The Downfall of Reusing Disposables
If one line of defense tumbles, the rest will likely follow
In recent years, disposable products have become the gold standard of infection control protocol. These single-use items are intended to be used on one patient and discarded. They should not be sterilized in an autoclave due to the heat-intolerance of their materials. Compared to reusable (or multi-use) products, disposable products reduce the probability of patient-to-patient cross-contamination and potential cross-infection.
In the not-so-distant past, “reusable” was more common than “disposable.” You may even remember when procedural items, such as saliva ejectors and prophy cups, were cleaned and sterilized to be reused on another patient. Since then, the FDA has repeatedly stated that it is unaware of any data that would establish safe and effective cleaning/sterilization conditions necessary for reuse of any disposable device (OSAP, 2012). Similarly, the CDC advises using single-use devices on one patient only and disposing of them appropriately. However, it is still generally accepted by dental professionals that many single-use products are safe to reuse if sterilized, such as…
Whether burs are single-use or multi-use remains a contested issue. Cleaning can be difficult due to burs’ intricate physical construction, and repeated processing cycles can deteriorate the cutting surfaces enough to potentially break during patient treatment. These factors, coupled with the knowledge that burs exhibit signs of wear during normal use, might make it practical to consider them single-use. A fair amount of resources are spent scrubbing burs and diamonds prior to sterilization, which equates to longer intervals between patients. From an infection control viewpoint, treating burs as single-use eliminates the risk of patient–to-patient cross–infection.
DISPOSABLE MOUTH MIRRORS
Plastic mouth mirrors are great alternatives to traditional mouth mirrors in that they significantly reduce cross-contamination. However, they are not meant to be reused and their plastic materials are not suitable for the autoclave. Because mouth mirrors are inserted directly into the patient’s mouth, improper sterilization practices can greatly increase the risk of patient-to-patient cross-infection.
Unlike most disposable items, which are single-use in the sense that they may only be used on one patient, face masks are only as effective as their designated time limit. The length of time that a mask protects against infection and cross-contamination depends on its ASTM level (according to FDA guidelines):
ASTM Level 1: 15-20 minutes
ASTM Level 2: 30-40 minutes
ASTM Level 3: 60+ minutes
Why the wide discrepancy between what is regulated and what occurs in the practice? For one, complying with every OSHA regulation and CDC guideline is easier said than done. And, because devices that were considered reusable twenty years ago are now deemed one-time use, adapting to new practices is slow to change. Plus, the misconception that disposables cost more could explain the discrepancy. On average, a dentist spends $20 in disposables to set up an operatory, which fluctuates depending on the number of patients seen per day.
However, the monetary savings gained by reusing disposables are minor when compared to the huge costs of an infection control breach. Although reuse of common disposable items may seem harmless, little things can accrue to a big problem. When it comes to infection control, loosening the slack in one area lessens the overlap and effectiveness of your total chain of infection control. Think of it as a line of dominos — once the first one falls, the rest fall along with it.
At PureLife, you don’t have to risk sacrificing your line of infection control defenses to achieve a happy bottom line. We offer a wide variety of top-quality, cost-competitive disposable items for any procedure. Call us at 877-777-3303 or visit PureLifeDental.com for our complete list of disposables.
A Comprehensive Look at Dental Unit Waterlines
Eliminating the risk of contamination requires going beyond the status quo
In 2011, the dental industry received international attention when an 82 year old Italian woman died from a case of Legionnaire’s disease she contracted during dental treatment—its source traced to contaminated water from dental unit waterline tubing.
A Perfect Storm for Biofilm
Bacterial biofilm is virtually universal in untreated dental unit waterlines and can begin forming in a new dental unit within days. Although there has only been a handful of reported cases of dental waterline contamination since 1963, many microorganisms of concern have been isolated from dental unit water, namely Pseudomonas species, non-tuberculosis mycobacteria, and Legionella, the causative agent of Legionnaires’ disease. Legionella poses a particular threat because it can be transmitted by inhaling aerosols or aspirating water contaminated with the bacteria. Because of their narrow tubing (1/8” to 1/16”), dental waterlines provide particularly well-suited conditions for biofilm–a community of bacteria and other microbes that adhere to surfaces and form a protective slime layer. Low water pressure, low flow rates, and frequent periods of stagnation also encourage any bacteria introduced from municipal water to accumulate within the tubing.
Anomalies of Waterline Testing
According to the American Dental Association (ADA) Council on Scientific Affairs’ 1999 report to the profession on dental unit waterlines, evaluating water quality before a treatment protocol is implemented is controversial. Because the scientific literature suggests that all units are highly contaminated, pre-testing to confirm contamination is of questionable value. However, testing water quality after initiation of a treatment regimen ascertains whether a waterline product or protocol achieves the desired outcome. Monitoring water quality according to an established schedule can help identify problems in performance or compliance and provide documentation of water quality.
Waterline Monitoring Recommendations
Both in-office monitoring devices and commercial testing services are available. Dentists should consult with the manufacturer of their dental unit or water delivery system to determine the best method for maintaining acceptable water quality (i.e.,
Waterline Treatment Options
FLUSHING: Mechanical flushing alone does little to control contamination in waterlines. Although it can temporarily reduce the number of microbes in the water delivered to patients by clearing away many of the free-floating organisms in the waterline, biofilm bacteria continually break free and recontaminate dental unit water during the course of clinical treatment. Flushing for several minutes between patients, however, may be valuable in removing contaminants that can enter the water system during patient treatment.
SELF-CONTAINED WATER SYSTEMS: Also referred to as independent water systems or reservoirs, these isolate the dental unit from the municipal water supplies, instead providing water or treatment solution from reservoirs filled and maintained by office staff. They allow the practice to control the quality of water that is used in the unit.
CHEMICAL DISINFECTANTS: A number of chemicals are reported to inactivate or prevent biofilm, whether through periodic (intermittent or “shock” treatment) or continuous presence in the waterline. Periodic disinfection involves purging the waterlines, adding a chemical to the water reservoir, filling the lines for the recommended time period, and flushing. Continuous chemical treatment refers to waterline treatment via an irrigant/coolant solution or the use of automated metering devices. Metering devices release low levels of chemical germicide into the treatment water to control biofilm to lower bacterial counts in the water. Some products may require both intermittent and continuous line treatments to maintain water quality.
No matter the treatment option you implement in your practice, strict compliance with the recommended treatment regimen is the key to consistent water quality.