Effective control of dental chair unit waterline biofilm and marked reduction of bacterial contamination of output water using two peroxide-based disinfectants.

Bacterial biofilm in dental unit waterlines (DUWs) is a widespread problem, and poses a potentially significant risk of infection to dental staff and patients, particularly those who are medically compromised or immunocompromised. The purpose of the present study was to investigate the level of bacterial contamination of dental chair unit output water in the Dublin Dental Hospital, and to investigate the efficacy of two hydrogen peroxide-based disinfectants in reducing bacterial loads to < or =200 cfu/mL as recommended by the American Dental Association. The chemical quality of dental chair unit input and output water was well within the limits recommended for potable water. Water supplied to the units yielded an average aerobic heterotrophic bacterial cell density of 184 cfu/mL. However, the corresponding density in output water was considerably higher; the average cell density in water from the three-in-one air/water syringes and cup fillers in 12 chairs was 8200 and 4300 cfu/mL, respectively. Dental unit water obtained from 18 separate reservoir-supplied units in general practices in the Dublin area yielded an average of 66000 cfu/mL. The bacterial species found were predominantly environmental organisms, which were also present at low levels in the input water. Some of the species identified (e.g., Burkholderia cepacia and Pseudomonas fluorescens) are known opportunistic pathogens. The capacity of two disinfectants, Sterilex Ultra and Sanosil, to reduce bacterial contamination to safe levels was compared. In a controlled study, once weekly overnight (15 h) disinfection using either agent reduced the bacterial density to below the American Dental Association recommended level of 200 cfu/mL. However, once disinfection ceased the bacterial loads increased to unacceptably high levels within three weeks. Electron microscopic analysis showed that both disinfectants markedly reduced biofilm in the DUWs, but the biofilm rapidly became extensive again when once weekly disinfection ceased. While both disinfectants were equally effective in lowering the bacterial counts to acceptable levels, Sterilex Ultra was associated with clogging of DUWs in some dental chair units after repeated usage, suggesting that Sanosil is a more suitable agent for routine use.

An evaluation of the use of chlorine dioxide (Tristel One-Shot) in an automated washer/disinfector (Medivator) fitted with a chlorine dioxide generator for decontamination of flexible endoscopes.

Microbiological tests were carried out to evaluate a new chlorine dioxide sterilant: Tristel OneShot. Preliminary in vitro suspension tests showed that solutions containing around 140 ppm chlorine dioxide achieved a reduction factor exceeding 10(6) of Staphylococcus aureus in 1min and of Bacillus subtilis spores in 2.5 min in the presence of 3g/L bovine albumin. Subsequent tests evaluated the effectiveness of Tristel One-Shot in a Medivator washer/disinfector fitted with a Tristel Generator for processing flexible endoscopes. Each test run involved three stages. In the first, the instrument and air-water channels of a gastroscope were inoculated with a suspension of Pseudomonas aeruginosa (10(8)cfu/ml) in 10% sodium glutamate and serum (0, 5 or 10%) and then drained, partially dried, and saline flushed through for total viable counts (TVCs). In the second stage, the channels were re-inoculated with test organisms; detergent was flushed through the channels which were then brushed; and saline was flushed through for TVCs. In the third stage, the channels were re-inoculated; detergent was flushed through the channels which were then brushed; the endoscope was processed in the Medivator; and saline was flushed through for TVCs. Carrying out all three stages enabled determination of (1) the contribution played by manual cleaning of channels prior to processing in the Medivator, and (2) the combined effect of manual cleaning followed by processing. Two series of test runs were done. In the first, the Tristel Generator was set to generate 230ppm chlorine dioxide, and in the second 150ppm. In the first, cleaning followed by processing in the Medivator consistently achieved a >/= 10(6)-fold reduction of test organisms, and in the second a >/= 10(5)-fold reduction. Pre-cleaning of channels was very important-when done the initial concentration of serum in the inoculum (0-10%) had no affect on the results obtained after processing.

Update on infection control.

Infection control is a dynamic and ever-changing subject and all dental staff should be kept aware of the most up-to-date procedures required to prevent the transmission of infection and should understand why these procedures are necessary. Regular monitoring and updating of all procedures in the light of new scientific evidence is necessary and all new staff must be trained in infection control procedures prior to working in the surgery. A practitioner who is routinely following an appropriate infection control policy, including the use of techniques and products of proven efficacy (perhaps through accreditation), is better placed to refute allegations arising in the course of civil litigation, health and safety at work prosecution, complaints and disciplinary procedures, or investigations by the GDC.

Quality control of decontaminating agents.

The present study evaluates the efficiency of the following decontaminating agents for the multiresistant, locally circulating bacterium Pseudomonas aeruginosa: glutaraldehyde 2%--makes A and B-, glutaraldehyde-formaldehyde; povidone-iodine-makes A, B and C-; sodium hypochloride; chloroxylenol--makes A and B-; and lapire chloride. The 9027 ATCC strain was used as a standard. A modification of the method of Kelsey and Sykes (1) was used to evaluate decontaminating efficiency. Highly satisfactory results were obtained with glutaraldehide 2% A and B, glutaraldehyde-formaldehyde and sodium hypochlorite. The results for povidone-iodine A, B and C were satisfactory but were unsatisfactory for chloroxylenol and lapirium chloride.