Treatment & testing of waterlines: how the U.S. Air Force minimizes bacteria buildup in waterlines.
Article Type: Report
Subject: Infection control (Methods)
Infection control (Military aspects)
Bacteria (Risk factors)
Bacteria (Prevention)
Shorelines (Health aspects)
Shorelines (Testing)
Air forces (Services)
Air forces (Health aspects)
Water (Purification)
Water (Standards)
Author: Higgins, Jill
Pub Date: 11/01/2008
Publication: Name: The Dental Assistant Publisher: American Dental Assistants Association Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Science and technology Copyright: COPYRIGHT 2008 American Dental Assistants Association ISSN: 1088-3886
Issue: Date: Nov-Dec, 2008 Source Volume: 77 Source Issue: 6
Topic: Event Code: 350 Product standards, safety, & recalls; 330 Product information; 360 Services information
Product: Product Code: 4941100 Water Treatment NAICS Code: 22131 Water Supply and Irrigation Systems
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 207643131

Each day patients entrust their health to dental professionals and the Air Force takes this safekeeping very seriously. Our tradition of exceeding the standard for infection control, specifically waterline treatment and testing, is insurance for this task.

Air Force dental clinics receive guidance from the Dental Evaluation and Consultation Service (DECS), that sets standards for infection control consistent with those of the Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA), the Occupational Safety and Health Administration (OSHA), the Food and Drug Administration (FDA), and the Environmental Protection Agency (EPA). Criteria for waterline treatment and testing are based on recommendations and regulations from these organizations.

Dental clinic waterlines have come under scrutiny in the last decade. In 2001, the evening news show, 20/20, ran a feature on the bacteria content in dental waterlines. During this episode, toilet water was compared to the water in dental clinic waterlines, and what was found was a much higher bacteria count in dental water versus toilet water. Consequently, the American public developed an even greater paranoia for dental clinics.

For anyone who works in the health care field, it is not surprising to learn that bacteria are ever present. Nonetheless, maintaining stringent protocols can keep bacteria counts to a minimum. Within dental clinic waterlines, the amount of bacteria present is directly related to the presence of biofilm inside the lines. Biofilm is a slimy substance of microorganisms that adheres to solid surfaces. If not removed, the biofilm forms thin layers collecting more and more bacteria. Plaque on teeth is one example of biofilm. Biofilm commonly occurs in dental waterlines because the waterlines harbor an environment in which biofilm thrives.

Although biofilm itself is not harmful, it does collect bacteria that are potentially harmful. In 1993, the CDC recommended that dental waterlines be flushed at the beginning of the clinic day to reduce the microbial load.

However, studies have demonstrated this practice does not affect biofilm in the waterlines or reliably improve the quality of water used during dental treatment. In their 2003 dental infection control guidelines, the CDC greatly expanded the section on dental unit water quality.

To minimize the amount of bacteria in the waterlines, Air Force dental clinics have transitioned to a self-contained water supply which allows waterline cleaning with dental unit waterline treatment products. These treatments range from daily to once weekly treatments with cleaning agents to using systems with reverse osmosis or ultraviolet light irradiation that purify or treat incoming water to remove or inactivate microorganisms.

Additionally, each technician flushes the lines for 20 to 30 seconds after each patient to physically flush out patient material (e.g., oral microorganisms, blood, and saliva) that might have entered the air or waterlines. Regardless of which method is used to maintain dental unit water quality, adherence to manufacturer maintenance protocols is essential.

While treatment of the waterlines helps keep bacteria counts down, testing can help determine if procedures are properly performed and that devices are working in accordance with the manufacturer's protocol. Testing dental unit water quality can assist in identifying problems in performance or compliance and also provides documentation. Each clinic follows manufacturer recommendations; however a minimum of quarterly testing is required in AF clinics.

The EPA, the American Public Health Association (APHA), and the American Water Works Association (AWWA) have determined bacteria [less than or equal to]<500 CFU/mL is safe for drinking water. Hence, Air Force dental clinics are charged with maintaining their waterlines at or below this level. If a dental chair is found above this number, the chair is immediately given an initial treatment and retested. It will not be used for patient care until it successfully passes a test.



While scientific evidence has not indicated an adverse health risk associated with bacteria found in dental units, our patients nave entrusted us with their health and expect us to do what is necessary to provide a safe water supply when receiving treatment. Accordingly, the Air Force takes this obligation seriously and strives to exceed the infection control standards with regard to the treatment and testing of waterlines.

TSgt Jill Higgins is the NCOIC Dental Education and Training at Keesler AFB, MS. She has been in the Air Force for 11 years and at Keesler for two years. TSgt Higgins holds an Associate of Applied Science in Dental Assisting from the Community College of the Air Force. She is married to Dave, and together they have a three-year-old son, Mekai.
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