Follow these steps to ensure your vacuum system is well maintained:
The Monarch CleanStream Evacuation System Cleaner from Air Techniques has a unique formulation designed specifically for daily cleaning. It penetrates and removes line buildup while maintaining vacuum performance and suction.
Amalgam separators have become an essential tool in dental practices, required by the EPA in order to reduce the discharge of mercury into publicly owned treatment works to prevent seepage into rivers and oceans. However, when a new amalgam separator is installed, it can fill up quickly affecting the system’s functioning, possibly rendering them non-compliant with the new EPA rules. If the practice doesn’t follow a daily cleaning routine of the evacuation system lines, debris accumulates and build-ups in the lines over time. With a new amalgam separator installation, the buildup can be disrupted and clog up the system. You will need to do a deep clean of your evacuation lines a few weeks before installing a new amalgam separator. This will help prevent clogging and premature filling of the system. Inspect the separator regularly to see if a filter change is necessary.
It may be tempting to come into your office, flip on all the switches, and start seeing patients as soon as possible. However, the treatment that you can offer is only as good as the tools at your disposal, and it is vital to understand the maintenance that your equipment needs. We all know how important a reliable HVE system is in reducing aerosols in the dental office.
The current pandemic is the perfect time to give these vacuum systems, and all the other equipment in the ‘mechanical room’, the care and maintenance needed. The wellbeing of our team members and patients is the priority, making it essential to keep your tools in working order by checking and following the advice from the manufacturers of each system. If you have an Air Techniques vacuum system, you can find maintenance information on our website.
by: Michelle Strange, MSDH, RDH
Different dental procedures require varying tools just as a contractor would not hammer a screw when building a home—it might do a similar job, but it is nowhere as effective. The same applies to the comparison between high-volume evacuators (HVE) and saliva ejectors. Saliva ejectors tend to be used during routine and straightforward procedures where fluid needs to be removed from the patient’s mouth, whereas HVEs are necessary during more extensive dental work because of their ability to quickly remove build-up of liquids and larger solids that the saliva ejector can’t evacuate. With the added benefit that HVEs can also reduce aerosol production by 90-98%. Understanding the appropriate and proper use of both tools is vital.
Flow Rate and Suction Volume
Performing dental procedures can be challenging if a practice’s vacuum system/HVE is inadequate. Without a proper vacuum system, dental professionals could be making efforts to prevent aerosol contamination, without correctly judging the airflow level that produces adequate suction for clinical purposes. Many dental team members have walked into the office, flipped the switch on to the vacuum, compressor, and water without thinking about the system being fully capable. Most practices however do not have the ability to monitor or check air flow from the HVEs. This requires specific instruments which are only recently available through some manufacturers (such as Air Techniques). So, most practices would not be able to check this themselves or even through their dealers unless they had an AT Sales Rep or Technician do a special on-site visit. This has become even more important during the current pandemic. There is more to understand regarding the use of this great engineering control that is meant to reduce the risk of spreading aerosols including the required minimum airflow levels for producing adequate suction.
HVEs and Saliva ejectors perform two different functions
Saliva Ejectors are for removing saliva and pooling water during patient care, HVE’s are meant for specific uses during a procedure like crown preparation, extractions, and to help reduce the spatter and spray during dental hygiene procedures.
Although saliva ejectors are useful during routine dental procedures, they do not have the power needed to limit the spread of aerosols. After all, aerosols can remain in the air and travel throughout the dental practice, posing a risk to all staff, even after the infected patient has left the building. The use of a high-volume evacuator dramatically reduces the risk of these aerosols escaping from the patient’s mouth. Keep in mind this requires the dentist or hygienist to use their free hand always with the HVE, or it requires a second assistant to hold a free HVE specifically for this purpose.
HVE Tips without High-Performance Vacuum Systems
Yes, we will need a saliva ejector to help the pooling of fluid in the patient’s mouth, but an HVE will be what is needed for most of our procedures in dentistry. We create spatter, spray, and aerosols for most of what we do so becoming accustomed to using our HVE is incredibly important. However, we have to think past the HVE tip and consider the vacuum system that is really the workhorse in this situation.
To help eliminate infectious aerosols spreading throughout dental offices, the Mojave Dry Vacuum can “provide the highest operational performance” required. The higher-flow vacuum is consistent and provides an exceptional level of suction without the noise levels of older models. It can adjust speed to accommodate the number of users online without the performance suffering.
The system will always provide the right speed, suction, and flow to ensure a safe and reliable dental procedure for both the patient and the staff. With low maintenance and offering 85% energy savings compared to other systems, the Mojave can save dentists money.
HVE’s are amazing engineering controls and should be the choice for aerosol reduction during dental procedures. We just have to remember they only work when we use them and only as good as the vacuum system to support their performance.
by: Michelle Strange, MSDH, RDH
When we think about controlling exposures to occupational hazards in dentistry, the first thing that comes to our mind is often PPE (Personal Protective Equipment). Although the role of PPE is crucial in a dental practice, we should recognize that it only serves as the last control when all other measures fail to protect against possible contaminations.
To optimally protect any workplace, a hierarchy of controls needs to be determined. The concept behind this hierarchy is that the control methods at the top are the priority as they are much more effective than those at the bottom. By following this hierarchy, the risk of contamination, illness, or injury reduces substantially.
Elimination and substitution are the most effective strategies to reduce any risk in the workplace. Clearly, when we remove the original source of hazard, the accompanying risk will practically disappear or substantially be reduced. Unfortunately, these measurements are often the most difficult ones to establish. A dental practice is limited in the flexibility of its workplace, and some equipment or actions are just inevitable.
Examples
Less effective than elimination or substitution as engineering controls do not totally remove the risk from the workplace. However, thanks to smart engineering solutions, they try to remove the hazard at the source. The initial cost can be higher than administrative controls or PPE, but are more effective and in the long term could be more cost-effective.
Examples
As a last resort, administration controls and PPE protect when all other controls fail or where taking other measurements is not possible. Their protective role is still beneficial, particularly during a pandemic, but it is crucial to realize its priority on the hierarchy of controls.
Examples
In dentistry, eliminating the source is not always possible. Engineering and work practice controls then become the highest priority. Therefore, training personnel with the correct safety procedures is essential.
Providing your dental practice with high-quality devices such as good HVE to reduce the aerosols during patient care can be essential to protect against infections too. Air Techniques Mojave Dry Vacuum System delivers more flow and the highest suction power of any dry vacuum system available resulting in effective aerosol capture with your HVE use. Administrative controls cover processes and standard operating procedures (SOPs) to reduce risk further.
Implementing a hierarchy of controls diminishes the risk of possible hazards in the workplace. However, although the controls at the top of the pyramid get the highest priority, it is the smart implementation of the right combination that will truly have the greatest impact.
by, Amber Auger, RDH, MPH
The waterlines of a dental unit promote bacterial growth and the development of biofilms due to the dark, long narrow tubing, slow flow rates and periods of stagnation. According to OSAP (Organization for Safety, Asepsis, and Prevention), waterline contamination consists of slime-producing bacteria, fungi, and protozoans.1 The microorganisms will begin to adhere to the walls of the tubing. As they grow, they develop a protective polysaccharide layer, which allows for the collection of even more microorganisms. Over time, they eventually break free and these heterotrophic microorganisms become planktonic-free floating microorganisms. They can find their way to areas of the tubing to grow another biofilm colony or into a patient’s mouth where they can potentially cause harm.
Monarch Lines Cleaner is a fast and effective way to shock and maintain waterlines in one single product. It gently removes biofilm from DUWL containing odor-causing bacteria in a non-corrosive solution. After the initial shock treatment, the lines only need to be treated once a week. Each treatment requires 2 oz. of the solution, which is poured directly into the water bottle undiluted.
Not all DUWL cleaners are treated equally. Monarch Lines Cleaner also meets the ADA and EPA guidelines. The product was tested in the Dental Advisor labs over a 3-month period. Bacterial concentrations met or were below 500 Colony Forming Units (CFU) per ml as recommended by the EPA. This level was observed just after a few days of treating the lines. The EPA established The Safe Drinking Water Act (SDWA). It is a federal law that protects public drinking water supplies. Under the SDWA, the acceptable CFU count is 500 CFU or less per milliliter of water.
When it comes to keeping ourselves, patients, and communities safe, cleaning DUWL should be a part of our infection control checklist and maintenance daily. Implementing the Monarch Lines Cleaner is a safe and cost-effective way to reduce biofilm contamination. Now, more than ever, our patients are aware of the importance of infection control. The Monarch line provides clinicians with the confidence of biofilm elimination our patients deserve.
by Michelle Strange, MSDH, RDH
A healthcare environment is a stressful place. Years and years of medical school and training, long work days, time constraints, emotional stressors, negative patient outcomes, rapidly developing diseases, and high-pressure emergency situations make being a medical professional one of the most challenging jobs. In the wake of a pandemic, it seems anxiety has reached a new level. It’s no wonder that the stress of being a dental professional tends to have negative impacts on both their personal and professional lives.
You can define professional burnout as “a special type of work-related stress, or a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity.”
Unfortunately, dental workers are more prone to professional burnout, anxiety and depression because of the nature of their practice.1 These feelings can cause employees to experience lethargy and lowers their attention to detail, which can result in imperfect dental infection control and cause safety lapses for both clinicians and patients.
The problem with dental burnout is that it can harm patient safety. Health care professionals who feel emotionally exhausted raise the odds of unsafe care, unprofessional behavior, and low patient satisfaction. In fact, the odds for poor patient care double, and patients are three times more likely to give low satisfaction ratings when visiting healthcare professionals who suffer from burnout.
Although this is a common issue that healthcare professionals have to deal with, there are solutions to make sure that your office is not compromised and that you are providing the safest dentist visits possible. Dentistry after COVID-19 may have dental professionals second-guessing their infection control procedures coupled with the anxiety of contracting this novel virus or any future ones. Establishing stress management programs would be advantageous to help dental professionals cope with any fears that are compounding with the already established burnout. All dental offices should have stress management programs and do their best to accommodate the needs of their workers. Doing your best to promote the positive mental health of your dental staff is one of the best ways to ensure better health and safety for everyone. Though stress management programs may seem like fluff, in this systematic review of the literature, “courses based on mindfulness showed to be effective in improving healthcare workers’ well-being, increasing their quality of life and the productivity outcomes”. After all, when you feel your best, you can be your best for your patients while adapting to new concerns that may arise!
by Michelle Strange, MSDH, RDH
In any profession, it is not unusual to hear things like “I have done this for 17 years, and I haven’t had any problems. Why change now?” While relatable, it’s not a good mindset to have in the dental profession. Dentistry is always evolving, which means that we must also if we wish to offer patients the best care possible.
In dentistry, infection control practices are not about us, but about the people who enter our facilities and sit in our chairs. Patient health must be the utmost concern, as it only takes one person catching an infection to put our practices and licenses at risk, nevermind the person’s suffering because of our mistake.
The biggest dangers come from healthcare-associated infection, medication errors, and unsafe surgery. As documented in many studies, numerous infectious outbreaks are due to a lack of compliance with established guidelines for disinfection and sterilization. When incidents happen, patients can be affected by minor to life-threatening ways ranging from temporary to permanent injuries or even death. Patients often advocate for themselves, but at the end of the day, it’s still on us, the healthcare professionals to properly care for our patients.
To improve the system and help prevent dental-related infections you can:12
Employ these strategies to improve the quality of your service and infection control to keep you, your practice, and your patients safer.
1 “World Health Organization: Patient Safety” https://www.who.int/patientsafety/education/curriculum/course1_handout.pdf. Accessed 5 Mar. 2020.
2 “Disinfection and Sterilization” https://disinfectionandsterilization.org. Accessed 5 Mar. 2020.
by Michelle Strange, MSDH, RDH
After working in one place for a long time, there is a human tendency to become somewhat complacent and move into an almost automated working process. However, as relaxing as this comfort is, it can cause problems because it means that you develop a particular set of responses that prevent you from being the most productive worker. Comfortable workers tend to be perceived as lazy, lack enthusiasm/passion, and settle for the bare minimum instead of going above and beyond. In the field of dentistry, this comfort can result in putting your patients’ well-being in danger.
One reason that people tend to become too comfortable in their working lives is because of a lack of accountability. Without accountability, unproductive behaviors are formed and can result in an environment where mistakes are the accepted norm rather than the exception.
In dental offices, professional mistakes often revolve around patient safety and can be something like forgetting to sterilize certain pieces of equipment. Errors like this can cause delays that upset patient satisfaction, but more seriously, they can be an indicator of lax safety rules. Many dental infection control safety guides have comprehensive directions to ensure as much as possible a reduction in healthcare-associated infections. If dental professionals lack accountability, it is all too easy for these tasks to get overlooked or done with complacency that fails to protect patients.
So, what can we do? Every dental practice needs to instill a sense of responsibility in their teams. The best way to increase accountability is to follow purposeful hiring practices, provide employees with clear deadlines, open clear lines of communication, have regular evaluations, and work tirelessly to have definitive expectations with clearly defined results. Accountability is the best way to build a high functioning team and limit the effects of accepted mediocrity because our patients deserve more than “just ok” when it comes to their care.
1 “4 Signs You’re Too Comfortable in Your Job”. https://www.themuse.com/advice/4-signs-youre-too-comfortable-in-your-job. Accessed 5 Mar. 2020.
2 “Accountability for your actions: Building a dental team culture that matures from its mistakes”. 1 May 2017. https://www.rdhmag.com/career-profession/personal-wellness/article/16409866/accountability-for-your-actions-building-a-dental-team-culture-that-matures-from-its-mistakes. Accessed 5 Mar. 2020.
3 “Environmental Infection Prevention: Guidance for Continuously Maintaining a Safe Patient Care and Survey-Ready Environment” https://store.jcrinc.com/assets/1/7/nexclean_environinfectionprevention_%28002%29.pdf. Accessed 5 Mar. 2020.
4 “3 Ways to Hold Your Dental Team Accountable”. 21 Feb. 2019. https://www.dentistryiq.com/practice-management/staffing/article/16363712/3-ways-to-hold-your-dental-team-accountable. Accessed 5 Mar. 2020.
by Michelle Strange, MSDH, RDH
Reading could be one of the most valuable skills that we develop in school. Yet, the older we get, the easier it becomes to “forget to read ” because we figure that we already know everything there is to know. However, that couldn’t be farther from the truth. In dentistry and infection control, it is imperative to read the labels. Not all disinfectant products are the same, and if not used correctly, the products can become useless. The only way to know how to use a product properly is to read the labels and instructions.
In dentistry, there are different levels of cleaning, disinfection, and sterilization required. Cleaning is a first step, followed by disinfection. Many people might think these terms are synonymous, or that the products for each process are interchangeable, but they aren’t. Some products only require 1-step, but you have to confirm by reading the instructions.
Failure to use these different products properly can create extra costs and safety hazards.1,2 According to the CDC, dental offices should only use disinfectant wipes that are approved for use in healthcare settings and follow the manufacturer recommendations. Even then, some products require multiple steps, and it’s crucial to follow the label to know how much is needed or if it needs dilution, how long it must make contact with the surface, how to use it safely, and also how to dispose of the cleaning products.
Reading a label only takes a few extra moments, but not reading it can cause a whole host of long-term problems for both your practice and your patients. So, the choice is clear: make sure you read and follow all instructions to make sure that you are doing your part to prevent infection and provide a safer, cleaner dental environment for everyone.
1 “Disinfection and Sterilization in Dentistry”. https://tdaperks.com/disinfectionsterilization/. Accessed 5 Mar 2020.
2 “FAQ- Disinfection” 2018. https://www.osap.org/page/FAQDISIN20184?&hhsearchterms=%22instructions+and+use%22. Accessed 5 Mar. 2020.
by Patti DiGangi, RDH, BS
In the time of the COVID-19 crisis, our patients will need even more assurance when they come back to see us that everything is safe. Though they may not realize the risk contaminated waterlines can create, we know and it is our duty to keep them safe. When we are protecting our patients, we are protecting ourselves and our businesses.
Is COVID-19 Growing in the Lines?
Dental unit waterlines (DUWLs) are used daily in dental practices. The importance of proper infection control to maintain the safety of both patients and healthcare professionals is apparent because DUWLs is a breeding ground for infection-causing biofilm.
The microorganisms that colonize in DUWLs can include bacteria, fungi, and protozoans, including Legionella, Pseudomonas aeruginosa, Candida albicans, and nontuberculous mycobacteria (NTM), and can increase in number to cause illness and infection. We must assume they contain COVID-19.
The CDC and the EPA regulatory standards call for < 500 CFU/ml of heterotrophic bacteria in DUWL. Heterotrophs are a group of microorganisms like yeast, molds & bacteria that use organic carbon as food as opposed to autotrophs like algae that use sunlight and are found in every type of water. Research shows microbial counts can reach 400,000 CFU/ml within 5 days after the installation of a new DUWL. That is 400x the recommended level. We know that COVID-19 grows quickly and is readily spread.
Keeping Lines Safe
Although flushing DUWLs was once recognized as an efficient way to control the microbial presence and decrease the planktonic bacteria in water, there are other strategies to control the presence of biofilm. Inside the tubing, water flows in a laminar fashion, meaning in parallel layers with no disruption in those layers. As a result, biofilm adheres to the sides of the narrow dental water line tubing and remains relatively stagnant, allowing continued growth. Biofilm can multiply rapidly and grow in an established, well-protected shell without treatment, so healthcare professionals must use effective methods to maintain water lines for the safety of themselves and their patients.
The product you choose must be an effective biofilm disruptor with rapid kill times. At the same time, it needs to be gentle on equipment and have no effect on restorative materials. Time is money so it needs to be time-efficient as well as sustainable with no harsh chemicals or leave a residue.
This means we must be picky when selecting products. For example, Monarch Lines Cleaner is a powerful formula that helps attack accumulated deposits in tubing lines without the use of harsh or aggressive chemicals.
Protecting Our Patients and Protecting Ourselves
Not only will patients have concerns coming back into the office; so will healthcare providers. With the COVID-19 Crisis, we have seen the importance of personal protective equipment (PPE). Every professional will be taking infection protection seriously more so in the future. We must take care of ourselves in order to take care of others.
Though waterlines may not have been subject to discussion with patients in the past, it can and should be. You can assure your patients you are doing everything possible to keep them safe.
by Patti DiGangi,RDH, BS
So here we are all sitting in our homes. Some of us are already bored; how many episodes can we binge in a row has reached new heights.
We are hopefully all keeping safe by practicing excellent hand hygiene in our homes. We know hand hygiene is one of the most important ways to prevent the spread of infection. Which song are you singing so it’s long enough? I got bored with Happy birthday and loved the suggestion of the Glory Gaynor’s song I Will Survive. This song has the dual purpose of helping us wash long enough while also reminding how long pathogens can survive. That’s why I want to kick the pathogens a bit farther by using Monarchs Hydrating Instant Hand Sanitizer. Following that with Monarch Revitalizing Hand Lotion leaves my hands to feel smooth silky and protected.
Now that I can feel confident with protecting myself, there is still the issue of boredom as well as the worry of no patients which means no income to the office. There are so many unknowns happening for practice owners. Great news here, you can see your patients connecting through teledentistry.
Teledentistry is a disruptive innovation and a rising trend. The long-held model and shared assumption for oral health care is Dentists’ Office are the System. Oral health can and should be addressed in many places and in different ways by a variety of health providers. Teledentistry expands the traditional dental practice.
The ADA is providing help in our current crisis. They created a Covid-19 Coding and Billing Interim Guidance that discusses not only how teledentistry can be used; it also talks about the billing and coding aspects of this treatment. This is important so patients with oral health emergencies do not end up in already overburdened hospital emergency rooms.
Teledentistry is also a great option for follow-up with our patients already in treatment, connections with medical providers, staying in touch with all of our patients and making a connection to new patients.
Like me, you have probably gotten notes from your bank, your internet carrier, your credit card and most everyone about how they are caring for you during this crisis. This is also a great opportunity for dental practices to stay connected with your patients. Let them know you are available for emergencies and urgencies.
You can also follow-up on patients already in treatment. You can look into everyone you have seen over the past 2 months and instigate a follow-up with them.
The ADA recommends that you offer assistance to new patients also. This can be a terrific form of referrals and practice building for a dental practice.
This is not simply a matter of having a FaceTime conversation. Facetime is a wonderful way to stay connected to our friends and family. I know I enjoyed seeing my granddaughter recently on Facetime. Yet it is not appropriate to connect with patients using any of the public-facing technologies such as Facetime, Facebook Live, Twitch, or Tik Tok. We need to leave those for personal use.
This a huge subject that can’t be covered in a single blog post. The important messages here are: Stay Safe and consider adding teledentistry as part of your procedure mix. Not just for the current crisis; teledentistry expands the traditional dental practice.
Author Bio: Patti DiGangi’s specialty is medically necessary coding. Her efforts have assisted thousands of professionals to code more accurately and efficiently. She teaches the why behind the codes. In fact, the American Dental Association recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for CDT 2018 Companion. Patti holds publishing and speaking licenses with ADA for Current Dental Terminology©2020. The Chapter Patti wrote in CDT 2018 Companion included the Teledentistry codes. Patti is the co-author with Cindy Purdy RDH, BS of the workbook Teledentistry Pathway to Prosperity Critical Choices. https://shop.dentalcodeology.com/. I have been on this bandwagon for a while co-writing the only workbook on the subject: Teledentistry Pathway to Prosperity Critical Choices that we are offering at ½ price through this crisis.
