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

Your Evacuation Valves Most Likely Leak

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.

hve

*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?

  1.  Seal off the liquid debris from leaving the interior of the valve.
  2.  Provide a swivel on the valve and tailpiece coupler
  3.  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:

oring

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”.

leaking valve

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.

 

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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

 

Uncategorized

Your Everyday Decisions Are More Important Than You Realize, by Mrs. Pat Pine RDH

Swab Test Case Study

I was asked to perform an informal case study on dental office evacuation valves. This was a challenge in many ways. Several offices I contacted were leery to allow swab testing in their offices even though they said they felt confident of their disinfection process. My infection control flag went up many times in those practices. If they felt confident, why are they leery of doing a simple swab test? What was the risk to them? One office wanted to check with his lawyer, wanted my license, and much more seeming ridiculous information. The offices that were welcoming wanted to know how they could improve their infection prevention protocol. A big benefit was they received bags of disposable valves for allowing testing of their disinfected valves.

Testing was done to determine if the valves were contaminated even after disinfection. What are the consequences of the unknown invisible organic matter? What pathogens are nesting here? When disinfected what pathogens are being reduced or present?

As an experienced infection prevention and safety specialist, I performed the swab-testing. After reviewing the results, I was glad I had donned the appropriate PPE. Yet maybe I should have worn a hazmat suit!

The Down and Dirty Results

I processed 212 valve surfaces and determined they were YES contaminated after a routine disinfecting protocol. Discovering the bacterial load on dental unit vacuum valves left me with an uneasy feeling. Are we creating a healthy environment for our patients? Occupational Safety, Asepsis and Prevention (OSAP) has repeatedly stated that dental patients should be in a safe dental environment which includes the entire dental facility and all the processes.

Just to begin to discover where problems happen, the first question should be if the valves were disinfected according to manufacturer’s instructions? Metal valve companies recommend routine disassembly, scrubbing and reprocessing of the surfaces between patients. Minimal industry standard between patient protocol should be to:

  • Wipe once to clean
  • Wipe a second time to disinfect

Saliva Ejector and Backflow Risks

It’s not new information that back flow from low-volume saliva ejectors is happening. Research has shown that when a patient seals their lips around the tip of the saliva ejector, backflow can occur via the pressure created in the patient’s mouth. Studies report that gravity pulls fluid back toward patient’s mouth when tube positioning is above the patient’s mouth or when both high or low suction is used at the same time. Unfortunately, like not going in the water for 30 minutes after eating myth, we have taught our patients to close their lips around the saliva ejector.

The CDC recommends that the dental community advise their patients not to close their lips around the saliva ejector. CDC concluded that research confirms the significant risk in backflow with microbial cross contamination between patients.

Is your office using old, outdated operating procedures that are as myth based as watermelon seeds germinating in your stomach? Updated written policies and procedures are a must for any dental setting. Standard Operating Procedures (SOP) can be used for training and OSHA safety purposes. These policies should be reviewed on an annual basis. Check lists are powerful reminders of what might be forgotten in daily routines. (Go to http://www.oshatrainingbootcamp.com/ to find checklists and more.)

Replace the Old with the New

Replacing an old car with a new car increases safety with airbags, hands free phone connection and camera’s in the rear panel to prevent from hitting a child or running over a bicycle. The prevention is worth every penny. Valves are now available to keep patient’s safe in any dental facility. New disposable versions are clean and offer backflow prevention. We need to protect our patients from microbial bio-hazardous debris and possible transmission of disease via backwash. The Hippocratic Oath and professional ethics standards demand that we first, do no harm.

About the Author

Mrs. Pat Pine, RDH is a national and international speaker specializing in OSHA, infection control, lasers and orofacial myology. She brings thirty years of experience in dentistry to provide exciting and evidenced based programs. Pat believes that safety, infection control, and whole health are important to providers and patients alike. Her philosophy is an empowered team is a healthy team, which in turn creates an unstoppable referral formula. Ms. Pine conducts in-office training’s, boot camps, online seminars, and dental/dental hygiene conventions. She is a member of OSAP speaker’s/consultant’s bureau and publishes regularly in several dental magazines. Pat reminds others that education doesn’t stop at clinical treatment. It is an on-going process to enrich ones-self and bring the highest quality of care to patients. Pat can be reached at info@oshatrainingbootcamp.com

Uncategorized

OSAP Recognizes Stoma Dental as Infection Control Standout

The Organization for Safety, Asepsis and Prevention (OSAP) held its Dental Infection Control Boot Camp, where it recognized two companies for their infection control product lines. Attendees voted to select the companies from among all the exhibitors that they felt deserved special recognition for infection control design.

The winner for Most Innovative Product was Stoma Dental, Chesterfield, Mo,  for its DOVE Disposable Valves. The company, which only recently entered the disposables market, created the product to address cleaning inconsistencies relating to evacuation valves.

For more, click here  –  OSAP Recognizes Stoma Dental

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