There has been much written in the professional dental press about digital workflow, as dental teams endeavour to embrace all that 21st century dentistry has to offer. But that is not the only area in which the concept of workflow has proven its worth – there is also the issue of infection control and the widely adopted idea of a ‘dirty’ to ‘clean’ workflow. Generally speaking, the focus here has been on how to handle dental instruments, surfaces in the practice and personal protection in order to achieve asepsis.
However, there is another element of significance that needs to be brought to the fore within workflow – that of biofilm elimination from water lines. This entirely fits in with what workflow is – essentially, a coherent sequence of processes that are performed to achieve a predefined outcome. Hand in hand with this, therefore, are ‘implemented systems’ that, in relation to infection control in a healthcare setting, offer the ‘what, how and why’ of a process.
Protection, policies, procedures
If we take a small step back at this juncture, you may be wondering why water lines are so significant in dental practices, so as to warrant its own section in the official guidance contained within Health Technical Memorandum (HTM) 01-05: Decontamination in primary care dental practices (2013). After all, most practices will obtain their water from the mains, which, in the UK at least, has been effectively treated to eliminate contaminants.
The stark truth is that while potable water is indeed safe to drink, research has demonstrated that the output water of dental units is colonised with over 40 different microorganisms such as Pseudomonas spp., Enterobacteria, Candida albicans, Legionella pneumophila and non- tuberculous Mycobacterium spp., as well as organisms commonly found in the oral cavity (for example Streptococci), which suggests that these bacteria may originate from both inbound water and patient ‘suck-back’.1,2
In no small part, this proliferation is due to the maze of plastic tubes that feed water to the dental chair unit, which offers an ideal breeding ground for biofilm. If this biofilm is not controlled and eliminated, this can result in serous illness, with reports suggesting both patients and dental team members have been adversely affected.3,4