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/

 

 

 

 

 

Advertisements
dental hygiene, dental safety, infection control, rdh

Dental Patients Likely Receive Backflow

Today, most would agree patient safety is of utmost importance.
Unfortunately, on a daily basis we continue to see dental offices instructing patients to close around suction straws. Research concluded as far back as 1993 that patient safety is compromised when lips are closed around saliva ejectors during procedures. The CDC also provides us clear warnings about the risk from saliva ejector backflow.
https://www.cdc.gov/oralhealth/infectioncontrol/questions/saliva.html

Studies concluded 23% (Nearly 1 in 4) likely receive prior patient backflow when lips close around straws. Flushing the lines will not address this problem nor will the cleaning of the valve components.  Countless studies, education, and training clearly show the risks of backflow. Using a disposable backflow eliminating product is the only way to guarantee backflow prevention. NEW affordable backflow eliminating products are readily available.

Instructing patients to close around saliva ejector straws goes against everything we know for the past 20 years. Simply wiping valves between patients is not enough. Recent ATP surface testing displayed over 99% of evacuation valves failing when only wiped between patients.
https://www.rdhmag.com/articles/print/volume-37/issue-11/contents/is-wiping-the-valve-between-patients-enough.html

Ask yourself;  Knowing that Dental Backflow is a proven fact, why do most offices continue to place patients at risk?

– If your patients knew the facts about backflow, would they want you to do something about it?

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/