Quality Resource Guide l Infection Control and OSHA Update Part One 5th Ed. 6 www.metdental.com water that was heavily colonized with bacteria. These tragic cases reinforce the premise that exposing patients or dental personnel to water of poor micro-biological quality is inconsistent with both universally accepted infection control principles and the high level of asepsis standards routinely exhibited in most dental offices. Successful engineering and manufacturing approaches to improve water quality continue to provide dental professionals with choices for exerting better control over the quality of source water used in patient care. These include: 1. An alternate water supply that bypasses the community and dental unit water by providing sterile and/or distilled water directly into waterline attachments from a separate reservoir, combined with chemical treatment. 2. Filtration involving in-line filters to remove bacteria immediately before dental unit water enters instrument attachment. 3. Chemical disinfection involving periodic flushing of lines with a disinfectant followed by appropriate rinsing of lines with water, or a continuous release chemical disinfection system. 4. Thermal inactivation of facility water at a centralized source. 5. Reverse osmosis or ozonation using units designed for either single chair or entire practice water lines. 6. Ultraviolet irradiation of water prior to entrance into individual unit waterlines. 13 Water used for irrigation, or as a coolant, during therapy that does not involve surgery (excision, incision or reflection of tissue) and/or exposure of bone can be of potable quality (<500 cfu/ml) and need not be sterile. When therapy involves surgery or exposes bone, sterile water or saline must be used to reduce the chance of postoperative infection. In these cases, the water delivery system must be sterile to avoid contaminating the water/saline. Filtered and bacteria-free water is not necessarily sterile water and therefore filtered or distilled water is not to be used in this instance. The clinician should also remember that conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs because the water- bearing pathway cannot be reliably sterilized. Sterile water systems for surgery procedures must bypass the dental unit and employ sterile disposable or autoclavable tubing. In addition, handpieces or ultrasonic scalers used during surgical procedures must deliver sterile water or other solutions using sterilizable or single-use, disposable tubing. 28 The keys for accomplishing dental unit waterline asepsis remain the same as for other infection control goals - application of basic infection control principles and compliance with product instructions. Contaminated waterlines, like contaminated hands, instruments, and environmental surfaces, should be cleaned first to remove accumulated microbial and extracellular material before treatment. Compliance with a manufacturer’s step-by-step procedures for accomplishing this removal is essential. Minimizing subsequent waterline colonization may require another series of protocols, some of which may be more time consuming than anticipated. Thus, the whole dental team needs to be aware of product costs, necessity for compliance, and the time required to reach recommended waterline microbial concentrations. Research developments in recent years have led to not only greater individual options for dental practitioners, but also the availability of combination system products, which contain separate waterline cleaning agents and maintenance chemicals. Summary Effective infection control must occur as a routine component of dental professional activity. Much has been accomplished over the years. Implementation and routine application of a vast array of logical, effective techniques and procedures have served to protect both the HCW and their patients who expect safe care. Recognition, understanding, and compliance with appropriate recommendations by dental professionals, health professional organizations, and regulatory governmental agencies continue to have a major impact on the way dental treatment is provided. The field of infection control is constantly changing with the development of new products and techniques. Readers should periodically review publications of new or updated guidelines and documents to stay informed of current infection control recommendations and practices as new information and technologies become available. It is important to respond to emerging challenges in this area by not only realizing the success of the practices called for years ago, but also realize we must remain current in our infectious disease control approaches. Infection Control and OSHA Update Part Two 5th Edition describes additional office procedures for infection control.