QAPI 123 - The Importance of a Dental Water Management Plan in the Prevention of Disease Transmission During Dental Procedures

Background: Nontuberculous Mycobacteria and Legionella outbreaks have been linked to water from dental treatment lines. Dental waterlines are prone to harbor bacteria because of the small diameter, line size, and the ability to have stagnated water for periods of time leading to biofilm production. The Centers for Disease Control and Prevention (CDC) and American Dental Association (ADA) recommend maintaining and monitoring dental water quality to meet the standard of < 500 colony forming units per milliliter (CFU/mL) of heterotrophic bacteria. It is critical to follow all steps in the water purification system’s manufacturer’s instructions for use (MIFU) to ensure water quality is maintained.

Methods: A review of the dental purification system MIFU identified several gaps. All gaps were immediately remediated by creating Standard Operation Procedures (SOP), and staff education. Due to these gaps, water samples were collected to evaluate the current quality of the water for heterotrophic bacteria counts. Initially, samples were taken from the 28 waterlines and one sink tap water. Waterlines that were out of compliance of >500 CFU/mL were re-shocked, re-flushed and the filters were replaced. Secondary water samples were obtained. Steps were repeated until reaching 0% contamination.

Results: Initial sampling revealed 11 out of the 29 samples resulted in >500 CFU/mL. The sink tap water was < 500 CFU/mL revealing the possibility of biofilm formation in waterlines. After waterlines were properly treated, a second set of water samples revealed that 5 out of 11 waterlines remained contaminated. Steps were repeated and samples were collected.

Conclusions: Dental clinics should develop a comprehensive water management plan to ensure that all steps in the MIFU of the purification system are being followed and to guarantee that the water used in dental procedures is safe for patient care. Periodic water sampling can validate that all steps in the MIFU are being followed.