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
#213 No More Maybes: Proven Waterline Protocols for Peace of Mind
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Is managing dental unit waterlines in your practice still a puzzle? In this episode, the Divas discuss how to better understand your water test results by having confidence in your water quality rather than guessing.
Resources:
- CDC - Dental Unit Water Quality https://bit.ly/3UR3ua5
- Agenics Labs Water Testing Resources for Dentistry https://www.agenics.net/resources
- Agenics Labs Special DICAM Give-away https://www.agenics.net/compliancedivas
- Agenics Labs STAT: https://www.agenics.net/s/STAT-Response-GP30040.pdf
Welcome.
SPEAKER_04I'm Leslie Kellum.
SPEAKER_03I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Juan. And together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I'll be the moderator for this episode. Dental water testing has been very much in the news recently, with reported outbreaks of infectious diseases related to contaminated water. While it seems that many practices are doing something to treat waterline contamination, not as many are getting the results they would like to see on their waterline tests. So we've invited our special guest from Agenics Labs to help us better understand how to have confidence in our water quality rather than just guessing. So welcome, Brianna. And I'm going to give a formal introduction for you as our esteemed guest today. Brianna Nieder-Schulte is the president and owner of Agenics Labs. She's an active member of the Association for Dental Safety, ADS, formerly known as OSAP, and several of the American Dental Association working groups with a background in engineering and theater from Northwestern University. Brianna lives at the intersection of form and function. Her problem-solving approach is equally scientific as it is human-centered. What a concept. She carries this principle into a genetics where results are obtained through scientifically grounded analysis and delivered with a customer-centric mindset. Healthcare professionals across the country trust Agenics Labs to provide water testing services and support tailored to their specific needs, delivering reliable and effective results. Thank you for joining us today, Brianna. We appreciate your time and expertise.
SPEAKER_00Thank you, Mary. It's absolutely my pleasure to be joining you all again.
SPEAKER_02Yay. So we're going to start out with Leslie, and she has a question about what you offer to your clients.
SPEAKER_04Hi, Brianna. Thanks again for joining us today. We just so appreciate your expertise. And I think one of the uh big uh ahas is that uh previously we only knew a genicisus water testing mail-in. And uh I think you offer both in office and mail-in testing services. If you could tell us a little bit about how you differentiate between the two and address testing for water chemistry, if you would, so our listeners have a better concept of what they should be doing.
SPEAKER_00Absolutely, Leslie. This is a great question because understanding the differences between in-office and mail-in testing helps dental teams make informed decisions based on their own needs and goals. Let's start with the basics. Both in-office and mail-in tests offered by Eugenics meet all current regulatory requirements. So no matter which route you choose, you're covered from a compliance standpoint. In-office testing is often the more affordable option, which makes it appealing for routine checks. But it's important to know that all in-office products, regardless of the brand, are inherently less accurate than mail in testing. That said, our MyCheck product stands out in this category. It uses a heterotrophic plate count method, which means it grows colony forming units just like the industry standard R2A test. What makes MyCheck unique is that it's one of the only truly quantified in-office tests available. Many other products give you a pass fail or an estimated range, but MyCheck provides an actual CFU count per milliliter, giving you real data to work with. Now, mail and testing is the superior option for several reasons. First, it's more accurate. Second, it requires minimal staff time. Just fill a vial and send it off. Third, it offers maximum liability protection because it's conducted by a third-party lab. You're not putting that responsibility on your team members. And finally, it provides the highest level of documentation. Our reports include both summary and detailed sample information. And with our standard check R2A test, you even get photo documentation of every cultured plate. It's the only test in the industry to provide that. All results are automatically stored in an online portal, so you have everything at your fingertips. One of our most exciting innovations, though, is Rapid Check. We developed it in-house by running thousands of samples side by side using flow cytometry and the traditional R2A method. Flow cytometry is a laser. It detects every single cell, even the dead ones. We apply a proprietary method to filter out non-relevant contaminants and report an estimated CFU count. The best part, you get results in just 24 hours. That's faster than most in-office tests, more accurate, incredibly easy for your team, and it's the same cost as a traditional R2A test. Now, I'm really glad you brought up water chemistry testing because it's often overlooked. Agenics is the only lab offering comprehensive water chemistry analysis, and it is a game changer, especially for troubleshooting those pesky failures or evaluating treatment product performance. It's incredibly helpful when establishing a new waterline management program, too. A combo test of bacteria and chemistry from one waterline and your source water, for example, gives you a wealth of information to guide your next steps. Here's a quick example. We worked with a large multi-site customer who was barely maintaining a 50% pass rate. After conducting chemistry tests on their source water and treatment water, we identified specific contaminants that were interfering with their treatment product. By ingesting their source water without changing their preferred shock and treatment products, they achieved a 98% pass rate on their next testing round. So if an office is struggling with repeated failures, a chemistry test can reveal what's really going on. And don't worry, you don't need to understand all the chemistry yourself. That's what our team is trained to do. Plus, because a GenX doesn't sell any treatment or shock products, we're truly an independent resource. Our only priority is helping offices find a protocol that works for their specific needs.
SPEAKER_02Wow. I am so excited about all the things that you have to offer. Linda, you have some questions that you wanted to ask Brianna.
SPEAKER_01Thank you, Mary. Welcome, Brianna. This is exciting to go even deeper. I think our listeners have been very, obviously, hungry for more information in this area because as Mary said, everybody's trying to do something, but we're not sure if we're all doing the right thing and they're all doing something different and creating their own protocols that don't even follow the manufacturer's instructions for use sometimes. So going back to the source with the water is so important. But Brianna, one of the things that I see is offices struggle with the choice of whether they should do a pooled composite sample, meaning taking testing all the water at one time from that unit, or testing individual water lines. So share your thoughts on that if you don't mind, please.
SPEAKER_00Of course, Linda. This is a topic that comes up often, and it's important to understand the nuances so teams can make smart, efficient choices. You kind of already covered the definitions, but just to make sure we're all on the same page, cold or composite sampling means you're combining equal amounts of water from each line on a single delivery unit into one sample vial. Individual line testing, on the other hand, involves collecting a separate sample from each line. So one vial for the air water syringe, one for the high-speed handpiece, and so on. For routine testing, a Genics recommends pooled sampling. It's practical, affordable, and gives you a solid overview of how that unit is performing. But there are a few important guidelines to follow. Only pool lines from the same delivery unit system. If your doctors and assistance units are connected to separate bottles, they should be tested separately. Never combine samples from multiple units or rooms. Doing so can mask a problem. For example, if four chairs are passing and one is failing, pooling them together could dilute the failing sample and give you a false sense of security. We also recommend keeping it to five lines or fewer per sample to ensure each line contributes enough volume. And if a sample is overpooled, a Genux will flag it as invalid. We believe very firmly in delivering accurate results. Now, when you're dealing with a persistent failure on a specific unit, individual line testing can be incredibly helpful. It allows you to pinpoint whether a particular line is the issue. If you find one, you can have a technician replace it and then retest to confirm the fix. And just a reminder, always test after any maintenance. Kind of like bags in an airplane overhead bin, things can move around and get dislodged. If someone is unsure which sampling method is right for their situation, they can give us a call or shoot us an email anytime. And we're happy to walk through what makes sense for them.
SPEAKER_01Brianna, I love the example. And first, thank you for all that great information. That was a really good explanation. And I'd like to circle back to a couple of things that you mentioned, especially when you use the airline analogy with testing after maintenance, you know, things shift around, things move, something happens. Yeah. So you can't be guaranteed that it's still the quality that you had once tested even a couple months ago or maybe a couple weeks ago. But I just like the idea that we can stress to our listeners that when one treatment room has different water bottles, to always test those separately. So thank you for that really important reminder. And I love the fact that you talked about the details of your report when you mail samples in. As a risk manager, that just really hit my hot button. The maximum liability protection. You can't ask for much more protection than that when you have a third party with detailed and summary information as well as photographs. So that's great. Thank you so much.
SPEAKER_02Thank you, Linda and Brianna. Um, as I mentioned earlier, our diva Olivia couldn't be with us today. So Leslie has some information that Olivia wanted us to ask you.
SPEAKER_04Brianna, I know how frustrating it is when something fails. You expect a positive result and you get a fail. Uh, you know, same with sport testing, there are a certain set of steps that need to be taken, and dental teams just simply don't have the time to think about it. I'd like to know what resources you have on your website for responding to a failed water test to uh help reduce that frustration. I believe you have something called STAT. Would you explain to our listeners what that is?
SPEAKER_00Absolutely, Leslie. We are very proud of the ACTSTAT framework. It's simple, memorable, and incredibly effective when responding to a failed water test. STAT is an acronym that stands for SHOC, test, assess, treat. Let's walk through it. First, shock the lines using your chosen protocol. This step is about resetting the system and eliminating the biofilm contamination. Then wait three to five days before retesting. That window is important. It gives any remaining biofilm a chance to show itself by re-releasing bacteria into the water. If you test too soon to that shock, you might only catch the free-floating bacteria that you killed and miss a deeper issue. Whether your retest passes or fails, it's time to assess why the failure occurred. And this is the most overlooked step that we see. We encourage teams to use a simple five wise method to get to the root cause. We could walk through an example case. Let's say we get our results back and one chair failed. So we ask, why did we fail? Well, the TDS on our report for the failed sample was really high. Why would it be higher than the others? That bottle may have been filled with the wrong source water. Okay, well, why would that have happened? Well, our newest dental assistant filled that room's bottle and must have used the wrong source water. Why would they have done that? They didn't know which water to use. Okay, well, weren't they trained? Yes. Oh, but the SOP didn't specify the source water we use. You can see how that chain of questioning helps uncover the real root issue. And a quick side note: a genux mailin tests are the only tests in the industry that automatically include TDS, total dissolved solids, and pH as additional water quality metrics in your results report. And then, of course, the final step of STAT, treat. And this is a bit of a double meaning. You treat the root cause, like updating your SOP and retraining staff, and you continue treating the lines with a solid maintenance protocol to prevent future failures. We have a downloadable version of the ACT Stat Guide on our website that walks through each step with examples, troubleshooting tips, and the most common root causes we see. It's a great resource for teams looking to build confidence in their response protocols.
SPEAKER_04I love that you drove down deep into the SOPs. And I think when we're writing SOPs, we simply don't remember all of the steps. And it's easy to overlook something as simple as, you know, what source water. So I love that you have that system of getting to the root problem. Um, and I think that can go for many of our other systems. So this is a great reminder for everyone on just about every SOP they have.
SPEAKER_02It is a fabulous reminder. Thank you, Leslie. I just wanted to mention that there are so many resources on the Eugenics website for users to um to access, and we will put links to those resources in the show notes so that anyone can go and download the STAT document. I downloaded it last week for a couple of practices that I've been working with, and I think it's a fabulous one. So, the one of the last things I wanted to talk about is that you see cited in studies that about a third of treated water lines still fail. Is this a common result in your experience, Brianna? And what can our dental practices expect?
SPEAKER_00That statistic definitely gets a lot of attention, Barry. And it is true that many offices deal with frequent failures despite their best efforts. But I want to be clear, this is not the standard dental team should expect, and it's certainly not the outcome they should settle for. At agenics, we see that number as a signal, not of inevitability, but of opportunity. It tells us that many offices are using treatment products without fully understanding how to build a protocol around them. Waterline management isn't just about choosing the right product. It's about pairing it with the right source water, the right maintenance schedule, proper training, and the right testing strategy. When all of those elements are aligned, pass rates can dramatically improve. We've worked with practices that went from that two-thirds average passing rate to over 95% passing simply by refining their protocols without changing the products they were already comfortable using. So, yes, the one-third failure rate is real, but it's not a ceiling. It's a starting point. And with the right support, offices can absolutely achieve consistent, reliable compliance. If a team is seeing repeated failures, we offer protocol reviews and chemistry testing that can help identify what's holding them back. We're here to help offices build a system that works not just for compliance, but for confidence. No one should be crossing their fingers and making a wish every time they mail out their water samples.
SPEAKER_02That is so true. And you hit on a really important point about how practices really do need to have a written protocol that a new employee can follow, as well as a long-term employee and everyone doing the same thing. But many times we find practices where one person does one thing with their water and another person does another, and then we get the interesting results. So, Linda, um, I'd like you to kind of take it home for us with a question that we have.
SPEAKER_01Brianna, this is an interesting question that comes to us from time to time. And it's just about the source water and what what role does it play in passing results, or does it play a role, or does it matter?
SPEAKER_00I'm so glad we're talking about this, Linda, because there's a lot of misinformation out there about source water, and it plays a much bigger role in waterline testing results than most people realize. In fact, source water is one of the leading causes of waterline treatment failures, which can ultimately result in those failed water tests. I think of it this way: good in, good out. You wouldn't use dirty water to run your dishwasher and expect clean dishes, right? The same principle applies here. If your source water isn't compatible with your treatment products, you're starting off at a disadvantage. Nearly all treatment products on the market require the water going in to already meet potable water quality standards. Now, the best water you can use hands down is purified drinking water. It's universally compatible with most shock and treatment products and can be found in bottles or jugs. If you prefer to source water on site, distilled water is a great option, but there are a few specific considerations to keep in mind. Tap water can also be perfectly fine if it's a high quality, and that's where a genetics chemistry testing comes in. We can help you determine whether your tap water is suitable for use. One type of water we strongly discourage is spring water. It's filled with bacteria and all the nutrients bacteria eat and grow on. It's essentially a buffet for biofilm. We actually have a new article on our website that breaks down all the different types of water, their pros and cons. I'll make sure your listeners get the link. So, yes, source water matters a lot. And if anyone's unsure what kind of water their office is using or whether it's compatible with their treatment products, our testing can help give those answers. It's a simple step that can make a huge difference in the outcomes.
SPEAKER_01Oi, Brianna, that was so powerful. I mean, this your whole podcast today has just been amazing. And I would encourage our listeners to listen to it several times, be sure they share it with the team, and maybe even listen to some of the excerpts together during a team meeting because there's a lot of information in the market. We know that. And trying to help keep it sorted is so very important. So I think addressing the water or the quality is something we haven't peeled back that part of the onion before. So thank you for doing that.
SPEAKER_02Absolutely. Thank you, thank you, thank you, Brianna, for such an informative podcast. What a great way to kick off Dental Infection Control Awareness Month that is celebrated by the Association for Dental Safety. And so we very much appreciate your participation. And we appreciate our listeners tuning in. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. If you have any questions from this episode, you can submit them by email to support at the compliancedevas.com. And we will have lots of resources and perhaps some surprises in the show notes. Thanks for listening.