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
#141 Preventing Backflow from Suction Lines and Ensuring Patient Safety
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In recent months, there's been a keen interest in dental unit water lines and the quality of water used in patient care. Another concerning area risk to patients in every dental practice is the back flow that occurs in the evacuation lines. In this episode, the Divas discuss the significance of this risk and offer practical tips and product solutions from our Sustaining Sponsor, HuFriedyGroup.
Safe-Flow Request a Sample: https://www.hufriedygroup.com/en/safe-flo
Resources:
- Coming Clean on Infection Control in the Dental Office: https://bit.ly/41F3HQe
- Preventing Back Flow Through Proper Evacuation Line Maintenance: https://bit.ly/3tkX7Sg
- Sanivac cleaner: https://bit.ly/41pqIXl
- Enzymax cleaner: https://bit.ly/3RITHCb
Welcome. I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_03I'm Olivia Wan. And together we are the Compliance Divas.
SPEAKER_04Welcome to the Compliance Divas Podcast. This is Linda Harvey. I will be your moderator for this episode. I think we all agree there are many important details and tasks that keep a dental practice running smoothly. There's one detail in particular that, if overlooked, can create a risk to one in five of your patients. Before we dive into today's content, as the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, the compliancedeevas.com. All the resources that we mentioned during today's podcast will be found on our website as well as in the show notes. We invite you to submit questions to support at thecompliancedivas.com. And don't forget to scroll down to the bottom of your podcast app and leave us a review. The Divas like to thank our sustaining sponsor partner, Hugh Freedy Group, for making this episode possible. Hugh Fredie Group, a global leader in instrumentation, infection prevention, and instrument reprocessing workflows, helps dental professionals be the best in practice with the highest quality products, services, and educational experiences in the industry. With Hugh Freedig Group, clinicians can reduce risk, improve efficiencies, drive compliance, enhance patient and staff safety, and achieve superior clinical performance to continue to be the best in practice. The risk that I alluded to just a minute ago has to do with evacuation lines. We know that a great emphasis and importance has been placed on our dental unit water lines. That is the water going in the patient's mouth. However, today the divas will address your evacuation lines and the risk they pose to patients from backflow. I'd like to start the conversation by asking our diva Leslie to explain what is backflow. And Leslie, how exactly does it happen?
SPEAKER_01Well, Linda, backflow is described as the movement of fluid in the opposite direction from which it was originally moving. In the case of a dental unit evacuation system, backflow is the flow of fluids from the evacuator line back into a patient's mouth. I uh tease my kids all the time. We would uh share beverages, and you always say, uh, you know, no backwash, no backwash. You take a sip out of a cup, and and uh, you know, the kids are always saying, Oh, there's backwash, I'm not gonna drink from that. So it's similar in that concept for a dental setting. And it happens due to several different parts that the components that can occur. And so when we're talking about backflow, what we're talking about is when you position the tubing of your evacuator lines, whether it's your saliva ejector or your high velocity evacuator above the patient's mouth, gravity could potentially cause backflow to occur. And uh sometimes it can happen when a patient's tongue or cheek is blocking the evacuator tip, like the saliva ejector. Um, patients sealing their lips around the ejector can cause a partial vacuum. And I know it's kind of an interesting thing because dental hygienists many times ask me to close my lips around the saliva ejector because it helps to evacuate the fluid in my mouth. But knowing what the CDC guideline states surrounding backflow and saliva ejectors, I always refuse to do it. So um they they think I'm not being an obedient patient. I'm uh certain there needs to be education out there for our dental hygienist to not encourage their patients to do that. Improper positioning above the patient's mouth, backflow can occur there, backflow can occur with this vacuum. Uh, and then backflow can also occur if there's a change in the pressure in your evacuation lines. So most dental practices have more than one operator, and usually the vacuum lines are all connected together. If one vacuum line is being utilized in, let's say, operatory one, and then in operatory two, a hygiene patient is being seen or a restorative patient, and then the vacuum system is shut off, there's a change in the pressure. So sometimes that can contribute to what's considered to be backflow. Linda?
SPEAKER_04Leslie, thank you for that great information. I'm sure that you are normally a very compliant patient. However, I agree with you. I think backflow is yucky as well, and we should just say no. And our patients should learn to just say no. Our diva, Olivia, could not be with us today, and she wanted to be sure we talked about the risk to patients with the evacuation lines and backflow. So I wanted to mention a couple of uh things because I think divas that many times over our clinical listeners aren't aware of this behavior in their practice pattern that no, so they're holding the saliva ejector in a position that helps to create backflow. They're asking patients to close around the saliva ejector. And so these are things that I think it would be helpful to be mindful of in their own clinical practice. So there's one group of patients that can be really highly at risk when you consider that one in five patients is 20% of the patients that you see every day. And we don't know which 20% that's going to be. So we have to be safe and efficient with all of our patients. But think about the immunocompromised and the pediatric patients. Some of those individuals are at higher risk. So if they're in that 20% category and they receive the backflow back into their mouth, they could be at higher risk. And so I'd like to just cite a couple of quick studies, just some really highlight details here from the Journal of Hospital Infection, NJATA, the Journal of the American Dental Association, in which backflow may contain residual blood, saliva, and other potentially infectious materials. So this is an outcome of the research that's been studied. And several other findings reveal that 91% of dental offices ask their patients to close their lips around the saliva ejector. So that would essentially be almost everybody listening to our podcast, perhaps. So please be aware of your behavior during the day and how you're asking patients to manage that saliva ejector. And lastly, 27% of dental offices admitted to flushing or disinfecting their evacuation lines only once a week. So, Mary, this brings me to the next question. This is very concerning to our patients. So could you share with us some things our listeners can do to lessen this risk for their patients?
SPEAKER_03Absolutely. We need to look at two things. One is is there a device? And yes, there is a device we can use that actually can prevent the backflow. And also, how well are we maintaining our evacuation lines? Remember that the better you maintain your evacuation lines, the better your suction you're going to get. If there's a lot of buildup of debris in the suction lines, then it's going to decrease the amount of suction that's actually coming through. I recommend to everyone that I work with that they first of all follow the instructions for use for the product that they use, but also it's a good idea to do it once a day, especially in a practice where they're doing a number of surgeries where you get blood that can adhere to the lines, and also in maybe a perio practice and in the hygiene operatories. And there's a whole um list of um helpful hints with every product that you purchase. Um, we like the two products that um Hufridi offers. One is Enzymax, and Enzymax is sort of a two-for-one product because it also is an enzymatic ultrasonic cleaner that is compatible with evacuation lines. So then you wouldn't have to have two separate products, but also um Sanabec is another product that um you could look at. So maintenance of your lines is critical, not just to backflow, but also to um making sure that you are maximizing the efficiency of your unit. And I mentioned earlier that you can also use a safe um uh evacuation device that actually prevents the backflow altogether. It's typically a valved device. The Hufridi product that we like is called safe flow. And it works to basically if the pressure changes or if someone is using that suction tip or the evacuation tip higher than the patient's mouth, it will close down enough so that there will not be any backflow coming through into the patient's mouth. Um is there anything that either of our experts that are with us today from Hugh Freedy would like to add, Michelle or Rosemary, anything about the device itself? Thank you, Michelle.
SPEAKER_02I was gonna just add that the device actually provides a physical barrier to prevent the backflow. So it's it's a physical stop. Okay.
SPEAKER_03And our are our listeners able to request a sample of the SafeLo device.
SPEAKER_02Yes, we have samples available and they can be requested.
SPEAKER_03Great. All right, so along with the resources about the research that Linda talked about and um more information about exactly what is backflow because it is actually described on the CDC website. We'll have those um resources in um on the website in the show notes, and we will put a link for our listeners to request a sample.
SPEAKER_04Mary, thank you for that good information. There's so much to be mindful of when it comes to backflow that I hope that our listeners are taking away some of the finer points, and I invite them to come back and listen to this twice. Backflow may not seem very exciting to you, but it's an important patient safety aspect in your practice, in every practice, and doesn't matter about the specialty or anything. And I wanted to share a couple things about the bacteria that's in the evacuation lines, and then I'd like to delve into the four solutions that the Hugh Friday group offers in this area. So a few minutes ago, I mentioned the research from the Journal of Hospital Infection and Jada, and the research further talked about how 60 to 70 percent of the viable bacteria in suction lines is likely of oral origin. And I'd like to draw an analogy for our listeners between the CFUs, the bacteria that they're testing for in their dental unit water lines, I want to draw an analogy between that and the amount of bacteria that they are colonizing and finding in the evacuation lines. So just to draw that analogy, and hopefully I can do so clearly, we know that with your dental unit water lines, the water going into the patient's mouth, the bacteria, the CFU, has to be below 500 colony unit CFUs. And ideally it's below 200 CFUs because the bacteria can grow so quickly. Now, during the research studies, they determined that 11 units tested, the bacterial counts were over 17,000 CFU. So when you think about the amount of the bacteria and 60 to 70 percent is likely of oral origin that's living in your suction lines, it's very important that they're that you prevent backflow from going into the 20% of your patients throughout the day. So hopefully that makes sense. So I'd like to ask Rose with Hugh Freed, let's talk about the four products that you all have, Rose. I know you've got several for the saliva ejector and several for the high volume evacuator.
SPEAKER_00Sure thing, Linda. We offer four different product options. Um we have high volume evacuation options and then we have low volume evacuation options, three of which um one is just the valve, two are a combination unit, which includes a saliva ejector tip and the valve combined, or you can buy just the valve to use with any of your low volume saliva ejectors. We also have a high volume um option, which can be used with any HVE tip on the HVE line. And then we also have a HVE to a low volume adapter, which is used on your high volume line, um, but used with any low volume saliva ejector tip.
SPEAKER_04Thank you, Rose. I think that's really important um to realize the different solutions and how easy it is to find a solution that meets your needs, whether it's the saliva ejector and the valve together. Rose, could you clarify for our listeners before I go on further to talk about the others? This goes on top of the valve that's already there. Is that correct?
SPEAKER_00That is correct. It goes on top of the metal valve that's already um attached to the tubing.
SPEAKER_04So how easy is that? We don't have to take anything apart. We don't have to disassemble, we don't have to move anything. So the Hugh Free group offers the saliva ejector and the valve, the valve only for the saliva ejector, an HVE valve, and then an adapter which enables you to take that high volume evacuator and use it as with a saliva ejector and have the same level of aspiration, but just using a saliva ejector. So what great solutions for that. So I think that's wonderful. Thank you. And I I know our Deva Leslie wanted to add in something else here, too.
SPEAKER_01You know, I spoke of my experience with my dental hygiene visit and being asked to close my mouth around the saliva ejector, but I think it's very helpful for dentists and dental assistants to know that this is something that patients commonly do because a saliva ejector is very similar to a straw. So it just seems natural that you would want to close your lips around it. I also want to remind some of our pediatric uh dental practices that the use of one of the devices of these uh evacuator uh valves for pediatric patients would likely make their job easier, because it is harder for kids to really understand the concept of doing something or not doing something when we're performing dental treatment in their mouth. And and it also may be very helpful for patients with certain developmental disorders or degenerative conditions like dementia, uh, so that they're not struggling not to close their mouth. Because with these safe adapters, they can close their mouth around the evacuator, and we won't have that worry on our minds along with everything else we think about during their dental visit.
SPEAKER_04Thank you, Leslie. There's so many different opportunities for our listeners to to evaluate how they're using the saliva ejector and try to prevent backflow. And Mary, I think you had another point as well.
SPEAKER_03A couple of points. One, as you've been talking about the statistics of one in five patients. Some people may think that that's not so accurate. Oh, how could one in five patients be at risk? But we see so many patients now who are in um treatment for cancer, and that cancer treatment in many cases um includes immunosuppressive therapy. So this is becoming an even more important issue. The other thing that I wanted to just bring up is that if you are using uh varnish, fluoride varnish on many of your patients, do not aspirate that into your suction lines because it will cause all kinds of problems. Have your patients spit in a cup to evacuate the saliva from their mouth. Don't put it in the evacuation system. Um, it you will be sorry. And some people have said, well, I'll just have them get up and spit into the sink. Don't do that either, because then you will have lovely fluoride varnish stuck to your sink and it's difficult to clean it. Now, if you do have some issues and you need to do, and I hate to even say the words, but it it sort of makes sense in this context, a deeper clean of um your evacuation lines. There are shock products available just for the evacuation lines to help remove some more of that um debris that gets um trapped and left behind in the suction lines. But cleaning every day, using a product like Enzymax or um SantaVac, which is an enzymatic cleaner, will help to keep those lines much, much cleaner.
SPEAKER_04Those are some great tips, Mary. And so when you think about shocking the lines, I mentioned that 27% of the dental office is admitted to flushing or disinfecting only once a week. So our I want to suggest to our listeners that daily is very important. And then depending on the type of procedures that you're performing throughout the day, it may need to be after a surgical case or a difficult SRP or maybe just midway during the day in general. So be mindful of uh building that into your workflow. It's very important. And also want to mention that the Hugh Freedy suction line products are very low, they're not they're not sudsy and foaming, they're very low volume of that. So they're very effective. As a matter of fact, in the Dillon Advisor research, and what year was that research, Mary? I need to look that up. There was a that Hugh Freedie was in that research a few years ago, and I wanted to mention other products that were listed, that um the Sanovac was the one that came out the best as far as cleaning the evacuation lines. The other products were effective, but the Sanovac had the best results for cleaning the inside of the tubing. And that's where we want to be so careful because much like the biofilm and the dental unit water lines, okay, again, the water coming into the patient's mouth, there can be film and debris that sticks to the lining of your suction lines. So it's very important that that gets Mary.
SPEAKER_03That um research was in 2015 when it was when it was published. And I also wanted to um mention that you know you you had a very good point about right after a surgical procedure or maybe a particularly bloody SRP on a patient, a small amount. You don't need to do the full amount that you might do at the end of the day of evacuation line cleaner, just a smaller amount in the lines to help keep that blood from solidifying. But the other thing is make sure whatever product you use, it is compatible in terms of pH because you don't want it, remember that um fluid is going through the amalgam separator. So we don't want our product to interfere with the amalgam separator. And it's not necessarily a good idea to use bleach because bleach is not compatible with your amalgam separator. So be careful. But a lot of people want to put a whole bunch of disinfectant down their suction lines, and you should not. You need to know what type of um or what are the instructions for use for the manufacture of your evacuation system. And the products that we talked about today are compatible with both wet and dry systems. So just make sure you know that your product is compatible and don't throw bleach down your suction lines.
SPEAKER_04Mary, I just want to reiterate that because bleach makes me cringe. I know that there are some bona fide uses, maybe uh still in endodontic procedures, but because of the harmful nature of the bleach, all it takes is one speck in your eye, one drop, and then you're gonna have eye damage. So I'm very cautious about that. But but just to help our listeners be thinking about that, because when I said and and gave the statistic of how high the bacteria count is in the evacuation line, we don't want anybody to be tempted to use bleach in that suction line in the evacuation. So please, as Mary mentioned, use a product like the Hugh Freedom products and stay compliant and really do the best that you can to look at your processes and your practice. How are you using your saliva ejector? Are you perhaps with some of the habits that you have during the day encouraging backflow with patients? And then look at the solutions that we've presented today for options to help to make patient safety and quality of care improved in your practice and your setting. And we thank the Hugh Free Group for being today's sustaining sponsor. We really appreciate their support. And with the gut, the compliance divas brings clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. All the resources that we mentioned today, including being able to get a free sample of the product, will be on the sh in the show notes and on our website. So please take advantage of that. We invite you to submit questions to support at thecompliancedivas.com. And lastly, don't forget to scroll down to the bottom of your podcast app and give us a rating. We look forward to seeing you next time.