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
#113 What Does a Successful Waterline Protocol Look Like?
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Dental practices are responsible for ensuring that the treatment water from their dental units is safe for patients and the dental team. The key to managing the dental unit water quality is to establish a protocol and follow it consistently. This episode examines all of the components of a successful water quality management protocol.
- CDC Guidelines for Infection Control in Dental Health-care settings 2003: https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf
- CDC Dental Unit Water Quality: https://bit.ly/3PARWWY
- HuFriedy Group - Dental Water Management Landing Page: https://bit.ly/3reF4M9
- What Does a Successful Waterline Maintenance Protocol Look Like? https://bit.ly/3NtRNBO
- Top Reasons Why Dental Unit Waterlines Fail: https://bit.ly/44ozepA
- Aseptic Technique for Obtaining a Water Sample: https://bit.ly/3rk0DdW
- HFG Water In, Water Out Brochure: https://bit.ly/439JVvh
- HFG Dental Waterline Testing : https://bit.ly/46yK3an
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_04I'm Linda Harvey. I'm Olivia Long, and together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I will be the moderator for this episode. The compliance divas bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedeivas.com. All of the resources that we mentioned during this episode can be found on the website, thecompliancedivas.com, and also in the show notes for the podcast. You can also submit questions by email to support at thecompliancedivas.com. For this episode, we are thrilled to welcome back our sustaining sponsor, the Hugh Freedy Group. The Hugh Fruity Group has over 200 years of collective experience in the dental industry. Hugh Freedy Group is a global leader in dental instrument manufacturing, infection prevention, and instrument reprocessing workflows and waterline safety, bringing together companies such as Accutron, Crosstex International, Hugh Freedie, and Paul Marrow to help clinicians be the best in practice. And we also have a guest with us today from the Hugh Freed group, Sam Hammerback. And Sam, I'm going to let you tell us a little bit about your background and then we're going to dive into this episode.
SPEAKER_00Thank you, Mary. My name is Sam Hammerback. I am a product specialist here at the Hugh Freed Group that covers waterline products and equipment and services. So which is includes the waterline testing that we just recently launched, the 24-hour in-office dental waterline test, which offers a very rapid turnaround and a quick check to make sure that everything is going well inside the dental units. And it's been quite the journey so far. And thank you for having me on the podcast.
SPEAKER_02Terrific, Sam. Thank you, and thank you for joining us. Today's topic is dental unit water lines and talking about what's the importance of a waterline protocol because there are so many different products and testing and all kinds of interesting information out there. It is important for a practice to establish a protocol and to follow that protocol consistently so that they know that their dental unit water is safe. We know that untreated water doesn't meet the quality standard of 500 CFUs per milliliter of water. And if you are not testing your water, you have no idea if what you're doing to treat that water is working. So we're going to start at the beginning with Olivia to um talk to us about the quality of the source water. So in other words, what goes into the dental unit? Why isn't that important? And please help us dispel the myth about distilled water being sterile water.
SPEAKER_04Sure, Mary, this is a common topic that we have to work with dental groups and helping them understand this maze of information. But I think a good place to start, Mary, and thank you, Sam, for joining us is that according to CDC, the dental unit water lines promote bacterial growth and develop biofilm due to the very presence of that long narrow tubing, adding in the inconsistent flow rates and the potential for retraction of oral fluids. And because of that, whether it's the dental employees or the patients, they could be at risk for adverse health effects if the water is not treated. And we've seen this time and time again with the different outbreaks of infection among pediatric patients. So whether it's a pediatric patient or immune-compromised adults, we don't want the patient to leave with something that they didn't have to begin with when they came to our office. So we have that responsibility to make sure that dental care is safely provided and water topic is incredibly important. And we've learned over the years, Mary, that based on science, that if the source water does not meet the quality standards established, well then the patient is at risk of infection and worse yet, harm, like the little pediatric patient in California that actually had part of her jawbone removed. And employees could be at risk as well. So that would trigger an OSHA issue where we are as employers are charged in providing a safe place to work and also factor in the cost of equipment being damaged. So when the patient ends up injured, the whole reputation of the practice that took years to establish credibility can be destroyed. I mean, one lawsuit, one class action lawsuit, and there it goes. And Mary, I'm glad you brought up about uh is distilled water sterile? You know, when I ask groups when I'm working on site what kind of water they're putting into the reservoir, they might say, well, it's uh sterile water or it's distilled water. But either way, it's still passing through that tubing, which makes the output at risk for the patients. So that's why we've got to embrace the science and understand what this is all about. Now, getting back to the distilled water, that means that the most of the minerals have been removed. So it's the process of converting steam into water. And many of the manufacturers recommend using distilled water to make sure that the equipment is not damaged with those minerals. But even if they're using sterile water, once it's exposed to the tubing, it's no longer sterile. Um, I find it interesting, Mary, with looking at if if they're using, for example, a bulb syringe to dispense sterile water, they might open a container and continue to use it, even though it says, you know, one-time use. And the concept is once it's open, it's no longer sterile. So, in simple words, we can define sterile water as a form of water that there is no disease-causing bacteria or or fungus or viruses. But once again, once it passes through that tubing, then it could be exposed to bacterial growth. And that's why this is such a hot topic, Mary, for us to understand the product line. So whether you're consultants or sales reps or you're the safety coordinator, we have to do our research and understand how these products work together so that that patient visit is safe.
SPEAKER_02So well said, Um, Olivia. Thank you so much for that. Um and I'm so glad you mentioned about the the sterile water issue because it is such a concern. So, Linda, can you lead us in a discussion of the importance of establishing that dental unit waterline protocol and why the consistency of following that protocol is so very important?
SPEAKER_03Sure, Mary. When I think about establishing a dental unit waterline protocol, there's a well-known phrase that comes to mind. And I think this will resonate with our listeners because we've all said it or heard it over the years, and that is we don't know what we don't know. And when we're aware of the fact that we need to be doing something with the water lines, but we don't know what to do or what products, we just don't know what we don't know. So that explains why we have to start with testing first. So when I think about this, first I want to back up, Mary, and explain the word protocol a little bit so that we're kind of on the same page with our listeners because words have different meanings to different people. Um, but a protocol for our purpose for our purposes is really we're talking about a sequence of steps that you're following. It could also be called your office process. Um, many times, if you formalize it, you might call it a policy and procedure. So no matter what phrase or term you're using in your office, we're kind of talking about those sequential steps that you have organized that meet the needs for the quality of water that Olivia was just speaking about. So when I think about establishing your successful waterline maintenance protocol, it really comes down to three steps preparation, implementation, and continuation. And that's sort of the triad of success, if you will. In the preparation step, Mary, it's just setting your testing interval. And to do that, we need to go back to the instructions or guidance from the equipment manufacturer. We always have to follow the manufacturer's instructions for use. And if none there, then look at the delineate orderline treatment that you've pro that you've selected. What are the instructions for use there? And also use OSAP's guidance. And I know we'll have the link to that white paper and OSAP resources in our show notes today. So someone can download that and make it real easy if they're looking to the next step in the preparation, educate yourself. So preparation is really a twofold step. It's the testing interval and it's educating yourself. That's very important. Um, sometimes we just rely on just one piece of information. We see a product on sale or we hear something from a friend or a sales rep that comes in. And we need to really understand why that's a good product and what works about it to make the best decision for our office. Because as Olivia mentioned, a lot depends on what the water quality is that you're using, the type of water. So you have to be really look at all these different pieces. It's sort of like putting a puzzle together as you begin to learn what we don't know. The next step is implementation. And so you have to start here with the test, Mary. So it's test all the water lines, and you can do a composite or you can do each line separately. And maybe the divas have some other thoughts on that. Um, we know there's pros and cons to doing a composite test, but if that's what you need to start with, that's fine. Start somewhere. I'm describing a composite test from a dental unit uh itself as being a combination of all the water lines for that unit, both air water syringes and the doctor's high speed or the hygienist ultrasonic. And then you determine did we pass or did we fail? And so if you passed, yay! Then you go on to the next step and you begin to treat and implement your protocol. And if you fail, now we have to go back and shock and then retest. So it's sort of a sequence, it's test and then to come to the stop sign and say, did we go, do we or red light, if we will? Is it red because we failed and we got to turn around and wait? Or is it a green light and we get to go forward and continue with the treatment of our of our units? Then the third step is continuation. This includes the documentation of your results, including pictures. Um, you may not see that too much in the Dental Unit Waterline instructions, but we've all been recommending that individually and collectively as the divas to have that documentation because with the waterline test, you know, they sometimes they fade over time and you don't have one that um it's not when you have the in-office test. Let me qualify that, Mary. When it's the in-office test, take pictures. If you're using a mailback system, then you're going to get a nice certificate and you will know which of your lines passed and which ones have failed. And I'll give them a little tip here, Mary. I have posted my clients um X third-party water test on Facebook when they've come back and they've all passed. So I think it's a great marketing tool for the practice. It really says a lot. And then another step in the continuation is educate. So again, it's educate and re-educate because we know education is an ongoing process. Um, it's there's new developments happening and there's new products. And I know, Mary, you're going to address that a little bit later. So that's the those are the three steps: preparation, implementation, and continuation. And I'd like to ask Sam to chip in here because I know he's just an expert in this area. So, Sam, please share some thoughts that you might have on this topic as well.
SPEAKER_00And this so you're absolutely right with the pictures. Uh and the number of times where we talk to offices and they say, Oh, well, yep, our our in-office waterline tests were passing. I'm like, Okay, great, prove it. Because if someone comes in and if someone's coming in and asking you about waterline tests, you know, other things have already gone wrong in your life. And if someone's asking you about your waterline tests and you say, Oh, yep, we pass, no worries, you're gonna have to provide something that shows you're passing. So uh to your point, your in-office water line tests come with um correction, I'm sorry, the laboratory-based or sending out for the results will come with a results page, whether that's digital, a PDF, or a physical copy, you'll get those results from an a an established laboratory or location. But the in-office ones, unless you take a picture at the time that you check it, because what a lot of I've I've seen this one and this one I chuckled, but again, it's you don't know what you don't know. They just kept their paddles. It was two weeks after the the test was done, and I said, Oh, but wait, we're now we're failing. I'm like, No, you have to look at your results when the the instructions, once again, you always go back to the knowing those pesky instructions. You're looking at the instructions, they tell you to check it at 24 hours, 48 hours, seven days. Whatever it is, that's the moment where you take the picture. Don't don't keep them uh in your drawer to show them, you know, to people who asked, because that will not help you. But I just that was just a quick kind of anecdote story I had to share about you know keeping your waterline test and just make sure you take the pictures.
SPEAKER_03I love that, Sam. Thank you. And I had chuckled a little bit when you use the word pesky because we sometimes we don't want to keep the extra paper or it gets lost and we don't think it's important. But it's so important for that continuity of communication and making sure that we're sharing the right word from person to person. Otherwise, it becomes like the telephone game that we all remember as children. You know, we're you know, by the time the five of us here on this call, you know, say something to one another, it's entirely different from the time we start. So we just can't have that happen. And then with the amount of turnover and individuals coming into dentistry with no dental experience, it really sort of solidifies that educational foundation that you need for your practice. So to recap, my three steps for success were preparation, which includes setting your testing interval with having all your instructions for use handy, educating yourself on those products, and then implementation, which consists of testing. And then once you pass or fail, you know what road you need to turn down. So you're gonna stop sign at a dead end. Do I go left? Do I go right? It's based on the results of those tests. And if it's a pass, then you go right through and you keep treating according to the manufacturer's instructions. And if it's a fail, then you've got to go the other direction and start back over and shock and retest. And then the third step was continuation, which includes your documentation with those pictures for in-house testing, as well as continually educating yourself and staying up to date. Mary, I'd like to add one more step to this success formula, and that is making sure that your protocol is written down. It can be a simple handwritten format if an office wants to. It doesn't have to be all typed and laid out beautiful, but whatever level they're practicing that that's practical for them and they're comfortable. And if someone is already using the Hugh Free Greenlight compliance program in their practice, then they have that protocol already written up and already customized to their practice. So it's important that that protocol be reviewed with new team members and that it's reviewed and updated on a regular basis. Because if you change your product, now your protocol needs to be updated so everything stays in the sync and matches. And Sam, just one closing thought for me to off to piggyback off what you said. If somebody's asking you what about the results of your test, then you probably have an allegation going on. And that's what Olivia was talking about with those lawsuits and class action lawsuits, or even a complaint to the Delm board. So important to have all that documentation. Thanks for asking, Mary are.
SPEAKER_02And I mentioned in the introduction that if you're not doing something to treat your water, you're not going to meet the water quality standards. So, Leslie, we're going to call on you to talk about what are the treatments available and how can practices decide what's best for them?
SPEAKER_01Well, Mary, that is important to make a decision on what type of product you're going to use and to make sure that it's actually designed for dental units and it's not going to cause harm and do a little research. And there are many products on the market that will work, but really what is going to work for you and what's going to be convenient for you and eliminate as much human error as possible. So, starting out, we have uh in-bottle or inline cartridges that are available. And uh, the cartridges actually, I should back up and say uh in bottle would be straws. There are cartridges that can be attached to a dental unit that doesn't have currently a water treatment type of uh protocol, and the cartridges will filter the water coming into the unit. So this is something that would be convenient for a practice. There's also cartridges that can filter uh water coming into the office, and there's systems that can be purchased that are what called water treatment systems. There are tablets that can be dropped into a water bottle that will dissolve and can be used as a treatment. And there are also the straws that I had mentioned earlier. So I think probably most of the time what I see are the straws in dental offices. And the reason people prefer the straws is there's less work and less human error, fewer protocols that they have to go through on a daily basis. The straws or the cartridges are what's considered to be a continuous type of treatment. Now, these are not for shocking, uh for shocking the dental unit water lines. These are simply going to be treating the dental unit water. Now, the fewer protocols that I mentioned, every time you fill up a water bottle with the water of your choice, and depending on your manufacturer's directions, that might be tap water, it might be distilled water, might be bottled water, might be reverse osmosis water. But uh you fill up your bottle with a tablet, you've got to drop a tablet into that bottle each and every time. Sometimes that uh water bottle gets empty pretty quickly. And I remember my days as a dental assistant, uh, when the water bottle became empty in the middle of a procedure, my doctor was none too happy that we had to stop what we were doing, disconnect, go and refill. And I think about in the heat of the moment, will I remember to put a tablet into that bottle or not? And I wonder if other team members might feel pressured to get back into the treatment room with that bottle of water so that the procedure can continue. So the continuous methods, uh, the straws and the cartridges certainly do take that worry out of uh the uh the picture there. Um, also, another thing about the tablets is that every time you replace your water bottle, you need to put a tablet into it. So let's say that uh you take your water bottles off at nighttime to let them dry out. Uh, you would be dumping whatever was in that water bottle and then putting new water in the next day or the over the weekend when you come back after the weekend, and then having to put another uh tablet in. So you can see a lot of waste would occur there if you had, let's say, half or three-quarters of a bottle of water that had a treatment tablet in it. Whereas with the straws, you simply just remove the bottle and replace the bottle, and the straw is not going to be, you know, there's no wasted uh product there. So whether a practice chooses to use straws, tablets, or cartridges, it depends on what's going to work best for them. Um, I have heard that the tablets are more economical. So if budget is a concern, uh that might be the way that a practice might go. Um, I've whereas the cartridges and the straws reduce the amount of time. So if you think about time as money, it may be. More economical to go with a cartridge or a straw. Now I think that the again, the products that are on the market today, each practice needs to make a decision as to what they're going to use. And then, of course, they need to follow the manufacturer's directions for use. One of the things that I came across frequently with dental practices that were using tablets is that they were using the wrong dosage of tablet for the size of the water bottle that they had. And so they might think, well, I'm following the directions. It says to put a tablet in each time you refill the bottle and then reconnect that bottle to your dental unit. But they may be using a one-liter tablet. Many dental units have one-liter bottles and others have the two-liter bottles. So if it's not the proper dilution or it's diluted too much, then it may not be doing its job. So we're kind of defeating the purpose. I equate that to drinking uh coffee that is half water and half coffee. It seems like it just doesn't kick in for me. So, Mary, whatever works best for the practice team should do their research. They should check with the manufacturer of their dental unit to see what their dental unit manufacturer is recommending as well. And then also check with their dental dealer and do a little research. You can certainly go to Hugh Freedy's website and take a look at the products that they have available and compare and see what's going to work best and what's going to be the most convenient for your practice and what you're going to stick with.
SPEAKER_02Thanks, Leslie. And I'm so glad that you mentioned checking with the dental unit manufacturer to see what is recommended from them and also following the instructions for use for whatever product you use. I've had over the years calls from practices where they were using tablets, and there was a manufacturer that I, and I think they've discontinued it, but they used to include a shock tablet along with the tablets that you put in every time you filled it up. And so the practice, somebody in the practice would call and say, Oh, our patients are complaining, and now the water's a different color. And like, oh, you probably put the shock tablet in instead of the regular tablet. So again, it's reading those instructions, knowing if there is a recommendation with the product that you use to periodically shock. Um, and another thing with using cartridges, I was just in a large facility um a week or so ago where they were taking their water bottles off at night and leaving the cartridges exposed, leaving the straws exposed. And that is not within the manufacturer's instructions for use. Their focus was, oh, we want the water bottle to dry out. No, you need the water bottle back on so the cartridge doesn't dry out. And Sam, I think you have something to add here.
SPEAKER_00I do. Uh Leslie talking about those products and you know, knowing wonderful points about, hey, you know, different products for different points of an office, maybe offices kind of life cycle is like, hey, you know what? We need to be a little bit more uh focused on the human aspect or or the the maybe the price is a deal, you know, at some points of it, which we totally understand. Everyone, everyone can understand that. But the one thing I want to mention is understanding those products and understanding what works with your equipment. Um, and this is something you might not even think about is not all delivery systems have those bottles on them. Some of them are just straight municipal plums, and I have been called before because the office went through the expense of buying a bottle-introduced product, and they don't have bottles because they someone, someone, I will not point fingers, someone told them, Oh, yeah, this is the best product, you got to use it. And so they bought it. Not knowing that they could not implement it into their system. So it's recognizing, yes, I hear here's the products that are available to me. What is compatible with my unit? What does my staff prefer? Those are all questions. Yes, uh small soapbox moment. I do recommend all offices get water bottles attached, retrofit onto the unit. It introduces so many opportunities for shock products to clean their systems and protects you from boil water alerts, all of those things. All right, put the soapbox away. But understanding the equipment and what's compatible with it and what your staff is more familiar with. Um, and if you do something your staff isn't familiar with, we go right back to making that protocol, the the stop sign. Hey, you know what? Staff is not familiar with this product. What do we do? We educate, we train. So you go you go right back into that flow.
SPEAKER_02Sam, you can get on your soapbox anytime. And and I agree 100% with your comment about the um the water bottles because we are seeing increasing numbers of boil water alerts in communities. And so if you are municipally plumbed to your units, you are shut down until you um the alert passes, and then you've still got to shock your system. You have to have a way to shock that system to be back up and running again. So, yeah, water bottles make the most sense. So I mentioned earlier that you need to test your water so that you know what you're doing is working. So many people will invest in the water bottles and a product, a treatment product, and just go on their merry way and assuming that everything is fine. So you need to test. We don't have um at this point in time from the CDC guidelines a specific interval. They still say test periodically. And many of us who gave our input to the CDC for their update to the um CDC guidelines for dentistry said, please put something specific in there. We do rely on the OSEP white paper, which says test quarterly, and that is if everything is working correctly. Remember that if you um test initially and you fail, you shock your system, you test again. If you fail again, there's a whole specific protocol for how you go through continuing to test and figure out where the problem is. And I do want to mention that Hugh Freedy Group has a fabulous waterline resource um center, if you will, on their website. And we'll direct you to that through our resources. And so there's lots of charts and and all kinds of great information for you to access to help you to know what to do. So there's essentially two types of waterline tests that we have: the laboratory test, as Sam mentioned earlier, where you collect your sample, whether it's a pooled sample or it's individual for each dental unit waterline, and you send it to a laboratory to be analyzed. And they will, of course, let you know whether you passed or not and help you through a protocol for um repairing or or fixing that system if you do fail. And then there are in-office tests, and in-office tests now come in two different formats, which I'm very excited about. One is the paddle tests, which again Sam referred to earlier. Um, they work well, they give you good results, usually in 48 to 72 hours. Um, some people have trouble um reading the test results. You have to compare them to a chart, and some are light with dark spots for the CFUs, some are dark with bubbles for the CFUs. I find those a little difficult to interpret, but Hufridi has just introduced a new 24-hour in-office test, which is super easy. It's a pass-fail test. You either pass it at under 500 CFUs or you fail by color change at over 500 CFUs. Now, some people get really freaky about well, I how many CFUs? No, I really need to know. What you really need to know is are you passing or not? And I think this makes it so simple for people to do. If they failed the first test and they need to retest getting those results within a very short amount of time, I think is very important because in the ideal world, we wouldn't use that dental unit um until we pass. Because if it's over 500 CFUs, it really isn't safe for patients. So um, Sam, is there anything that you would like to add in about the new 24-hour test? I'm just so geeked about this one. I think it's gonna make it so simple for people.
SPEAKER_00Having the ability to, like you said, we failed, we shocked, but we want to get up and running with confidence as soon as we can, especially if uh, you know, some of the more uh officials the wrong word, but the the federally controlled offices might have those protocols in place that they have to shut down the unit during any sort of failure. And so, you know, close closed ops is you know, not more, you know, you you say no to patients who really need the treatment, you you you are saying uh you are shutting off the maybe a more vulnerable area of the population. So getting those units back up and running as quick as possible. And again, yeah, that pass fail, like my college grades. That's all I need to know. I just look at it, is does the color change? Oh, oop, hey, we got a large color change on this, and hey, guess what? Let's go back to our other talk when we talked about the pictures. Because we've already been it's one of the things we're already going to talk about. Is I have so many phone calls now of is this a different color? Like, what was your original color? Like, oh, we didn't take a picture. Like, um well, okay. So for the for our 24-hour waterline test, we we asked that you take a picture right when you take the sample, and then at the 24-hour mark. It's so easy then to compare the picture. You can do it on a white background uh for easiest recognition. But the interpolation that you mentioned with the paddle tests, and uh because I've been sent that too. Hey, this is what it looks like. Is this passing? It's the it's the interpretation is you know, does the really, really big growth in the corner count as more than one? That's that sort of questions. Um and so yeah, a simple color change, or as long as you understand the test that you are doing, I'm happy. I I I that's that's all you need to do is like, hey, nope, this is passing. I believe this is passing. I record my results. Great.
SPEAKER_02Thank you, Sam. That's that's awesome. And I would like to mention so that I don't forget, there will be a link in the show notes and on our website for our listeners to request a sample of the new 24-hour test so you can try it out for yourselves and see how easy it is to know whether you're passing or failing. So we're going to round Robin a little bit and finish out our episode with some additional points. Um, Linda, I know you wanted to share some information about who are the vulnerable populations to contaminated dental unit water. There's been so much emphasis on children. Who else do we need to be concerned about?
SPEAKER_03Yes, Mary, when you think about the realm of patient safety, we have to really put a lot of emphasis on our vulnerable populations, not just with water lines, but yet that is an extremely important piece with good medical histories and all kinds of other aspects of that component. But let's focus strictly on vulnerable populations and the quality of water that we are putting in that patient's mouth during their treatment and care with us, because when that patient walks in the door and sits in our dental unit chair, they put a lot of trust in us. Trust us that we're going to provide quality care. We're not going to hurt them too much. Nobody wants the pain, right? But we're that as little as Olivia said, they're not going to walk out with something, a disease that they didn't walk in with. So in addition to the pediatric population, where we've seen those lawsuits, and particularly, you know, California and Georgia and the class action lawsuits. I think our listeners should also be aware of other patients who are immunocompromised. I'm sure that someone who's under active chemotherapy, for example, for cancer is not going to be coming in for routine cleaning. So put that aside, but think about patients that have autoimmune disorders that maybe they don't even realize they have one, or they're taking some kind of medication that one of the side effects suppresses the immune system. So this is where that medical history is so very important and understanding the different drugs and medications that are prescribed today. And if we don't know, have a resource handy. It's too easy not to have something on your phone or on your computer in the office, you know, if we don't have the written volume of the current uh physician's desk reference anymore. So it's very important, Mary, that they really focus on that because that population really has my heart with patient safety. And I think Sam wanted to piggyback off that.
SPEAKER_00The patient safety is one of those things that you might not worry about in the dental office. That's all you're just getting your teeth cleaned. And you you don't we as the general population, right? Hopefully everyone listening to this does go to the dentist. If you don't, please make an appointment as your nearest at your earliest convenience. But the walking in, sitting back there, everyone is worried about oh, the pain, oh, it's the tingle, oh, it's gonna feel weird. No one is thinking, I wonder what this water line is putting into my mouth. And you shouldn't have to worry about that using the simple steps uh that we already talked about, you know, implement, you know, evaluation, implementation, you know, using those steps, those that person shouldn't have to worry about it. And what most people don't think about is a week, two weeks after their appointment. What if they get a little bit of a chest cold or they're you know they're sick for a couple days? No one worries about where that comes from until it gets serious, until you have the the outbreak events that we had in uh 2015 and 2016, I believe it was. Until that goes on the news, no one worries about it. And already people have you know, the general population has already forgotten about those events, even if they were on the major news networks. That they're those events are not in their heads anymore because you know so much other stuff is currently going on. It's it's one of those things that the general population doesn't worry about it, so we have to worry about it for them, and we have to take care of them without them ever realizing there could be an issue. And you can't do that unless you know what's going on in your water lines, and you don't know what's going on in your water lines unless you test. So it all comes back to the testing. You don't know what you don't know, and I think that is such a wonderful uh phrase. You don't know what you don't know, and it's and it's no possibly no fault of anyone's that you don't know it. It's just you haven't learned it yet. So I I I I think that's such a wonderful tagline. You just don't know what you don't know, but you can know if you test.
SPEAKER_02Oh, Sam, you are a rock star. I love that. Um you know, and it's so interesting too when we interact with with um dental practices that they're well, what does OSHA say about it? OSHA doesn't really address it. And and because it's not an OSHA regulation, some practices think that they don't have to do it. Well, it's just recommended by the CDC. And like, oh, don't even get us started on that one. We've talked about that ad nauseum that you know it's it's doing the right thing, it's following the standard of care um and making those patients safe. So, Leslie, share with us again the importance of following instructions for use.
SPEAKER_01Oh, Mary, this is so important. And um, you know, before I get into that topic, I just want to remind our listeners that last year, late in the year, we had CDC's health alert network, a Han Alert, that said that dental offices should be particularly concerned about dental unit water. So CDC is telling us that we need to be vigilant for our patients to prevent outbreaks from occurring. And that is because we had another outbreak that occurred that hasn't been much publicized, and and we are uh anxious to find out exactly where that dental office was. That we had at OSAP had a little bit of information about the event, but we didn't get an exact location yet. So back to importance of instructions for use. When I ask dental practices if they are doing something with their water lines, sometimes I get a very bizarre answer. Like we run a vacuum line cleaner through our evacuation system at the end of the day. And then I say, well, I'm not really talking about the suction, not the saliva ejectors or the evacuation system. I'm talking about the dental unit water, what you put into a patient's mouth, not what you take out. So I see that there is some need for education uh for the masses on what we're talking about when we say dental unit water. And then the other thing I think that uh people sometimes misconstrue is that um, well, they get the training from maybe a team member on how to treat the dental unit water lines or how to maintain their unit or how to process instruments. And it gets diluted just like a telephone game where you leave out a little component, uh a piece of the instructions, and then the instructions aren't followed. So IFUs, instructions for use. I am so glad that Hugh Freedy has what's called a sample or a protocol for the technique for obtaining a water sample, so that you know exactly what the steps are. As Linda was saying earlier, it's so important to have these steps in place. So your preparation might be to print out this uh technique for obtaining a water sample. And then uh implementation. I'm also thrilled that that Hugh Freedy actually has this what does a successful waterline maintenance protocol look like? A printed out set of instructions that you can follow. And uh these, by the way, these uh these PDFs will be available for downloading on our uh the Compliance Divas website. We're gonna make sure that that all of this great information and instructions for use are available. And of course, you follow your manufacturer's direct instructions for use of your dental unit and of the product, whatever product that you're using. You've got to take all these things into consideration. But um, you know, getting your printed materials and your instructions is so important. And I just want to add in on a personal note, uh what I do for fun as a hobby, I do something called trail trials with my horse. And it starts out with uh six to eight to ten obstacles where a judge will give you uh maybe um a paragraph of instructions for you for what you're supposed to do. It might be like pick up the rope, walk through the flags, end at the blue flag, back up. And so um it's it surprises me and astounds me how many times um I get these simple instructions and I miss a step. And so I get marked down. I don't I lose points because I missed a step in this particular process. And it's only a paragraph of instructions. So I can see how for dental offices, you might get some instructions from a coworker or from your dental um representative. But unless you have something in writing to follow, it can very easily lead to making mistakes or skipping steps that are important in the process.
SPEAKER_02Fabulous, Leslie. And I love your analogy. Olivia, remind us one more time about the importance of documentation. We've talked a little bit about it throughout, but kind of summarize it for us, if you will.
SPEAKER_04Well, like you said earlier, Mary, if if you don't document it, you didn't do it. And with the civil lawsuits that I handle, there's a process we go through to wear the other side down, so to speak, Mary. And this involves interrogatories, requests for admissions. You might get from opposing counsel that sues you over something like this, you know, 10 pages of requests for admissions, and you'll read the questions, and it the six of them will sound the same, but worded differently, because they're just wearing you down and wearing you down and trying to get you to settle. They might also slam you with requests for production of documents. So let's say it's a waterline suit and they issue requests for production of documents and they're asking for these waterline tests, and you have zip. So if you have zip, you're done. You're cooked. So it's very important. If you're doing self testing, you've got to document it. And I can tell you what, if you're doing the testing, you would know that your water quality wasn't meeting the standard. So that it all goes hand in hand. Or if you're having the test sent to a laboratory, saving those results and having the protocols. So just it's key, Mary. I can't emphasize it enough to maintain documentation. And I'm sure Sam would state the same thing.
SPEAKER_02Thanks, Olivia. And I want to mention one last thing because it's come up in a number of conversations with some of the clients that I have worked with, and that is the topic of deadlegs. So a dead leg is a piece of tubing or could be in plumbing a pipe that was attached to something at one point and has been capped off, but water still flows into it, and water can then by gravity flow back into the main delivery system. So they that stagnant water will have very high CFU counts because that water is just sitting there and it's not necessarily getting treated. So if you have very high CFU counts or you fail and you shock and you fail again, then you need to have your junction box looked at. You need to have your water um, your dental unit um examined by uh a tech rep so that they can figure out if there are any deadlegs in your system that need to be removed. And Sam, any thoughts on dead legs?
SPEAKER_00So many. We don't have time, but I'll I'll focus on a couple. But so, and you're absolutely right with the you mentioned the dead, you know, failing a waterline test, then shocking. And I many times uh over the years as we've shocked units, they've tested again and they still failed. And okay, I'm like, and I saw you you ask a few questions and you and you look at the I call it the three Ps, the product, uh, the people, the product, the protocol, the people, and you look at okay, what product are you using? Great, I'm familiar, or I learn about it. Um, the protocol, how'd you do it? Uh not to cast shade on anyone. Sometimes people are in a hurry, things happen. It you know, we're humans, it happens. But the a common one I find is that when using shock products, that they they only do they only clean the lines they use. So, and that can vary. Um for example, I'm not calling any particular profession out. This is just an example, please don't at me. Um, so if you're if you're perhaps in a hygiene room and you're not using all of the handpiece lines that are on your unit, so when you shock or you clean it, you you you clean the ones you use, which it kind of makes sense in your head, but it's not what you're supposed to do. So that leads to right into the deadlegs. The the line, the water lines you don't use, they harbor biofilm, they harbor bacteria. The other lines get cleaned, great, but the movement of water inside the system, especially pressurized systems that moves back and forth anytime there's a change in pressure, that can recontaminate that dead leg just recontaminates that other line almost as soon as you're done. So making sure you clean all of your water lines. And I and and that's when we we're talking about uh other specific products, you know, flushing your water lines on a daily is part of the maintenance, is part of the instructions. And I ask them, do you flush your water lines? They say, Absolutely. I say, Do you flush all of your water lines? I was like, Well, no, I flush this and this. I'm like, okay, that's where the issue lies, that's where the dead legs lie. And if it gets serious, to your point, absolutely get a service tech in there and they can help. They can, you know, clean out those more pesky lines. Another one is systems that are a bit older. They have been maybe retrofit a couple times with new equipment, new updates, and there's a whole bunch of extra tubing in there for systems they don't use anymore. Get it out of there. It's useless to you, and it's just harboring biofilm bacteria. Sorry, all right, but putting the soapbox away again. Sorry.
SPEAKER_02As I said before, you can get on your soapbox anytime, Sam. And thank you so much for joining us today. And we thank the Hugh Freed Group for their support of our podcast. And as we wrap up this episode, we want to remind you that the compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. If you have questions, please submit them by email to support at the compliancedevas.com. All of the resources, and there are many great resources from today's episode, will be posted on our website, the compliancedevas.com, and also in the show notes on your favorite podcast app. So thank you for listening, and we'll see you next time.