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 and has little to do with the specific program or dental school.  More important, patient safety is at its highest level when the dental staff is properly trained.  Taken together, when processes are poorly performed or understood, repair costs are high, performance is low and the patient risk of cross contamination 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

 

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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

Your Suction Lines Remain Dirty “After Flushing”

The following images display the interior of a dental vac suction line “before and after” flushing.  Debris will remain regardless, unless the interior surfaces are scrubbed.  Since this is not possible, “Backflow” of suction devices should be a major concern.  Our new Saliva Ejector Backflow Prevention Valve alleviates the risk!interior valve after flushing

Uncategorized

5 Reasons To Use DOVE Disposable HVE and SE Valves?

5 Reasons To Use DOVE
1.  Single-use Disposable Devices are SAFE & eliminate the worry of cross-contamination
2.  DOVE Valves contain an Antimicrobial to prevent growth of microorganisms
3.  Each Valve is NEW & provides 100% Performance
4.  Saves valuable staff time if reprocessing
5.  Easy to use on any dental unit