cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh, Uncategorized

A Peek into POOR Dental Device Maintenance & Why

At a recent trade show, we questioned 100’s of Dental Professionals (including DDS, Hygienists and Assistants) about standard maintenance between patients.  We also questioned if the office addresses backflow.  The cleaning method between patient’s responses include:

  • wiping only the exterior surfaces between patients (100+ of respondents)
  • wiping the exterior and sheathing the valve between patients (25+ respondents)
  • autoclave the valve components between patients (2 responses)

Flushing the evacuation lines frequency responses include:

  • flushing at the end of day (50+ responses)
  • flushing weekly (50+ responses)
  • flushing between patients (2 responses)
  • flushing?  (1 response)

How do you prevent Backflow risk from Saliva Ejectors to your patients?

  • 0 respondents used any device to alleviate patient backflow
  • An estimated 5 respondents warned patients to not close around suction straws
  • 100+ respondents had no idea about backflow risk

Where and how were you taught valve maintenance?

  • An estimated 20 respondents learned maintenance in school
  • 100+ respondents did not learn valve maintenance or the risks of backflow in school
  • 100+ respondents learned on their own or from their predecessor.

Evacuation Valve IFU’s (Instruction for use) instruct users to disassemble parts routinely, flush daily or between patients and the CDC states DHCP should not advise patients to close their lips around the tip of the saliva ejector to evacuate oral fluids.
We should be concerned when 99% of respondents do not follow the Instructions for Use and are unaware about backflow risks.

If you would like a copy of your existing IFU for evacuation valves, you can contact the Dental Chair Mfr or find them online.  Most can be found in the Dental Assistants Instrumentation Packets.

Do you do this for EVERY Patient?  The IFU recommends it.

hve

 

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cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh

Prioritize Patient Safety

When we visit the dentist, we place our trust in the dental professional(s) who is treating us.  As patients, we also expect the dental instruments to be clean, safe and in good working order.  Also we listen to our dental professionals instructions (open wide, swallow, bite, close, etc) during our visit.

However, patients instructed to “Close” during routine suctioning, unknowingly put themselves at great risk of cross contamination from the last patients fluids, blood, bacteria and chemicals in the line.  The concern, Saliva Ejector Backflow, has been proven to potentially occur in an estimated 21-25% of patients who close around suction straws, or 1 in 5 patients receive the junk in their mouth from the last patient. (1a)patientclose

Originally discovered in the 1990’s, research proved backflow occurs from low-volume saliva ejectors when the pressure in the patient’s mouth is less than that in the evacuator.  Simply closing around the suction straw forms a seal around the tip of the ejector that creates a partial vacuum. That vacuum can cause the last patients fluids, blood, bacteria, chemicals in the line, etc. to go back into the patients mouth.

Why hasn’t the industry made it mandatory to prevent Saliva Ejector Backflow?

Until now, alleviating the backflow risk has been reliant on teaching and educating dental professionals to instruct patients to not close.

Unfortunately, it occurs much too often.  At a recent tradeshow we questioned 100+ Hygiene and Assisting Professionals about backflow prevention.  Responses were as follows:meeting pic

Q&A:  How do you prevent the potential Saliva Ejector Backflow risk to you patients: responses

  • 0 respondents used any device to alleviate patient backflow
  • An estimated 5 respondents warned patients to not close around suction straws
  • 100+ respondents had no idea about backflow risk

What is the reason for the lack of education or prevention?

This answer will vary dependent on the following: where and how dental professionals were trained / your particular dentist & office expectations or lack thereof / habits / and the office or space lacks the necessary tools and devices to manage patient care properly.

Dental Schools and teaching facilities set the tone early on.  We’ve spoken with numerous programs that only wipe the exterior surfaces between patients and state it’s too expensive to clean the valves properly.  While other programs have a instrument manager in charge of maintaining suction components.  In these situations the students, unfortunately, do not learn valves pose a risk and why.

Finally, in many private offices, strict budgets are set on infection control products.  In other offices, the doctor sets the tone that it’s not important to offer patients clean evacuation valves because he or she never experienced it and its not mandatory.  Therefore, do the bare minimum.  While in others, efficient patient turnover is the priority so the room needs to be turned over quickly vs correctly.

What does the CDC say?

Backflow occurs when previously suctioned fluids present in the suction tubing flow back into the patient’s mouth. Backflow can occur when:

  • There is pressure in a patient’s mouth (a result of closing their lips and forming a seal around the tip of the ejector) that is less than in the saliva ejector (similar to how liquid flows back into a cup after drinking through a straw).
  • The suction tubing attached to the ejector is positioned above the patient’s mouth.
  • A saliva ejector is used at the same time as other evacuation (high-volume) equipment.

Although no adverse health effects associated with the saliva ejector have been reported, dental health care personnel (DHCP) should be aware that backflow could occur when they use a saliva ejector. DHCP should not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids. DHCP should contact the manufacturer of the dental unit to review proper use and maintenance procedures, including appropriate cleaning and disinfection methods.

Our view…

We believe patient safety should be the #1 priority.  The dental industry and the CDC take valve backflow too lightly.  Every day we view valves that leak and are filled with debris.
dirtyvalve
We are hopeful the CDC and the Dental Industry reassess the risk involved.  In the past, it was not possible to alleviate backflow easily and cost-effectively.  Instead, we relied on dental professional to warn patients.  This strategy is not working.
DOVE Dental Products introduced Disposable Backflow Prevention Saliva Ejectors in 2017.  They eliminate any potential risk.
Our original founder, a Dentist, stated about backflow “its not a matter of if a breach will occur, its a matter of when”.  Backflow is real, its proven.  We are 100% confident dental patients would want protection against it.

(1a) https://www.ncbi.nlm.nih.gov/pubmed/9868623

 

 

cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh

The Dental Device IFU – Are You Putting Patients at Risk?

Last month at the Hinman Dental Convention in Atlanta, GA we introduced our newly designed Disposable DOVE evacuation valves.

Over the 3-day meeting, we held 100’s of conversations with Dental Professionals.  We also sponsored a leading Infection Control Workshop with 60+ attendees.  When conversing, we inquire how their office manages maintenance of both HVE and Saliva Ejector Valves between patients and ask if the office addresses backflow?  The protocol for cleaning varies from 1 respondent to another, responses include:

  • wiping the exterior surfaces between patients (100+ of respondents)
  • wiping the exterior and sheathing the valve between patients (25+ respondents)
  • autoclave the valve components between patients (2 responses)

We always note when we hear anything besides the typical “wiping only” response.  Flushing frequency receives a variety of responses as well:

  • flushing at the end of day (50+ responses)
  • flushing weekly (50+ responses)
  • flushing between patients (2 responses)
  • flushing?  (1 response)

Lastly, Saliva Ejector Backflow responses were all similar:

  • 0 respondents use any device to alleviate patient backflow
  • An estimated 5 respondents stated they warn patients to not close around suction straws

So what is the correct way to clean a valve or is the evacuation valve left up to the discrepancy of the user?  Why is there such a variation of responses?  Do all evacuation valves have an IFU?

Whats the correct way to clean a valve?

DOVE believes patient safety should be the #1 priority.  Regardless of the dental device, if there is the potential risk of cross contamination to a patient or dental professional, the IFU (Instructions for Use) should always be followed.  Metal Evacuation Valve IFU’s in the N. American market instruct users to reprocess routinely.  Some companies are more detailed in the instruction process stating to disassemble each part, scrub each part and reprocess each part routinely.  Finally, a few metal valve manufacturers have checklists instructing flushing & reprocessing to be a routine part room turnover process.

Why is there such a variation of cleaning suction devices?

This answer will vary dependent on the following:  where and how you were trained / your particular dentist & office expectations or lack there of / habits / and the office or space lacks the necessary tools and devices to manage patient care properly.

We’ve spoken with many dental school programs who only wipe the exterior surfaces between patients and state its too expensive to remove the valves.  While other programs have a instrument manager in charge of maintaining the valve components.  Many of these students, unfortunately, never learn the correct valve maintenance.  Many attendees at the Hinman Dental Meeting were unaware valves disconnect from the swivel adapters and its part of the IFU – every usage.

Often in private offices, strict budgets are set on infection control products.  In other offices, the doctor sets the tone that its not important to offer patients clean evacuation valves.  While in others, efficient patient turnover is the priority so the room needs to be turned over quickly vs correctly.  Proper valve maintenance requires patience and time.  Backflow is a proven risk from numerous studies and the CDC.  As evidenced from our conversations, less than 1% offer a backflow preventative device less than 1% warn patients of the potential risk.

Lastly, maintenance requires multiple parts because valve components can breakdown when they are cleaned and reprocessed.  Many offices have 1 valve per chair. Ultimately the room could not function if the valve were to be reprocessed.

All Traditional Dental Evacuation Valves sold legally in N. America contain IFU’s that were prepared by the manufacturer.  These can be found in Assistants Instrumentation Packets if sold with the chair or online at the respective dental chair unit manufacturer.  Or, if the valve(s) were sold separately, IFU’s most likely are included in the original packaging and or online.
Instructions for use (IFU) are based on:
-in most cases they are required or in accordance of FDA Guidelines to provide a clean safe product
-the manufacturer has validated the steps necessary to prepare a device that is
safe for patient use
-The Centers for Disease Control CDC recommends following device IFU’s
-the manufacturers’ IFU is necessary to deliver a safe product for surgery
Not following the Manufacturers’ IFU puts patient safety at risk because the devices may be cleaned improperly, wrapped improperly, and or loaded into sterilizer improperly.  Most common valve risks are backflow, leakage and unclean parts coming into patient contact.
Why the conversation needs to start?
The below chart displays the leading N. American metal valve companies IFU recommendations.  Given the recent meeting conversations, dental offices are failing to deliver clean safe HVE Valves, clean safe Saliva Ejector Valves, do not address backflow and do not effectively manage the flushing of suction systems.  When 99% respond that they do not follow the IFU, something needs to be said.
cross contamination, dental hygiene, dentistry, infection control, rdh

Introducing NEWLY Designed DOVE Disposable Evacuation Valves at Hinman

March 10, 2018

DOVE Dental Products will exhibit in booth #11 at the upcoming 106th Annual Thomas P. Hinman Dental Meeting, March 22-24, 2018.  We will introduce NEWLY Designed DOVE Disposable Evacuation Valves that will include:

  • DOVE Disposable Saliva Ejector with Backflow Prevention offered now in Purple! Dental patient backflow risks occur when patients close their lips around suction straws. Prior patient backwash (or backflow) goes back into the mouth.  Only a backflow prevention device can eliminate this risk.
  • Our NEW High Volume Evacuation (HVE) is now offered in 2 comfort-driven designs! Valve comfort for Hygiene and Assisting is of the utmost importance.  Our 2 designs provide the greatest selection in the disposable market.
  • 2 NEW Connections for the HVE Valves! The current dental chair marketplace has many HVE connections.  Our new adaptors allow us to connect to over 95% of N. American Dental Chair units.

Providing a clean and safe evacuation valve is not possible when dental professionals only wipe the exterior surfaces and intermittently flush dental suction lines.

DOVE will also sponsor Ms. Nancy Dewhirst Infection Control Workshop on March 23 from 1- 4:00 PM.

For more, please inquire at sales@stomadental.com.

cross contamination, dentistry, infection control, rdh

Do you guarantee clean evacuation valves?

Disposable dental devices have come a long way in the past 10 years.  Not long ago, a disposable evacuation valve would have been unreliable in both fit and performance, not to mention prohibitively expensive.

DOVE Evacuation Valves changed all that.  These plastic valves are made in the USA in a clean-room ISO 13485 facility, guaranteed clean from contaminants.  Plastic molds are extremely accurate producing a disposable product with consistent quality and reliable standards, manufactured to assure outstanding performance in the dental office at an affordable price.

 

Furthermore, DOVE Valves have been evaluated by leading infection control experts; all agree our disposable valve is a cleaner and safer alternative.   Our valves were also voted by OSAP member’s at the most innovative infection control product in early 2017.

We encourage you to carefully consider what is specifically required of your dental office is to guarantee a clean, sterile evacuation valve for every patient.  As one dentist studying the situation commented, “It’s not a matter of if someone is going to get sick from a valve that was only wiped, it’s a matter of when.”

As you evaluate, consider the cleaning protocol that your staff learned in their training program, school or university.  Each teaching facility tends to instruct the student in a protocol that is biased by its orientation, for example “busy,” programs have patients that are so tightly scheduled that wiping a valve clean, the bare minimum, is reinforced.  Teaching programs, on the other hand, are constantly exploring ways to lower costs and shockingly some students never even learn that the valve can be removed!  Minimal steps may be taught, valves maintained infrequently, flushing occurring daily or even weekly.  Finally, larger universities tend to reinforce “central sterilization,” allocating the cleaning process to an outside team.  Here students may learn to flush the lines occasionally but have very little knowledge of how to remove and clean a valve, relying on outside personnel for maintenance and repair.

The below image is a typical parts room at a University.   Most students never see this side of the routine maintenance.

dental cleaning room

You might wonder why there is no industry protocol on sterilizing such an essential piece of dental equipment as an evacuation valve. especially in today’s climate of infectious disease awareness.  Shockingly, it’s not even on the radar, taking a back seat to money makers like 3D imaging, CAD CAM, etc.

Speak with each of your staff about their cleaning techniques.  You may be surprised to find that staff use different cleaning methods even within the same office, varying among rooms.  Some flush, some wipe, some are more thorough than others.  The following are various cleaning methods that we see when we visit dental offices.

#1 – wiping the exterior and flushing the lines at the end of the day

It’s important to note that wiping the exterior surfaces without scrubbing them does not remove debris.  Recent testing on 212 valve surfaces that were only wiped between patients “all failed” a ATP bacteria test.  Also flushing once a day is only considered a preventive maintenance step (like drano) and will not clean the lines for the patient.  If backflow is a concern, every line will fail a clean test.

#2 – wiping the exterior and flushing between patients

Wiping the surfaces, as in #1 above, without scrubbing, does not remove debris and consequently not all the valves will be clean.  Flushing the lines between patients is a great start, albeit rarely done, but without a backflow prevention device every line will fail.  The same applies to cleaning the interior surface of the lines.  Unless blood and debris is scrubbed and the surface sterilized contamination will still be present (see photo below of a flushed line).

interior valve after flushing

#3 – wiping the exterior and not flushing the lines, or flushing once a week or even once a month

This replicates the scenarios above.  Every week we encounter a new office that has never flushed the evacuation lines.  All the valves and lines maintained this way are not clean.

dirtyvalve

#4 – removing the valves, disassembling the parts and running them through a sterilizer.

This is actually what the manufacturers of the metal valves recommend be done between each patient.  We have found that only the VA clinics follow this recommendation.  This process, stipulated in the metal valve instruction guide, is the only process that will guarantee a clean traditional valve.  The major risks are in transporting the parts and assembly.  The downside of this method is time (approx 12 minutes per valve) and cost (over $3.00 per valve) which ranks it second to the disposable option.

In private practice we have found that when a sterilizer is used, it is only used once a day or infrequently at best.  In addition, unless the parts are scrubbed prior to sterilization, then the contaminants are merely baked on and not removed.

#5 – disposing of the valve and using a new DOVE Saliva Ejector or HVE valve for each patient

A DOVE Disposable Valve guarantees each patient a safe, clean valve.  DOVE Saliva Ejector Valves eliminate backflow.  Performance is consistent, time is negligible and cost (approx. $2) is less than frequent cleaning through a sterilizer, making this a superior choice.

While all the above cleaning methods do meet CDC minimum guidelines, only #4 (maintaining the valve frequently) and #5 (offering a disposable version) are truly worthy of our dental patient’s expectations.

Guaranteeing a clean, safe visit for your dental patients is easier and more affordable today than ever. It’s more than an option. In today’s environment, with busy offices and discriminating patients – it’s an imperative.

References:

http://www.osap.org/news/328694/OSAP-Issues-Boot-Camp-Exhibitor-Awards.htm

http://www.dentaleconomics.com/articles/print/volume-103/issue-3/practice/cleaning-or-disinfection-whats-right-for-the-suction-lines.html

https://www.cdc.gov/oralhealth/infectioncontrol/questions/saliva.html

https://www.oralhealthgroup.com/features/does-your-evacuation-suck/