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
#170 Dental Unit Water Testing Made Easy
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Testing the dental unit water lines is a critical task in infection prevention and control. But how do you test? How often do you test? And, how do you find the time to test the waterlines? The Divas explore the new Fast Check 15 dental unit waterline test and explain the step-by-step protocol to make this task simple to perform. The Divas are joined by Brian Mergentime, of Solmetex, dentistry's complete provider of water solutions.
Resources:
- Journal of the American Dental Association - Dental Unit Waterline Infection Control Practice and Knowledge Gaps https://bit.ly/3WM8ONu
- American Dental Association Resources - Dental Unit Waterlines https://bit.ly/3WJ9mnn
- CDC - Dental Unit Water Quality https://bit.ly/4c8wUqj
- Solmetex - Sterisil Product Series https://bit.ly/3yb9mTW
- Solmetex Customer Resources https://bit.ly/4chXJZm
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_00I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas Podcast. This is Linda Harvey. I'll be your moderator for this session. In May, episode number 159 to be exact, we discussed a brand new dental unit waterline test that was a game changer. Well, today we have more in-depth details to share with you. As the compliance divas, we bring clarity and simplicity to compliance by helping you navigate the regulatory world. We invite you to subscribe to our podcast through our website, thecompliancedevas.com, or on your favorite podcast channel. If you have any questions, feel free to submit them to support at the compliancedevas.com. We also invite you to scroll down at the end of your podcast app and leave us a review. We'd love to hear from you. The brand new water test we spoke about in May was the Fast Check 15, the newest product in this Sterocil Waterline Products. Steracil is part of the Sometex family of products. And Solmetex is dentistry's complete provider of water solutions. Their brand of products represents solutions to manage the water lines into your practice, throughout your patient care, and then out of your practice. It's our pleasure to have Brian Mergentine with us, who is the Director of Sales East. Brian, it's great to have you here today.
SPEAKER_04It's great to be speaking with you again.
SPEAKER_02Well, we can't wait to learn how to run this test and what some extra details are for all of our listeners. So let's jump into how exactly to use this product, along with some other tips and suggestions from both Brian and the divas. For our listeners who are joining us from Podcast App, please be aware this session was also video recorded. If you hop over to our YouTube channel, you'll see the video on how to perform a fast check 15 test. Mary, could I ask you to jumpstart us by describing the steps for conducting this fast check 15?
SPEAKER_01Sure, Linda. Just like with any dental procedure that you might perform on a patient, an important part of performing a waterline test is to get yourself ready to prepare your materials and so forth. This would include preparing a clean surface for you to open up the test kit when it's time and to perform the test. So the first thing you're going to do is wash your hands and put on gloves. Next, you're going to purge the water lines for 10 seconds per line. This is very similar to what you would do after you finish a procedure on a patient. You purge the lines. Then open up your pouch and lay out the supplies inside. You'll have a pipette and a vial and a test strip. So with a permanent marker, put the location, meaning the treatment room number if you have them numbered and the date of the test on the vial and then start to collect water in a clean cup from each of the water lines. Try to collect similar amounts of water from each one of the water lines. And once you've done that, you take the pipette and you draw up water into the pipette, which you are going to then place in the vial. And you want to only put five drops of water in the vial. Don't fill it all the way up to the line. Then gently tap it on the surface, swirl the vial around a little bit to help dissolve that reagent and set a timer for five minutes. This will help make sure that all the reagent is dissolved. After five minutes, again swirl the vial, make sure all the reagent has been dissolved and place the test drip in with the arrows pointing down. The way that the test results will show up on this strip that you place into the vial is going to be similar looking to a COVID test. When you first put the material into the COVID test, you'll see a red line. Well, this is what you're going to see at the end of 10 minutes. Remember, set the timer for 10 minutes once you've put the test strip in. And if you see line, you've passed. If you see two lines, you have failed. So one line means you're below 500 CFUs. Two lines means you're above 500 CFUs. If you don't see any lines after 15 minutes, meaning the initial time and the 10 minute time for the vial with the test drip, that means that something's gone wrong with the process and you need to repeat that test with a new test kit. You should record the results. And then if you did fail, you need to follow the manufacturer's instructions, shocking and testing your lines again so that you make sure that you do fall below 500 CFUs. I think the video is really helpful, as well as the audio instructions, but to really see how easy it is to perform this test and the fact that you can get the pass fail result in 15 minutes time. That will be very important to know if you need to shock, if you fail, we'll be talking about that. And in making a decision whether you maybe ought to or ought not to be using a treatment room if you failed a test.
SPEAKER_02Those are some good points, Mary. And one of the things that's amazing to me is just how technology is revolutionizing this aspect of patient care. You know, when you think about, you know, dentistry, you know, crown in a day and all the different other types of services that we can provide that involve a lot of technology, lasers, and all different technology. You know, Brian, I think Silmetics has really stayed on top of the technology really nicely.
SPEAKER_04I think this is part of a natural evolution, yeah. And the beauty of this test in particular is now that four years past the beginning of the biggest pandemic of our lifetime, it's in a format that we've we're now completely accustomed to. We know what the results are going to be just by looking at it. And it's something we've really grown accustomed to over the last four years.
SPEAKER_02Well, we want our information and we want it now. We want accurate information. That's very important. So thank you very much for being the leader in that. Now I'm going to call on our diva, Olivia Juan, to talk about a Jada article, the Journal of American Dental Association. There was some interesting information in that article, Olivia, about the barriers to water testing. So, how are all the dental practices doing across the country?
SPEAKER_00Well, Linda, it's interesting that they conducted this study this past year and they assessed dental offices, dental unit waterline, infection control. And interestingly, what they found is that you know many of the practices, although they recognized the importance of infection control, they knew that it was something that it should be done. Many of the practices had barriers to implementing a process. Whether that barrier was maybe insufficient knowledge, maybe not knowing how to do it, maybe not having enough time to do the testing and monitoring, or it could even be budget constraints. And we are all very familiar with the fact that many practices are suffering with staffing shortages, which means if we don't have enough people to work, there may be tasks that are going incomplete. So those are some of the things that we learned out of the article, as well as our firsthand experience working with dental practices on site. So, Linda, I think that's a good way for us to start that conversation. I agree, Olivia.
SPEAKER_02And let's talk for a minute about the barrier of the knowledge. You know, what do we think is causing that? Do you think there's just a confusion? Do you think there's, I mean, there's certainly lots of information. Is it folks that are new to dentistry that maybe haven't had a chance to be trained? What are your thoughts?
SPEAKER_00I I've seen it both ways. I was actually teaching a seminar, Linda, and a dentist came up to me after the presentation and he said, This is a topic that I learned in dental school, but it's not something that my clinic has launched yet. And so maybe doctors like him have knowledge that it should be done, but it's not something that's in their standard protocols. So there's a variety of reasons why what the barriers are, and I think that's our goal is to remove some of those barriers.
SPEAKER_02So true. Brian, what are your thoughts on the barriers and all these different obstacles?
SPEAKER_04I think there's a lot of information out there. Uh, I would think that one of the barriers, or maybe the main barrier, is that that information isn't synthesized in any one place in any sort of concise manner, along with the fact that while there's guidance given from a few different organizations, right now it's still kind of the wild, wild west. There's only one that mandates testing for dental offices. And then there's some other states and some other municipalities that have recommendations, but there's no enforcement yet. So and I think this is going to become increasingly topical as time goes on, kind of just like a Malcolm Separation was as well.
SPEAKER_02Yes, and I remember those days for sure. Mary, what are your thoughts?
SPEAKER_01I totally agree with what Brian said about this being the wild, wild west. We see so much legacy learning or legacy training going on that we've perpetuated perhaps incorrect procedures along the way, one employee to another, and so many people new to dentistry that don't have any idea. The other thing that surprised me when we opened practices back up after the COVID shutdown, when we got recommendations for people to shock their water lines because the units had been sitting stagnant and there would have been water sitting in those lines, and the biofilm counts could be pretty high. That so many people said, I never heard of such a thing. I didn't know we ever had to do it. And for some other people, it was the first time they ever even thought about what they were doing in terms of water quality safety from their from their practice.
SPEAKER_02True, true. Leslie, what are your thoughts?
SPEAKER_03Well, I agree that there is an abundance of information available. And I think that might be part of the problem too. There's so much information that I believe dental teams don't know where to start. And as the old saying goes, a confused mind always says no. So it would be great if we could get alongside one type of regime and stay there, and of course, rely on the manufacturer's directions to guide us the rest of the way.
SPEAKER_02And I see Brian nodded his head on that too. Leslie said. Ooh, that's definitely scary because we rely on a lot of those water fountains to fill up our water bottles in between flights. So, ooh, not a not a good thought. So Lisa, let's let's play off of this a little bit more and let's talk about those instructions for use in the education. And so, can you talk to us about the specific manufacturers' instructions for use for the Fast Check 15? And then what do we do if the test fails? How can we help on office with that?
SPEAKER_03Well, again, Linda, it is important to follow manufacturers' directions. And according to the directions from SteroSo, and also this echoes true with OSAP, now called Association for Dental Safety, is that you do your testing monthly. And when you have two monthly successful tests, then you can move on to quarterly. And this way you can always be aware, it gives you a chance to stay ahead of any problems that you might have. And we need to recognize that bacteria duplicates every four to 20 minutes and can exceed the 500 colony forming units very, very quickly. So monthly testing is not only practical, but it's now affordable through this fast check 15. You asked about failure, and I think that that's something that people always want to know what exactly do I do in the event of failure? Well, a dental unit waterline test should be shocked and retested with the same testing method. So we don't want to switch around products. As I mentioned before, that could be very confusing. And so if you're using the same product and you fail again, then you might want to just make sure that you are following the directions according to the manufacturer's directions. Sometimes it's operator errors why we might get a failure. The guidelines call for shocking and cleaning lines again before treating patients and testing until a pass test is achieved. And again, if two successive, meaning not successful, but two in a row, uh, water tests fail, you might want to consider the mail-in R2A lab testing to obtain more specific information on the count. And this would also help for assessment of water chemistry and for troubleshooting the potential source of dental unit water for repeated failures. It's nice that Sterisell has a customer support line so someone can get on the phone with you and walk you through some of the steps, and they have a water testing page portal where you can log your results and they can be archived and analyzed and used to support ongoing waterline infection control efforts. Now, something that we want to keep in mind is that if you have a failed water test, then you might want to consider the manufacturer's directions to wait five days before you retest again. And if you can't pass a test no matter what, then again, are we following the manufacturer's directions? Are we shocking and cleaning our lines thoroughly? And when there's repeated failures, it's mostly due to biofilm accumulation. So it's important to make sure that we understand what we should be doing with our dental unit lines and what we should not be doing. It's not recommended to put bleach in your water lines because it's known to be corrosive to metals and parts over time, maybe will damage hand pieces, valves, and other metal parts of the dental unit. And downstream, it can also cause damage to your vacuum. So it's important to get help if you need help. Make sure you're following the directions maybe you think you are, but double check that you are. And then if all else fails, reach out to Sterishell so they can help you with some of the steps.
SPEAKER_02Thank you, Leslie. Brian, one of the things that Leslie mentioned was using a third-party water testing company. And I think that has a lot of value. Could you speak to that for us, please?
SPEAKER_04Absolutely. And I'll I'll take some of that a little bit further, which is actually the protocol that we're recommending now is do the in-office test two months in a row. Hopefully those are passing, but regardless of whether you're passing or not, every third month, do that third-party test, do that R2A test and mail it in. So you actually get a true CFU count as opposed to just a pass-fail. So we're kind of moving on from the past two months and then move it to quarterly. And it really just follows the theory of an ounce of prevention, right? If we can if we can catch this on the earlier side before it becomes a snowballs, it becomes a larger problem, then it'll be easier to handle upstream. As far as the third-party testing, the R2A test that we're actually using is through a company called Dentasafe, which is happens to be the only EPA certified lab for R2A testing in the United States.
SPEAKER_02Wonderful. We are familiar with Dentisafe and we with the Divas think highly of them too. So I think it's important that they use a third-party test, like you're mentioning, because it gives you that extra validation. And certainly the divas have talked about validation in other ways, like spore testing and using mailback with that to have that third-party validation. And then you get the actual number of colony forming bacteria. So it really can be eye-opening to know how much did we fail by or how much, you know, where how much do we have to correct. Mary, what are your thoughts?
SPEAKER_01Well, I want to go back to how we performed the test initially because the video shows and the explanation that we have is that we're doing what's called a multiple source or a pooled sample, where we collected water from all the lines and just did one test. And so one of the recommendations also, if you have a failure or successive failures, is that you then use one test kit per water line on a unit so that you can identify, if possible, the offender, because it may be that there are some lines that perhaps have a dead leg in them, or there's something particular about the tubing on a particular line. So that's another thing to consider along with a male-in test for more specifics about the CFU counts.
SPEAKER_04I think that's a good point. I, you know, there's again, because there's so much information out there, even different speakers will say different things in terms of pooling tests. I had one speaker fairly recently say that it was okay to pool from multiple operatories within the same office into one test. Well, if you fail, now you're redoing every single operatory and trying to identify what room or rooms have the problem. So I'm okay with pooling tests per operatory. And typically what that's going to look like is two high-speed lines, two syringes, and maybe a Cavatron. So a typical operator might have five water sources that are potentially entering a patient's mouth that I would pull together into one sample. That's fine as long as you're isolating that one operator.
SPEAKER_02And those are good points, Brian. And I would like to challenge our listeners that when they have a failed test, the word that I'd like you to keep in mind is ethically. Ethically, what should you do without waterline? Because as Brian just mentioned, you know, the water fountains in Arizona Airport were shut down, you know, because of legionellus being found in the water. So how would we, what would we manage with our patients? How would we handle that? And so I think that's an important thing to address, don't you, Brian?
SPEAKER_04Absolutely, I do.
SPEAKER_01Mary, what are your thoughts? Well, Brian, I'm so glad that you mentioned pooling more than one operatory because that's really going to add to the confusion. And the other thing that if you are testing in some older treatment rooms, the assistance instrumentation, their air water syringe, may not even be pooling water from the same source, depending on how it's set up. So you really have to know your equipment once you start your testing journey, because you may have to do two tests in some treatment rooms if they're coming from two different water sources. So if our listeners out there are confused, it's understandable because, as Brian keeps telling us, there's so much information and there's so many things to consider. In one office, you could have maybe five different operatories of equipment, and each one of those is going to have its own little idiosyncrasies. So we have to really understand what we're doing.
SPEAKER_02So true, Mary. So it's a matter of recommending to our listeners to take time and be sure they have the correct manufacturer's instructions for use for the products that they're using and not strictly just rely on a sales rep or someone in their territory. And I know they're typically their trusted advisor, but sometimes, you know, those different individuals in the local level don't know every single product in this particular area because it's just evolving so much. So let's talk about some of the things that the divas we've seen in our client offices, or maybe we've heard in our presentations from attendees, or maybe some bloopers that Brian's heard of. Leslie?
SPEAKER_03Well, there's not a confusion between water out, like the evacuation lines and sections, and dental unit water lines. So the explanation needs to be better to the general dental community so they can differentiate between the two.
SPEAKER_02That's so true. I think they need to understand because that we I have seen that as well, Leslie, that they're confused over the fact that they, you know, what's the water going in the mouth and what's the water going out? So true. Olivia?
SPEAKER_00I think also the issue of tasking this to be performed and looking at one client's records, it's like, oh yeah, we do the water monitoring. And when I looked at the record, there was only one test. And so I think you know, we are so busy making sure we specifically assign a team member to handle this process and then accountability, checking the records to make sure it is completed. And also, Linda, making sure that the records are accurate, that it includes the date. I always like to have a digital photo of the test itself so that you know, if something were to happen later on, we have stronger evidence to support our findings in addition to lab tests.
SPEAKER_02Oh, true. I think it's it's not just skimming the surface when we're working with our clients. As well as when we're speaking to groups, teaching them to go just a little deeper and to kind of peel that onion back and make sure, because they may be doing one test, like it could be one test a year. And in their minds, they've met that obligation. But actually, there's a lot more to it than that. Wouldn't you say, Ryan?
SPEAKER_04Absolutely. And I think part of the part of the beauty of what we've designed with Fast Check 15 in conjunction with the the Dentisafe R2A test is we have a spot within our My Solutions Center on our website where offices can actually log their test results digitally, not have to worry about having it printed, but can certainly print out a result to keep it in binder as well. And when they're sending those quarterly R2A tests off, those automatically come back entered into the customer's test result is there for them.
SPEAKER_02Amazing. That's great. So they don't even have to think about it. It's just, it's right there. That's perfect. Well, one of the things that I really love about the Fast Check 15 is that it just it's a game changer for me and with our clients that they can now test on any day of the week they want. You know, previously with other tests, you were kind of tied to maybe the first half of the week. Now you can test any time that you have time. If you're going to do it right before lunch or at the end of the day, any day of the week. And if you need to shock, you could be prepared and do it right then and not have to wait till another certain time frame. So it really gives offices more flexibility and managing this task, as Olivia said, and making sure they understand the task.
SPEAKER_04Absolutely. And it's and it's cut and dry. Subjectivity, we removed any sort of interpretive nature to the test. It's one line means you pass, two lines mean you fail. We're not comparing colors with a contrast sample or trying to count spots on a paddle test. So I think the beauty is in its simplicity, truly.
SPEAKER_02I know we've been liking it to a COVID test that nobody wants to talk about these days, but they get the concept with that strip and whether they're two lines or one line, they get that. So is there anything else that we want to talk about before we begin to wrap up?
SPEAKER_01Well, one of the things that I like about this test is that I can take it into a client office. And while we're talking about this, and especially if they say, well, gee, we haven't been testing, and I just did it in a client office on Friday, that we pick a treatment room and we run a test to see if they pass or fail. And then it's real to them. Then it makes a difference. So I think it's a trainer and a consultant's best friend to be able to have this to really show number one what is happening with their water. Are they passing or failing? But also to show them how simple it is.
SPEAKER_02Beautiful. Well, I think I would say that if you haven't checked this product out, check this product out. Talk to your dental sales rep or go to the Solmetics website. I know you had a great special at one time, Brian. They may still be running.
SPEAKER_04We still do.
SPEAKER_02It's it's important to go and find these firsthand information sources for the practice. So I think this will be great so that they can call if they have questions about a failed test and have a resource, a qualified, bona fide resource they can go to for good answers. Brian, thanks for joining us today.
SPEAKER_04It's a pleasure, as always.
SPEAKER_02As 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 our podcast at your favorite podcast channel or on our website, thecompliancedivas.com. We also welcome your questions and you may submit them to support at the compliancedivas.com. And don't forget to scroll down at the end of your podcast app and leave us a review today. We'd love to hear from you. We look forward to seeing you in the next episode.