each waterline requires a separate filter that must be maintained daily or weekly, depending on the brand. Biocides are chemical treatments used with self-contained water systems to reduce the number of microorganisms in dental waterlines. These products can be used intermittently as a shock treatment to inactivate or remove biofilm or as a continuous presence in the waterline to prevent biofilm formation. Although these products can be highly effective in controlling water quality, they may be time consuming and technique sensitive and they require strict compliance. Some chemical treatments may be incompatible with dental equipment or dental materials such as dental adhesives. Dental unit and waterline product manufacturers should be consulted to determine whether various waterline products and dental equipment and materials are compatible (U.S. Food and Drug Administration [FDA], 2018). Regardless of the water treatment method chosen, all operatories and devices that are attached to waterlines must be treated. In the hygiene operatory, this includes ultrasonic and Special considerations - dental radiography The radiographic process offers the possibility that body fluids will contaminate disposable and reusable items. Whether exposing and developing dental radiographs or utilizing digital radiography, standard precautions apply. Gloves should always be worn, and other PPE should be worn when spattering of blood or body fluids is anticipated. For radiograph placement, use heat- tolerant or disposable intraoral devices. If the lead apron is contaminated with blood or saliva during radiograph exposure, it should be cleaned and disinfected with an intermediate-level surface disinfectant. Other special considerations Several special considerations pertain to the dental hygienist in the dental office: ● Cleaning, lubricating, and sterilization of devices that can be removed from air and waterlines : Ultrasonic and sonic scaling tips, dental handpieces, and associated attachments including low-speed motors and reusable prophylaxis angles should always be heat sterilized between patients. If these devices are not cleaned and sterilized properly, the next patient may be exposed to potentially infectious materials. ● Backflow from low-volume saliva ejectors : Occurs when the pressure in the patient’s mouth is less than that in the evacuator. Studies have reported that backflow in the low- volume suction lines can occur and microorganisms present in the lines can be retracted into the patient’s mouth when a seal around the saliva ejector is created (CDC, 2016). This backflow can be a potential source of cross-contamination. Thus, dental patients should be advised not to close their lips tightly around the tip of the saliva ejector. ● Single-use or disposable devices : Offer greater infection- control advantages than reusable clinical products. Single- use devices are meant for one patient only and then they should be discarded. They should never be reprocessed for use on another patient. These devices are generally not heat-tolerant and cannot be cleaned reliably. Examples of single-use products include saliva ejectors, prophylaxis cups and brushes, exam gloves, face masks, patient napkins, and sterilization wraps and pouches. Certain items, such as prophylaxis angles and air-water syringe tips, are now available in disposable as well as reusable forms and it is important to be able to recognize the difference between disposable and reusable versions. ● Pre-procedural mouth rinses : That contain an antimicrobial agent may reduce the level of microorganisms in aerosols and spatter during dental procedures and decrease the numbers of microorganisms introduced into the patient’s bloodstream during invasive dental procedures (Strange, 2020). However, there is no evidence that these rinses
sonic scalers. With any water treatment product, it is imperative to follow the manufacturer’s recommendations for monitoring water quality. In addition, the manufacturer of the dental unit should be consulted for appropriate methods and equipment to maintain the quality of dental water. It is important to note that the CDC does not provide recommendations for the monitoring and frequency of testing for water quality, but recommends that manufacturers be consulted for these issues. In the event of a boil-water advisory, it is imperative not to use public water for patient care. This includes water in the dental operative unit, ultrasonic scalers, or any other equipment that uses the public water system. Handwashing and patient rinsing should be done with water sources other than municipal water (e.g., bottled water). When the boil-water advisory is lifted, waterlines, equipment, and faucets should be flushed for several minutes prior to reusing public water for patient care. A final key recommendation for dental unit water quality includes the use of sterile saline or sterile water as a coolant/ irrigant when performing surgical procedures (CDC, 2016). Consult manufacturers of digital radiography sensors and computer components about appropriate barriers and recommendations for disinfection and sterilization of these items. At a minimum, digital radiography sensors should be covered with FDA-cleared barriers, followed by cleaning and disinfecting with an intermediate-level, EPA-registered hospital disinfectant with intermediate level (tuberculocidal) activity after each patient. It is important to note that manufacturers of all medical devices must provide instructions for reprocessing (cleaning, disinfection/sterilization; CDC, n.d.b.). prevent infection transmission in the dental setting and the CDC has made no recommendations regarding the use of pre-procedural antimicrobial mouth rinses. ● Regulated medical waste : Comprises a minimum of the total waste generated from a dental office. Examples of regulated medical waste include solid waste soaked or caked with blood, extracted teeth (without amalgam restorations), surgically removed hard and soft tissues, and contaminated sharp items. Extracted teeth with amalgam restorations should not be incinerated because of hazardous mercury vapors released during the incineration process, which are extremely harmful when inhaled. Regulated waste must be contained in closable bags or containers that are colored red or labeled appropriately. A single, leak-resistant biohazard bag can be used for containment of non-sharp regulated medical waste. Sharp items, such as scalpel blades, needles, syringes, and unused sterile sharps should be placed in a puncture resistant, color-coded, and leakproof container that is kept closed to prevent spillage. All regulated medical waste should be disposed of according to federal, state, and local regulations. ● Transmission-based precautions : Are a set of practices that apply to patients with documented or suspected infection or colonization with highly transmissible pathogens for which precautions beyond standard precautions are needed. Such precautions have become increasingly important because of recent outbreaks, as noted with the H1N1 influenza pandemic and ongoing tuberculosis challenges. These diseases are spread through airborne transmission, droplets, or contact with skin. Patients do not usually seek routine dental outpatient care when they are acutely ill with these diseases. However, a general understanding of transmission precautions for such diseases is critical because some dental care providers are hospital based, patients infected with these diseases might seek urgent treatment at outpatient dental offices, and DHCPs might become infected with these diseases.
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