The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#85 Managing Risks with Independent Waterline Testing
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This episode is sponsored by Dentisafe.
This week the Divas go deeper into the finer points of DUWL testing. If you are unsure about the safety of your DUWL or having difficulty achieving passing results, check out this week's episode.
- CDC Guidelines on Dental Unit Water Quality - https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/dental-unit-water-quality.html
- OSAP Dental Unit Waterlines Toolkit - https://www.osap.org/topics-dental-unit-waterlines-duwl
- Dentisafe Resources - https://dentisafe.com/resources/
Welcome! I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. My name is Olivia Juan and I will be your moderator today. We are so excited to work with Landon Hillard of Dentasafe. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or visit our website, thecompliancedevas.com. Any resources we mention during this episode can be found on our website. Please submit your questions to support at the compliancedeevas.com. So Landon, we're so excited to have you on this episode. So thank you first of all for making time out of your busy schedule. I know that our listeners are excited to hear from you. And to get us started, Landon, would you please give us a brief history about your company and also your involvement with the company?
SPEAKER_00Yeah, really appreciate y'all having me on today. Super excited on behalf of Dentisafe. Um in 2017, we started uh by a doctor, um, a dentist in the area that saw the need for water testing. Um, he was working on a project at the time uh just to do water testing in general. So he just started doing some experimental stuff at his office, and he saw that actually he was failing some lines, and he was doing everything right and still failing. He said, If I'm in this position, then what are these doctors that really are not championing this uh avenue? What where are their lines going to be at? And so he called me, we started the business idea and moved forward from there. About a year of RD to take time to see what the industry is looking at, what testing they're doing, and kind of built the model from there. 2018 we launched and found that it was actually a world of difference. Um, that we saw testing was not being done. Their water lines were really above the 500 CFU that the CDC is putting on municipal water, and uh we kind of went from the races from there. We uh were super different in the fact that we do not have a product, we really did not want that conflict of interest. Our goal was to come in and be the water authority for the offices, and we could really provide them education on why it's important, why testing is necessary in the office, and what to do if they really failed. So once we launched, um we hit the market hard, and our data came back time and time again saying that testing is very needed. And we started connecting with the solutions. Uh, and so we provide this the contacts to our solutions and walk them through the whole process uh from failure to passing.
SPEAKER_02That's super interesting, Landon. What a forward-thinking dentist that you work with. Uh, an amazing area of compliance to focus on. I know Leslie had some things that she wanted to ask you about. Leslie.
SPEAKER_01Well, thank you, Olivia. Landon, we we know that you're passionate about your company is passionate about education, but you take it uh further than just a few videos on your website and a list of instructions for the client. Tell us a little bit about your education process for the greater good uh for dentistry.
SPEAKER_00We started shifting in about 2019 to doing free educational classes for dental schools, hygiene and assistant schools. We really wanted to see their um knowledge base grow. Uh, a friend of mine is a dentist in the my area as well, um, went to a prestigious dental school. And one day I asked him, I said, How much information did you gain in your four years of college on biofilm, making sure you're testing and what you're doing? He said, Honestly, man, I've done two days out of my four years on education on this stuff. And it baffled my mind because this is something that could really shut down a practice quickly. And so after that, uh again, we started going into the schools to give that free educational class. And so anyone can sign up for that. Um, we we have a presentation, we normally do testing for those schools as well. So we have real-world examples uh that they let us share with their students. And so that's uh uh one example of how we really push for education in the dental community.
SPEAKER_01Well, how about in the private practice or in the group setting where usually one dental assistant is responsible for infection control? Is there uh some compliance issues that you might discuss with us to help us understand how to get to that one private practice or that group?
SPEAKER_00We have found, like you said, there's only one person really champion this um waterline testing or even waterline in general. We find that the dentists themselves um are normally busy with crowns or implants, and the hygienists or the assistants are the ones that are really thinking about this. And um so what we do is uh we provide a binder for the private practice um that has all of the information that we provide, um real-world analytics on why you should test. Uh, that's also a place that they keep all their testing that they've done previously. And um they've also been able to contact us at Dennis A for any solutions that they need.
SPEAKER_01I've heard you once before mention in our uh conversations before this podcast, a water champion, someone in the practice that is actually going to uh follow through with everything. So, what what tools do you give to someone that is like the water champion? I mean, there's some videos on your website. I actually saw that video and I thought, well, that's very super easy. And in less than three minutes, I can understand what it is that Dentistate is going to send to me and and how to package everything up. But what if I do everything right and I follow the checklist and I still have problems? What's the support that I would get if I were the water champion?
SPEAKER_00So, what we do, uh, let's say an office does fail and they contact us. We walk them through the process. It's not a test, failure, and forget uh kind of company. We really are a hands-on uh company that wants to walk you through the process. And we have clients time and time again that have started with massive failures, and by the end of our time, we're seeing under 20 CFUs. And I think that's just the ability that we can have those conversations, we can have the testing that is proving that our solutions or what the staff is doing is actually working. And if we don't have that regulatory contact, we don't see the testing actually doing much or even the solution. Um, and so for us, we really want to have the ability to have those one-on-one conversation, phone calls. I can't tell you how many times I've looked at my phone and it's been an hour conversation just on dental lines. Um, and so we really do budget our time to have that one-on-one service with the clients.
SPEAKER_01Well, thank you. That means that the person who is doing the testing, if they fail, they don't have to feel like a failure themselves. It sounds like you are right there to hold the hand of the person so that they can be successful and then feel successful.
SPEAKER_00Absolutely.
SPEAKER_01Thank you.
SPEAKER_02Landon, that's super helpful, and I appreciate you elaborating on those topics and Leslie, your feedback. I'd like to jump over to Mary because Mary wanted to dive into more of the science of biofilm.
SPEAKER_04Thanks, Olivia. And again, Landon, thank you for being here with us on this episode. Um, can you just give us a brief overview of why we're worrying about testing the water? What is it that is causing the problems? And what kind of um options do we have to alleviate the problem?
SPEAKER_00Well, that is probably a podcast on its own to talk about biofilm. I try to keep it very brief. Biofilm is broken up into two different um avenues. So biofilm itself, which is essentially a glob of different organisms that are growing in the water lines, and then underneath that is the biomatrix. A lot of times our active ingredients will get rid of the biofilm itself, the organisms, but there's this grid-like pattern that is left underneath the biofilm called the biomatrix that actually helps biofilm grow back after it has been cleaned out. That's why shocking is so important. Uh, a lot of times when we shock, that is actually getting rid of the biomatrix underneath it as well. Um, and so the products out there, we've seen that there's three main products right now. There's the tablets, there's the straws, and the liquids. We have found that in most cases, all three of those are great options. Um, you really do need to see, for example, we have a client up in Boone, uh, North Carolina that has really hard water. And so we have seen that some products don't work there. And that's why testing is so important to see which product is actually gonna work well in the office. And then to answer the follow-up question, there is why is this important? Well, biofilm, as it breaks off, if we get a high count of biofilm, it's gonna break off with the water pressure. And then if we're working uh inside the mouth in the dental office, whether that's even uh cleaning and we're scraping, there's gonna be some open wounds. And as we're putting that water in there and blasting all the bugs from the biofilm into that open wound, we've seen that you can get super sick from that. Um I think we have some great examples in in uh Georgia and California where we've seen biofilm has affected uh even Pete's pediatric dentistry. Uh and at the end of the day, that's just something we can't be doing. We can't have our patients becoming sick from our dental unit water lines.
SPEAKER_04Well, and Landon, I think you would probably agree that um we don't want our team members getting sick either because they're exposed to that aerosol from the water lines, even though they should be wearing their respiratory protection, they still may have some exposure.
SPEAKER_00Yeah, absolutely. I mean, aerosol bacteria doesn't just go away once a patient walks out the door, or if we're changing our um mask or anything like that, it's gonna be in the the air for a good while after that patient leaves. And then you have another patient coming in that is now breathing in that aerosol bacteria as well. So, yes, it is a staff um issue. Uh, our doctors and our staff are breathing in that aerosol bacteria and then our patients as well. So that's a great point that we need to be concerned um not just with the bacteria that's going into our mouth, but also as we're breathing in. Legionella is a huge issue, and that is an aerosol bacteria that we breathe in and it's gonna set into our lungs.
SPEAKER_04Absolutely. And we actually had a woman, I believe it was in 2018, in Italy, who died from Legionella that was traced back to the dental office that she was treated in. So that is a huge concern that we all should have.
SPEAKER_00Absolutely. And that is the only bug that we really test uh individually for. Uh we normally test for um all of the bugs are CFU count. Um but because Legionella, like you said, is so deadly, we want to ensure that we test for that specifically. And so any office that is worried about Legionella, that is something that we isolate and ensure that we have control over that specific bug.
SPEAKER_02Great information, Landon. I I appreciate how you explain beautifully about the science of biofilm. I would like Linda to take the lead now in speaking with you about waterline tests.
SPEAKER_03Thank you, Olivia. Landon, I'm enjoying the perspective that you're bringing for our listeners and the different ways that you're enlightening them to even just going deeper in dental unit waterline testing that you know, the difference between the biofilm and the biomatrix, and that although there's great products on the market, they have to really discern which one is best for them. And it's not so much maybe if I could just say quickly a price issue, it's about what's working with their water and really going deeper on that. So, talking about testing the water, what's your observation of the waterline test comparison between direct plumbed water lines and those that are connected to the municipal water bottle, uh municipal water, you know, can could you compare that to the self-contained systems for us and kind of help our listeners go a little deeper on that, please?
SPEAKER_00Interestingly enough that you bring that up. Uh, we just had um an office that we tested and they wanted to test their source water. Um, so that's the water coming out of the sinks, that's the water that is plumbed directly into their dental unit water line before it gets to the dental unit water line, straight from the city. Three out of the four source water um that they took had 300 CFUs or above. One of them actually was above the 500, which is a failure. So for us at Dentista, we highly recommend that we use distilled water because that's starting at zero CFUs. If we're already having trouble with distilled water failing in dental unit water lines and we're at zero, if we introduce something that is at let's say 400 CFUs, and then that's in a warm environment over the weekend, we found that our numbers grow instrumentally from that. And so for the inline plumbing, that is something that we highly recommend is changed over to the self-contained, and that we do start with distilled water.
SPEAKER_03Thanks, Landon. Let's go deeper just a second, if you don't mind. So distilled water and self-contained water is really important. So just to reiterate that point, because I think it makes a difference for offices that are maybe older, and some of these double unit chairs don't have an independent water bottle system. So while doctors are busy adding other areas of technology and growing in um different realms, you know, in their practice and clinical care, it's so important to kind of come back to the basics, wouldn't you say, Landon, and really focus on what's happening in that realm of patient safety?
SPEAKER_00Yeah, absolutely. We've also found that um while ago they were using heaters in their dental unit water lines. So again, if we're starting at 400 CFUs from the city, and then we add a heater to that, so now we're creating a super warm environment and it's like a hot tub for these bugs. They just grow uh out of control from that. And so, really looking at our process of how water is coming in to the final um endpoint of the patient's mouth and breaking down where those we'll say pain points are heaters are something that we really shouldn't have because we found that those bugs grow uh super fast with those. Um, getting water from the city, it's probably not the best. That also has minerals in it, uh, high count of minerals that are going to make our hand pieces not last as long. And you're gonna have to send those off and get fixed. And so, starting with that distilled water, we found that is really the best solution for these offices.
SPEAKER_03Yeah, thank you. And I'll just wrap up and say just quickly, I remember as a very young hygienist working in a very old unit that we had the heater and we had a little spray bottle where we would put mouthwash in it and spray mouthwash into the patient's mouth once we were finished. So that way they really kind of came out with this refreshed. And who knows what contamination we were putting in their mouths back then. I won't tell you what how that was in the dark ages. But Mary, did you want a comment here too, please?
SPEAKER_04We did um simply because I know there are some practices out there that have their old distillers that they're making their own distilled water, and just to call their attention to the fact that they need maintenance just like their water lines do, because you can grow biofilm in the distiller. And there have been some studies done, I believe, in the um the military investigative service that that they had higher CFU counts in the dental unit water when they were using their own distillers than they might have otherwise. So got to maintain the distillers as well.
SPEAKER_00Absolutely, and that's a great point of testing that source water wherever you're getting your water, if it's not from a bottle, uh let's say at the grocery store delivered, uh, that is something that's super important to see where you're starting at. Uh, and if you think that the distiller in your office is bringing you true distilled water at zero CFUs, but then you test it and you actually find, like you said, above the 500 CFUs, that's something we should look at and take care of.
SPEAKER_02Great information. Landon, thank you so much for helping us understand these issues and how to address them in dealing with biofilm. But now I'd like to ask you a couple questions about the monitoring that you've been speaking about. Can you talk to us about the waterline test kits and how that works, please?
SPEAKER_00So when we designed our kits, we wanted it to be a simple process. Uh sometimes as we're getting into the weeds of water testing and biofilm and biomatrix, uh, the staff can get overwhelmed. And so for us, we wanted to break it down into exactly what you need to do. On our website, we have a video that shows the step-by-step process of ordering the kit, getting the kit in, and sending it back to us. So for us, we do it per line basis. If you have 10 lines that you want to test, you get a 10-line kit. If you have five lines, we send you a five-line kit. So let's say you have five lines. From us, we pre-package everything in there that you would need. So your five vials, you have a freezer pack in there, you have a return shipping label, and you have an order form. The office will receive that. They'll throw the freezer pack into the freezer overnight. The next day, they purge their line for 30 seconds, and then they fill up our vials, seal them tightly, take out that freezer pack, throw it back into our insulated mailer, and then the prepaid mailer goes back on top, and then it comes back to us. Super simple process. We didn't want it confusing. And then on our end, we take those samples, we plate them, and depending on which tests you have, will depend on your results. But within uh seven days, you'll have your results back to ensure where the office stands, where the baselines are, and then we do that follow-up call that we've talked about or follow-up email to really work with the office if there are failures and what we would advise to go from there.
SPEAKER_02That's helpful, Landon. Thank you. Can you explain to us the difference between these in-office test kits with the paddles versus the test kits that you do in your lab? Can you explain that difference to us?
SPEAKER_00Yeah, absolutely. So for Dennis Safe, we've gone through a rigorous program to get certifications. Uh, CDC Elite is one of our um certificates that we have at our lab. We're state certified. Um, so there's processes that we've had to jump through to ensure that our lab is actually up to standards. And so for in office testing, uh, you don't necessarily have those standards. Now, we will say that the in office tests are a quick, dirty way, per se, to get results. They're not as accurate or really that accurate at all. And there's a huge margin of error that can occur in these offices with the The in-office test. So for our lab, we are under those standards, under those practices that ensure that the results that you're getting back are truly what you have. And so a big difference there is just ensuring that we're getting true numbers and that we're not getting a false reading from those tests.
SPEAKER_02That's interesting, Landon. Thank you. Mary, what else can you probe with Landon that might help our listeners?
SPEAKER_04One of the challenges that I run into all the time is reluctance to add additional expense to a protocol and you know the attitude that nothing's happened and why do I need to worry about this? How give can you give us some talking points? Um, some additional talking points about how do we actually address this?
SPEAKER_00It's a great question. We've seen that a lot of people do not associate getting sick with the dentist. Um let's say 30, 40 years ago, um, a lot of people thought the hospital was a safe place to go. Um and now we've seen that probably if you're feeling bad, you going to the hospital for a cold or something like that would not be a good place because there are a lot of a lot of bacteria and a lot of aerosol bacteria there that you probably can contract there. And the dental offices in the same way. Uh we had a case recently um where I was contacted and they said, Well, in the last two weeks, um, my mom got really sick, and we don't know exactly where it came from. She doesn't travel much. And in our industry, obviously, I asked, did she go to the dentist? And she actually did. Um, and they never associated uh the mom getting sick with probably the dental unit water lines. Um, and so that would be our our first talking point. Um, would be do we truly know where we're getting sick? And if we test our lines and we fail, then that's probably a great indication that the sickness has come from the dental office. The mouth is the highway between the brain and the heart. And so everything travels through there. And so if we're adding those bugs into our mouth, it's only going up or down and can hit some major organs that can cause us to get sick very quickly.
SPEAKER_04One more question, Landon. Um, and this goes back to actually facilitating doing the testing. Um, many practices have been told that they should do a homogenized or a pooled test as opposed to testing individual lines. Can you address that for us and help us understand which is better?
SPEAKER_00At Dentus Safe, we highly discourage homogenized samples solely for the fact that if I have a line that is at uh if we're testing, let's say four lines our airwater syringe, uh assistant, airwater syringe doctor, our cavitron, and our hand piece. And three of those are at 200 CFUs. So our average there is 200 CFUs, but then we have uh one that is at 600. And that will dilute the 600 to be a passing test. And for us, we would rather do single line testing at a less count than we're testing everything, quote unquote, uh, with homogenized samples. Uh, we just see that uh the dilution there can give us false hope that what we're doing is actually working when some of our lines are actually failing and need attention.
SPEAKER_04And I imagine that would be helpful too if uh practice keeps failing, but they're trying to figure out where the failure is coming from, even if they have some deadlegs um in their systems. So that that might be helpful as well.
SPEAKER_00That was another thing. Uh, deadlegs um are something that if you don't use a water line very often um and you can do without it in your practice, we highly recommend to cut off those dead legs to discon disconnect them from the water system itself uh because we don't think about them. We don't think about flushing out um those water lines. Uh and biofilm can grow backwards in that area and actually start contaminating all of our other lines from just that one dead leg. And so, again, that's something that we highly recommend talking to one of your techs for to get that cut off. Um, and a lot of times that can solve some of the dental unit water line issues.
SPEAKER_02Thank you, Mary and Landon. Uh, we'd like to ask Linda to wrap up our episode questions. Linda.
SPEAKER_03This has been so helpful, Linda, when you think about the false test results that offices can get and what the huge margin of error and give them a false sense of security when really they're still jeopardizing patients' health and they may not realize it. So, in closing, then just can you give our listeners something? What are your thoughts that they should think about for the beginning of the new year? And if you have any specials or anything you'd like to share with us, we'd love um to hear your thoughts on those.
SPEAKER_00Recommendations for the new year would be just to get a baseline. Um, whether that's one line per operatory, whether that's just testing all of your lines to see where you are in the new year. Uh, that is invaluable information to start off 2023 with. Again, the solutions are actually pretty simple. We just have to know that we need those solutions. Uh, when we see that failure, it's an easy process of probably just the staff flushing out the lines a little bit more. Or maybe the product you're using is actually ending in the third quarter instead of the fourth quarter. Um, and so that regulatory testing is so important to be able to see if our staff is doing what we're they're supposed to, if our product is doing what they're supposed to. Um that will those two issues right there will solve a host of problems with our dental unit water lines. And starting off that new year with that understanding, and our goal, our hope would be that when you get that waterline result is that we're under the 500 CFUs, that we're down in the 20s. That would be amazing for us to be able to share that information. But we found that um those that are not regulatory testing will have about 60% chance that one of their lines in their office will fail. And that's just something that in the dental profession, we shouldn't be seeing that. Um, we should be having those dental unit water lines that we use every single day with every single patient. Those should be under the recommended 500 CFUs by the CDC. And so, in the new year, for for anybody that listens to uh the podcast, we're gonna do 20% off your first test um testing. Um, and we really want those um that are looking for the new year to listen to this podcast, to listen to all these podcasts, um, to get the wealth of knowledge that you really need to understand where the pain points are in compliance and with the dental unit water lines, especially. And so, again, 20% off. Um, the code will be divas. And we really look forward to getting to meet all the dentists and all of the hygienists and assistants that listen to the podcast. And even if you have any questions, you can contact us at l.hilliard at dentisafe.com. Again, that's l.hilliard at dentisafe.com. And we would love to we'll talk to you more about it. And um, hopefully we see you in 2023.
SPEAKER_02Thank you, Landon. Landon Hillard with Dentistafe. We so appreciate your time. We know you're a busy person, but thanks for taking the time with us to talk about the science of biofilm and how your company offers water testing. We appreciate you helping our listeners to become the water champions in their individual offices. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliancedevas.com, and the resources that we talked about will be available on our website. Please take advantage of that 20% discount. Thanks again, Landon.