We were excited to have RDH Magazine stop by our Chicago Midwinter Meeting Exhibit to interview DOVE Dental Products in the marketplace.
Recently, Dove Dental learned of another dental breach at a U. S. Dental School. It was discovered that for nearly 2 years dental handpieces were merely wiped between patients instead of following the mandatory sterilization protocol set forth by the CDC, the dental school and the manufacturer’s instructions for use (IFU). Given our access to education and technology how can this continue to occur?
Starting in the late 1990’s I spent over 10 years working with accredited teaching programs at dental schools and universities as a school and government regional manager with KaVo Dental. In those years, there were many infection control inconsistencies ranging from incorrect methodology to simple carelessness. For example, teaching basic routine dental handpiece maintenance varied between programs and in some cases was not taught at all. Unfortunately much of this became engrained and passed onto the next generation of dental professionals, as last week’s breach makes clear, this issue is ongoing.
Some of the major problems in the 90’s with improper cleaning were a result of not having enough instruments on hand to ensure proper cleaning; students were typically instructed to purchase just one handpiece (dental offices traditionally contain 3 highspeed handpieces per room). Additionally, instructions (IFU) were not strictly taught or followed with some instructors relying on central sterilization instead of teaching the student to properly clean the instrument by hand.
From my experience, variations in cleaning, sterilization and performance included:
|Variations on handpiece maintenance|
|*Using incorrect lubricant or wrong nozzle to spray|
|*Autoclave/reprocess with a sheath/bag|
|*Autoclave/reprocess with no sheath/bag|
|*Lubricating with a bur|
|*Lubricating without a bur|
|*Lubricating after sterilization|
|*Purging with a bur|
|*Purging without a bur|
|*Usage of a purge/lubrication machine vs manually|
|*Disassembly during cleaning (lowspeed components)|
|*Not disassembling lowspeeds or motors during cleaning|
|*Reprocessing that never dries|
|*Too much or too little air pressure PSI|
|*Dental water line flushing or lack there of|
|*Shortage of instruments resulting in hurried processes between patients|
|*Using a hot handpiece immediately out of the autoclave and cooled under water|
Naturally, after graduation any bad habits learned persisted and many continue today. When educators conducted due diligence at a dental office we often saw that processes were all over the map, even within a single office: some purged, some lubed, some did not purge and some lubed with odd lubricant/oils not intended for dentists. Naturally, performance reflected these practices. For example, a result of not purging was water line biofilm continuously clogged most water ports and electric motors on the market. Dental offices tended to become defensive about their procedures and quick to blame the manufacturer of handpieces for poor performance rather than focusing on proper cleaning and maintenance. And while educators noted the inconsistencies around cleaning protocols and resultant risks, much went unnoticed by the industry.
An important note: handpiece repair service was and continues to be a highly profitable business with direct ties to the inconsistent and incorrect maintenance methods learned early on.
Subsequent to my experience at KaVo Dental, I worked at SciCan and continued to witness inconsistencies in the schools, distributors and hundreds of offices that I examined. At SciCan we specialized in the Statim Sterilizer, a fairly simplistic machine. But again, practices varied resulting in some of the following:
|Variations of maintenance on Statim usage|
|*level machines that drained properly|
|*machines that dried correctly|
|*pouches that were dried correctly|
|*unleveled machines that did not drain|
|*leaking seals around cassettes resulting in failed cycles|
|*instruments (handpieces) not disassembled|
|*pouches that never dried|
|*some instruments were bagged, others were not in the same cycle|
|*never using a spore test|
|*stopping cycles ½ way through hot, because they did not have enough instruments for the next patient|
|*never cleaning the cassette|
|*never changing the bacteria filter or not knowing it exists|
|*using incorrect water in the machine|
As I continued to examine the inconsistencies, I understood that the key to proper handpiece performance at the best value is heavily influenced by the processes that maintain the instruments between patients. Patient safety is at its highest level when the dental staff is properly trained consistently on instrument management through schools, teaching programs, Universities and mentors. When instrument management training is poor and inconsistent, the results carry on for years and patient safety risk is tremendous.
Since 2014 I’ve served as the VP of Sales at DOVE Dental Products where I focus on teaching Evacuation Valve maintenance 101. Through hundreds of office visits, trade shows and phone interviews our company listens to how offices maintain HVE and Saliva Ejector Valves. We discover the same inconsistencies that existed in the 1990s. The use and maintenance of valves varies widely, resulting in unclean instruments, poor performance and leakage and backflow; major risks to patients, a critical issue that only grows in importance with each passing year.
|Variations of maintenance on Evacuation Valves|
|* removing the evacuation valve for cleaning frequency, sometimes, rarely, never|
|*cleaning the interior of valve frequency, sometimes, rarely, never|
|* reprocessing the valve components, sometimes, rarely, never|
|*only wiping exterior surfaces only between patients|
|*wiping, flushing between patients – some do it daily, weekly, monthly or often never|
|*cleaning the solids collector daily, weekly, monthly, or never|
|*never changing o-rings (3 in a HVE) and (2 in a Saliva Ejector) – these prevent seepage or leaking|
|*not knowing the valve is removable (very common)|
|*using a barrier between patients|
|*not using a barrier|
|*inspecting vacuum line condition routinely, sometimes, never|
|*ignoring leaks and bubbles from the sides of the instrument (very common)|
|*instructing patients to close around suction straws (very common)|
|*when patients do close around straws, nothing is mentioned to prevent Backflow|
|*warning patients to not close around straws|
When we examine dental programs today we see many of the same problems with evacuation valves that we’ve seen in the past. Many students have no idea that the valves are designed to swivel and should routinely be removed and cleaned even though every instruction guide clearly states: remove, scrub, reprocess routinely. Many rely on central sterilization or a person who maintains the chairs to insure clean and sanitary instruments. As always, patient safety is critical and it is of concern that weekly we are contacted by a dental school or program to explain “backflow,” and to question its importance as related to protecting the patient.
It’s been 20 years since we first raised concerns about water line bacteria, inconsistent maintenance of instruments and the need for consistency in infection control processes. Last week a U.S dental school had a major breach because dental handpieces were merely wiped and not properly cleaned for two years. In 1993 researchers provided solid proof that saliva ejector backflow occurs in 1 in 5 patients who close their lips around straws. However, just yesterday I had a conference call to explain saliva ejector backflow to a team of RDH’s in charge of infection control at 8 locations with nearly 50 chairs, and who did not know it exists.
Dove Dental continues to promote safe and effective dental practices for the benefit of the dental industry and for the patients. We are confident that our products provide the best solution for both dentists and patients; a simple, cost effective and expedited cleaning and maintenance regime at the dental office which insures a safe and sanitary dental experience for the patient.
For more information on Dove Dental Disposable Evacuation Valves, visit dovedentalproducts.com
November 28, 2018
by Amanda Batchelor, ABC 10 News
Nova Southeastern University’s College of Dental Medicine recently informed patients that they might have been exposed to certain viruses due to an “inconsistency in the prescribed sterilization procedures.”
According to an NSU letter dated last Friday, the issue was discovered at the Post-Graduate Orthodontic Clinic at 3200 S. University Drive in Davie. None of the university’s 11 other dental clinics appear to have been affected.
To view the article in its entirety, click here:
November 22, 2018
by Sheri B. Doniger DDS
Do you ever request your patients to close on the saliva ejector to evacuate fluids from their mouths? If so, when was the last time you effectively cleaned out the valve? When a patient closes on the saliva ejector or the tip becomes occluded, backflow may occur due to a temporary drop in vacuum pressure. Saliva ejector backflow has been proven to potentially occur in an estimated 21-25%, as studied by the University of Montreal in 1998. 1 These studies indicated water contamination containing bacterial levels ranging from 1 CFU to 300 CFU* per occurrence. [*CFU (cfu or cFu) is defined as colony forming units in microbiology used to estimate the number of viable bacteria or fungal cells in a sample.] More plainly stated, one in five patients may receive the backwash in their mouths from the last patient. Think of how many times you ask your patient to “close”? That is a lot of bacteria!
To view the article in its entirety, click below:
Great article from Dentistry IQ and Ms. Patti DiGangi, BS, RDH covering the importance of safety and the dental evacuation lines. Click on the link below.
We are excited to launch SalivaEjectorBackflow.com a new educational website designed to inform dental patients and professionals about the risk Saliva Ejector Backflow presents at every dental visit.
The website contains 3 pages in total. The homepage offers data and statistics on backflow as well as the CDC link on backflow warnings. Our contact page allows for additional information to be requested from DOVE Dental Products also a samples request to ship DOVE Valves to respective dental offices. Finally, our Photos page contains many photos of risky valves we encounter daily.
For a sneak peak, view the image below.
I know what you’re saying, Not My Valves! And we hope that is the case, however, there’s a very good possibility they do. Here’s why…
Lets first ask a couple of questions to see how well maintained your office HVE and Saliva Ejector Valves are.
*How often do you disassemble the parts on the HVE and Saliva Ejector? See image below. Each manufacturer states you are to disassemble as part of the regular routine and then scrub each part.
*Do you lubricate the o-rings frequently? All manufacturers state to routinely lubricate the orings. Specific to the leading chair mfr, they state to remove the orings entirely and lubricate each routinely.
*How often are you replacing the o-rings? Valve companies state to inspect orings often and routinely. Most agree to replace all valve orings yearly assuming your offices are already following the above-mentioned disassembly & lubricating routine. Not following the above routine likely means changing more frequently.
*What is the main purpose of the orings inside the evacuation valves?
- Seal off the liquid debris from leaving the interior of the valve.
- Provide a swivel on the valve and tailpiece coupler
- Provide a smooth easy on/off rotation
With respect to your office. Visit each room and see if the following is easy to do:
*Pull off the HVE or Saliva Ejector easily. These are designed to connect similar to a dental handpiece. They will click into place and should require NO force.
*Swivel at the connection. Same applies, similar to dental handpiece designs you should have swivel ability. Dental unit instruments were designed to work with you and not against you to reduce carpel tunnel syndrome. Also they are designed to reduce tangling of tubings.
*Pull/push out the On/Off lever. These are designed to push out with relative ease. This should require very little force.
So why is our article titled “Your Evacuation Valves Most Likely Leak?”
Over the past 3 years we’ve visited 100’s of offices, spoke with countless dental professionals and continue to work with the leading infection control professionals in the industry. We rarely see valves maintained correctly.
When orings are not maintained, they will not work properly. Our experience is based on the following:
1. It very rare when we offices disassemble the valves. Our last poll consisted of a few hundred dental professionals resulting in less than 1% following the IFU (instructions for use). Most valves we encounter are never removed off the lines and never lubricated.
2. Many offices we visit require a pair of pliers to remove the valves. It is a sure indicator the orings do not work. In these situations, the orings have become dry and brittle. Blood, saliva and other debris leak into the areas where the oring was designed to seal. These valves most often seap (leak) out the sides.
3. We speak to dental professionals and ask them if they have ever seen a bubble on the side of the valve during a procedure. More often we hear YES as opposed to NO as the response.
We’ve personally viewed leaking blood, saliva, water and bubbles. The cause for concern is where these leaks end up. Many of the leaks end up on the patients! To quote one RDH, “I quickly wiped the bubble off of my patients ear in horror”.
Finally, just because you cannot see the leak does not mean it’s not occurring. Bubbles and blood are obvious indicators. However, when orings are compromised and no longer function as they were designed, they will leak air and faint fluid because they will take the path least resistance when suction is on.