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

Stop! Don’t Close on the Suction by Jennifer Reese RDH, BHSA

The day and life as a dental hygienist:

“Open bigger. Turn towards me. Stay open. Oh, don’t close on the suction.”

Throughout my hygiene career it is a priority to place patient care first, providing comfortable quality treatment, maintaining proper infection control, and comprehensive assessments; in the midst of watching the clock and time managing the day. While wearing many hats in our small office, I took on the role of infection control. Implementing the latest protocols office wide including cavicide wipe and rewipe, autoclave handpieces after every patient, change our traps, clean and scrub our suction lines, run our evacuation detergent nightly, and barrier protect next to everything touchable.

In school we learn about backflow risk from saliva ejectors. We are taught to instruct the patients not to close on the suction straws. However, the reality is patients’ frequently do close around the suction during treatment. I was tired of cringing under my mask when a patient close tightly without being able to stop them knowing they are at risk to be exposed to back flow.

According to the Centers for Disease and Control (CDC), backflow occurs when previously suctioned fluids and microorganisms remain present in the suction tubing or valve and flow back into the patient’s mouth. Backflow cross-contamination can occur when there is pressure in a patient’s mouth caused from closing their lips and forming a seal around the tip of the ejector, raising the ejector above the patients’ mouth during use, and when the saliva ejector is used at the same time as the high volume suction. The CDC also advises dental professional to inform patients to avoid closing their lips tightly around the tip of the saliva ejector and to contact the manufacturer of the dental unit to review proper maintenance procedures.

As a hygienist we took an oath as a patient advocate, to stand up to what is wrong, and to provide the best care possible. We know that backflow can occur, we should not put our patients at risk, we know better and there are solutions.

Take out your saliva ejector and take a look into your valves, would you want someone using it on you? Every dental unit is different; I learned many do have removable HVE and saliva ejector valves, which need to be autoclaved between each patient. Check your instructions for use (IFU) manuals for your valves. The proper maintenance process for the HVE and saliva ejector valves in our office took excessive time. They required autoclaving after every patient, checking and replacing O-rings, and disassembling them weekly. Unfortunately, this is something many of us do not learn before entering the workplace, instead, we learn it while on the job. It is our responsibility to read the manuals on each device and properly maintain them whether it takes time or costs a little extra.

At our office, we tried other backflow products, sampled using sleeves on our valves and attempted to clean properly between patients as instructed. Each process implemented proved to be too lengthy of a process or uncomfortable, and were really only putting a Band-Aid on the real issue of our evacuation valves which were a petri dish of all the days’ patients.

In the end, our office agreed upon Dove disposable valves which are disposable HVE and Saliva Ejector Valves that stop and eliminate the risk of backflow. For us, we removed backflow risk and alleviated the nuance of timely cleaning of the valve parts. We finally have peace of mind when patient close around the suction straws.

Jennifer Reese RDH, BHSA

https://www.linkedin.com/in/jennifer-reese-b6189963/

 

 

 

 

 

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

Inconsistency Causes Risk

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
*Not Purging
*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.

They include:

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