particularly useful for surfaces that are touched frequently by gloved hands during patient care, surfaces likely to be contaminated with blood or saliva, and areas that are difficult to clean. Examples include chair control panels, air-water syringe buttons, light handles, and computer keyboards. Surface barriers are a single-use item, replaced after each patient. Although barriers are highly effective, contamination of the surface beneath is possible. It is not necessary to clean and disinfect a properly covered surface unless the barrier fails, or the surface becomes accidentally contaminated during treatment. Remove and discard disposable barriers between patients, while dental personnel are still wearing gloves. Place clean barriers with newly washed hands. handpiece or air-water syringe. These filters trap free- floating microorganisms before they can be released into the water. Although this method is not labor intensive, it has no effect on the biofilm within the waterline, and it may be more expensive than other methods because each waterline requires a separate filter that must be maintained daily or weekly, depending on the brand. Biocides and shock treatments are chemicals used with self-contained water systems to reduce the number of microorganisms in dental waterlines. These products can be used intermittently to inactivate or remove biofilm or as a continuous presence in the waterline to prevent biofilm formation. Although these products are highly effective in controlling water quality, they may be time consuming and technique sensitive, and they require strict compliance with manufacturer’s instructions. Dental unit and waterline product manufacturers should be consulted to determine which waterline products and dental equipment and materials are compatible and used. 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 sonic scalers. With any water treatment product, CDC recommends following the manufacturer’s recommendations for monitoring water quality. OSAP provides much more guidance on DUWL water quality and more guidance on how and when to monitor DUWL (Mills et al., 2018). In the event of a boil-water advisory, it is imperative not to use public water for patient care. 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. Healthcare Considerations: IIn 2015 and 2016, there were several recent outbreaks of Mycobacterium abscesses due to contaminated waterlines in pediatric dental clinics where children received pulpotomy procedures. Sadly, these young children suffered severe infections, and required hospitalization, intravenous antibiotics and surgical procedures including permanent tooth loss. CDC published these outbreaks in a Health Alert Network and highlighted the importance of maintaining and monitoring dental waterlines and improving standards for DUWL maintenance (CDC, 2022j; CDC, 2010).
the contact time indicated on the disinfectant’s label. Also consult the label instructions for disinfectant contact time, dilution, safe use, and disposal. High-level disinfectants and liquid chemical sterilants should never be used for environmental surface cleaning. It is important to remember that all products used for clinical contact surfaces visibly contaminated with blood must be disinfected with an EPA-registered hospital disinfectant with intermediate- level activity (i.e., tuberculocidal claim) [CDC, 2016h]. Manufacturers’ instructions need to be followed strictly for all products used for cleaning and disinfection in the dental operatory. Surface barriers boosts safety and efficiency in that they require less time than cleaning and disinfecting and contain no potentially irritating chemicals. Surface barriers are Dental unit waterline quality Dental unit waterlines (DUWLs) are narrow-bore plastic tubes also carry water to ultrasonic scalers, air-water syringes, and other dental equipment that requires water. All dental and hygiene operatories should be equipped to maintain appropriate water quality. The EPA has set standards for DUWLs at the same level as that of drinking water: fewer than 500 colony-forming units of heterotrophic water bacteria per milliliter of water. When infectious agents, such as bacteria, viruses, and fungi combine to form a microbial colony that adheres to waterlines, this is known as a biofilm . Biofilm and waterborne pathogens generally do not pose disease risks to healthy persons; however, they may pose a risk to patients—especially those with weakened immune systems (CDC, 2016i). Key recommendations to maintain dental unit water quality include consulting with the dental unit manufacturer for appropriate methods and equipment to maintain water quality, adhering to recommendations for monitoring water quality provided by the manufacturers of the unit and waterline treatment product, and using sterile saline or sterile water as a coolant/irrigant when performing surgical procedures. Dental waterlines should be flushed for 20 to 30 seconds between patients to help remove contaminants and free- floating microorganisms that may have been retracted into the DUWL. Flushing alone will not improve water quality because it does not prevent or eliminate biofilm formation. In addition, biofilm bacteria continually break free and recontaminate dental unit water during clinical treatment. Self-contained water systems isolate the dental unit from the municipal water supply. They provide water from reservoirs filled and maintained by the dental staff. This process allows the dental team to provide a way to introduce chemical agents to waterlines and allows the use of water of known quality. However, self-contained water systems cannot reliably improve the quality of dental water without additional chemical or mechanical treatment against biofilm. Additionally, if this system is improperly maintained or contaminated, it could deliver water of worse quality than from a municipal source. Several strategies can be used to improve the dental unit water quality, including (but not limited to) self- contained water units with biocides for disinfection, shock treatments, physical barriers, and antimicrobial materials that inhibit biofilm formation. Physical barriers or filters may be positioned on each water-bearing line near the
Special considerations Dental radiography
Whether exposing and developing dental radiographs or utilizing digital radiography, standard precautions apply. Gloves should always be worn, and other PPE should be
The radiographic process offers the possibility that body fluids will contaminate disposable and reusable items.
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