Abstract
Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.
Highlights
Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental health care personnel and patients
Immediately after the preliminary treatment with hydrogen peroxide, total hetrotrophic bacteria were present at low concentrations (HPC 22 °C and 36 °C < 5 CFU/mL) and the other tested microorganisms were not detected in all the samples
The following conclusions can be drawn from this study: (1) S. aureus and β-haemolytic streptococci were never isolated from the water of any f the units
Summary
Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental health care personnel and patients. Data on healthcare-associated infections in dentistry are under-reported in the literature [10], a small number of case-reports directly linked to contaminated DUWLs are described. There are no reports of occupational infections associated with contaminated DUWLs in dental healthcare staff, but there is evidence for adverse health effects on dentists following exposure to bacterial endotoxins in dental unit output water [16] and a high prevalence of Legionella seropositivity was observed in dental personnel [17]. Exposing patients or dental health care personnel to water of uncertain microbiological quality, despite the lack of documented effects with significant impact on public health, is inconsistent with accepted infection control principles [18,19]
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