• Waterline valves must be maintained, clinic maintenance

HOW TO REDUCE THE AMOUNT OF BIOFILM IN

WATERLINES

WHAT IS THAT PINK STUFF WE SUCTION THE WATERLINES

WITH?WHAT DOES IT

DO?

• Powerful cleaning solution that dissolves and destroys a wide range of dental debris

• keeps the trap and evacuation lines open, prevents build-up that can hinder the system’s performance, and helps the system operate properly and more efficiently

• Dissolves away the toughest debris to provide optimal suction.

• Dissolves: impression materials, bone fragments, organic tissue, rope-like saliva, and calcium deposits that can build on the evacuation pump.

• FDA regulated

THE PINK STUFF

• Inhibits the growth of microbial contamination in the Dental Unit Waterlines

• Waterline maintenance

• Non toxic, odorless, tasteless

• no effect on enamel and dentin bonding to composite

• EPA and FDA regulate

BLU TAB

Our videohttp

://www.youtube.com/watch?v=MLHXmZRcg3A

FOOTHILL POLICY

1. What does running the waterlines do?C) Temporarily reduces microbial count in the

water2. Which dental appliances were found to have the most microbial count?

B) Air and water syringe3. Which component in biofilm allows nutrients to flow though it?

C) Fluid channels4. Polyurethane is the most effective material in dental unit waterlines to keep a low microbial count within the lines.

False5. What does Purevac do?

A) Dissolves biofilm and impression materials, and bone fragments

QUIZ ANSWERS:

• Porteous N, Luo J, Herrera M, Schoolfield J, Sun Y. Growth and Identification of Bacteria in N-Halamine Dental Unit Waterline Tubing Using an Ultrapure Water Source. Intl J Microbiology [Internet]. 2011 Sept 19 [2012 Jul 16]; 2011(767314): Location. Available from: http://hindawi.com/journals/jimb/2011/ 767314/

• Depaola, L, Mangan, D, Mills, S, et al. A review of the science regarding dental unit waterlines. J Am Dent Assoc. 2002; 133, 9: 1199-1206.

• Appendix A: Regulatory Framework for Disinfectants and Sterilants [Internet]. MMWR. 2003, Dec 19; Vol 52: 62-64. Atlanta. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a2.htm

• Reddy, Padma. Control and Prevention of Biofilm in Dental Office. Indian Journal of Dental Advancements; April-June 2011: 512-519

• Watanabe, E., Agostinho, A.M., Matsumoto, W., Ito, I.Y. Dental unit water: bacterial decontamination of old and new dental units by flushing water. International Journal of Dental Hygiene; February 2008: 56-62

• Byrd Mann, Ginger L., Campbell, Tamara L, Crawford, James. Backflow in low-volume suction lines: the impact of pressure changes. Journal of the American Dental Association [Internet]. May 1996; Vol. 127: 611-615. Available from: http://www.wsulibs.wsu.edu/quickguides/nlm

• Al-Hiyasat AS, Ma’ayeh SY, Hindiyeh MY, Khader YS. The presence of Pseudomonas aeruginosa in the dental unit waterline system of teaching clinics. Int J Dent Hyg 5. 2007:36-44  

• PUREVAC Evacuation System Cleaner-Sultan Healthcare[Internet]. Hackensack. Sultan Healthcare [Internet]; [One screen]. 2007 © Sultan Healthcare All Rights Reserved. Available at:http://www.sultanhc.com/sw/swchannel/productcatalogcf_v2/internet/model.asp?ProductMasterID=297561&ParentID=215652&SWID=1

• Dental Product Shopper. Your source to product evaluations and amp; Information [Internet]. Manalapan. Dental Supply Shopper [Internet]; [One screen]. Available at: http://www.dentalproductshopper.com/purevac-sc

REFERENCES