CONTINUING EDUCATION What’s all the fuss about dental unit waterlines? If you’ve been in the dental space for a long time, you’ve seen a lot of change, particularly in the infection control space. I remember practicing without gloves and masks and wiping everything down with an alcohol-soaked 2X2. Nowadays, none of us would even consider skipping gloves, and we understand the need for proper disinfection and sterilization of patient care items. But what about all this dental unit dental unit waterline stuff (DUWL)? I had been a hygienist for over 20 years before I had even heard of treating and testing waterlines. Back in 2018, I went to an annual OSHA bloodborne pathogens and infection control continuing education course, and the speaker mentioned testing and treating waterlines. I went back to my office the next day and asked if we were compliant. I was met with blank stares. Thankfully, my dentist fully supported me in taking on the project, and by the next Friday, I was shocked and testing lines. Why all of a sudden? To me, it felt like this waterline thing was brand new. But in reality, G.C. Blake highlighted the likelihood of microbial contamination of DUWL all the way back in 1963. Then, in 1993, the Centers for Disease Control (CDC), followed by the American Dental Association in 1996, began looking into guidelines for DUWLs. Ultimately, in 2003, the CDC issued its Guidelines for Infection Control in Dental Healthcare Settings, recommending that all dental units produce water that meets the EPA standard for safe drinking water of less than 500 CFU/ml.1 Is all this overkill? While I understood the research, I had been practicing for over twenty years and never made anyone sick. This sort of felt like busy work and one more thing in an already busy workday. But then I learned about some actual cases where people had, in fact, been sickened or even died as a result of contaminated DUWL. In the United States alone, there have been three high-profile cases and countless other cases that get settled quickly and quietly. In 2015, 24 children in Jonesboro, Georgia, were infected with nontuberculous Mycobacteria (NTM) after receiving pulpotomies. Then, in 2016, it happened again to 71 children in Anaheim, California. These two cases shined a spotlight on dental infection control, particularly DUWLs. But it still felt pretty rare and kind of one-off. Interestingly, in the Anaheim case, the symptoms showed up in 71 children over a long period of time. The first child developed swelling one day after treatment, and the 71st kid displayed symptoms 409 days after receiving their pulpotomy. 409 days? The frightening thing about these infections is they can stay dormant for so long. If the Anaheim outbreak hadn’t been so large and well investigated by public health, more than likely, no one would have linked the last child’s infection to their dental visit. What I take from that data is all I can confidently say is I don’t know if I’ve ever made anyone sick. But with a proper protocol in place, I can ensure moving forward, my DUWL will never sicken a patient. Crashing the Biofilm Party: Understanding the path to safe dental unit waterlines with AMANDA HILL 10 | Sept 2024
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