Vacuum Shock™ & Vacuum Clean™ Evacuation Line Cleaners in the COVID-19 Age
Q&A with Dr. Sheri B. Doniger, DDS Published: December 1, 2020
Palmero Six Questions
Infection control is part of our practice’s everyday routine. We constantly strive to achieve the highest of standards for our patients and our team. We painstakingly pay attention to instrument disinfection, sterilization, and storage. We maintain the integrity of our water lines daily by ensuring they are flushed and cleaned. We focus on the water outflow in our operatories to our ultrasonic devices, handpieces, and, ultimately, our patients.
But how much attention are we paying to the water capture in our evacuation lines? The same biofilm and debris that we are concerned with in the water lines are building up in our evacuation lines. If the high and low suction lines are not cleaned daily, they are at risk of not only clogging, but also retracting bioburden-laden water into our patient’s mouths. From day one, we have maintained the suction lines after each patient and at the end of the day — and for good reason.
Imagine a tunnel that is in constant use and that collects debris from the vehicles that travel through it. If the tunnel is not flushed and cleaned, new debris will build up on the old and degrade lighting and air quality. Similarly, if evacuation lines are not cleaned, they will continue attracting the bioburden that is passing through the system. Eventually, that bioburden may occlude or completely block the suction’s functionality.
Although we think the water is moving quickly through the suction lines, it may only be active for a short period, giving bacteria ample time to multiply and become planktonic.
The cost of these evacuation lines not being maintained is high in terms of both equipment maintenance and standard infection control. Let us explore what is really at risk and how to solve this open link in our infection control procedures.
Q: Why must we maintain evacuation lines?
Dr. Doniger: If you do not maintain your evacuation lines, they risk clogging. The last thing a clinician wants during a patient treatment is a breakdown in the suction system. Whoever is maintaining the operatory equipment and the evacuation lines will also need to attend to two “traps.” One is attached to the saliva ejector. This disposable basket may have bioburden, calculus remnants, and food debris that were removed from the mouth. Not replacing the basket regularly will prohibit the free working of the suction device. The second trap is in the main unit. While both traps should be replaced at least monthly, the one attached to the saliva ejector may need more frequent replacement. You will also want to change the tubing yearly or when it starts to look ragged.
Q: What must be cleaned?
Dr. Doniger: According to the CDC, because of the negative pressure that occurs when a patient closes their mouth around the suction device, backflow may occur. So if you don’t maintain or clean the suction lines, there’s a higher risk of backflow and blood, debris, and bioburden from random patients returning into your patient’s oral cavity.
Although we should advise patients not to close their lips around the suction device, other reasons may cause this backflow, such as the negative pressure from the saliva ejector getting caught in the buccal or lingual mucosa. For this reason, suction lines must be disinfected daily.
Alternatively, adaptor products such as SAFEFLO® saliva ejectors, contain an internal one-way seated valve, allowing the evacuation of fluids from the patient’s mouth. When the vacuum pressure changes, such as when the patient closes their mouth around the tip, the valve snaps into a closed position and creates a barrier to prevent the backflow.
Q: How do we maintain the lines to protect patients and equipment?
Dr. Doniger: Disinfecting evacuation lines is similar to disinfecting water lines. It takes two steps: shock the system (to rid th
e lines of accumulated bioburden) and then clean it. Palmero’s two-step system, Vacuum Shock and Vacuum Clean, works to eliminate the buildup and allow free flow in the suction lines.
One of the main advantages of this system is that it does not contain bleach, chlorine, iodine, or peroxide, which may affect any metal pieces or housings in the dental unit. This system also does not contain any oxidizers, which can cause mercury to release from amalgam particles and can lead to water contamination. Hence, it is very eco-friendly and meets the EPA rule for “Best Management Practices for Dental Amalgam Waste.”
The shock component keeps vacuum lines clean and extends the life of the vacuum pump, while the clean component is a self-activating tablet that releases enzymes over the course of a week. It will also restore suction pressure and keep the vacuum lines clean and free-flowing, which will extend the pump life and allow consistent vacuum suction and asepsis, as per guidelines.
Q: Where do we direct our attention when disinfecting our suction lines? 
Dr. Doniger: You should initially shock the lines with Palmero’s Vacuum Shock product, and then continue to shock them every month. After you turn off the system, open the evacuation trap and insert a new trap. Insert one Vacuum Shock tablet in each evacuation trap and replace the lid. Turn the pump system on, and vacuum approximately one gallon of warm or hot water through the suction and HVE lines. Then turn the pump off and empty any buildup in the main pump filter after you clean the HVE line.
Use the second component, Palmero’s Vacuum Clean, weekly to keep lines in peak performance. Again, turn off the vacuum pump, remove the evacuation trap’s lid, insert one Vacuum Clean tablet in the evacuation trap, and secure the lid. Turn the vacuum pump back on, and the tablet will be activated. Insert new tablets every three to five days, depending on the usage in the operatory.
To clean the high- and low-speed evacuation tubing, create a concentrate by dissolving five Vacuum Clean tablets in a Pour & Clean 16-ounce dispenser with hot water. Two ounces of concentrate produce one gallon of evacuation line solution cleaner. Aspirate one quart per operatory through the tubing weekly to clean it.
Q: When should we perform these tasks?
Dr. Doniger: Perform suction maintenance using the two-step system at the end of the day after patient treatment and leave residual product in the lines to keep the lines fresh and functioning at peak performance. Properly maintaining suction lines will not only enhance and improve infection control protocols, but it will also improve the longevity of the vacuum pump by ensuring there is no buildup to clog the equipment.
Q: How does optimizing an evacuation system help with aerosol mitigation in a dental office setting?
Dr. Doniger: COVID-19 has changed many things in the dental world. Although we have always been at the forefront of infection control, reducing aerosol contamination is paramount to a safe dental environment. Saliva ejectors alone do not remove the aerosol present from dental procedures. To prevent disease transmission, we should also use an HVE, which has been shown to reduce aerosol contamination by 90%.
Many clinicians are working solo and should have an HVE to capture the aerosols from ultrasonics, air polishing, and high-speed handpieces. Now more than ever, we must work more efficiently while navigating the challenges of working without an assistant. Utilizing the HVEsolo is a highly effective and ergonomic way to decrease aerosols by 90%. The short 2.5-inch shaft allows access while not causing the torque or strain on wrists and hands that a standard-length HVE would. The three vents mean you are not engaging the tissue, while the unique scoop design helps remove fluids and debris from the oral cavity while offering added retraction. The smooth edges do not dig into the patient’s soft or hard tissues, so not only are you more efficient, but you are also giving the patients a comfortable experience.
When you attach the HVEsolo to an efficient evacuation system, it will remove a large volume of air (up to 100 cubic feet per minute). And while continued
maintenance of the suction lines has always been important, as we navigate through the new world of COVID-19 and beyond, maintenance is more important than ever. Keeping the evacuation system working at peak performance is critical. Evacuation lines must be clean, so you are not overtaxing the system or decreasing the system’s effectiveness. Having a clean evacuation line will create a stronger flow of air from the oral cavity into the suction unit and let the line work at peak performance.
There are many benefits to using the ecofriendly Palmero Vacuum Shock and Clean. The system maintains the lines without damaging the environment or equipment, it is simple to use, it’s time-saving and cost-effective, and it eliminates odor from the biofilm buildup in the lines. With Palmero’s comprehensive line of evacuation products, maintaining and disinfecting vacuum lines is easy and effective.
Combining the efficiency of aerosol reduction with the HVEsolo with reducing aerosols through a clean evacuation system is instrumental for the health and safety of your patients and your team, as well as for a healthy environment in your practice space. This is exactly what you need for your patients and your practice in this era of COVID-19 and beyond.
References
Cleaning or disinfection: What's right for the suction lines? https://www.dentaleconomics.com/articles/print/volume- 103/issue-3/practice/cleaning-or-disinfection-whats-right-for-the-suction-lines.html
Saliva Ejector and Backflow: https://www.cdc.gov/oralhealth/infectioncontrol/questions/saliva.html
Backflow Matters: Think Disposable https://www.oralhealthgroup.com/features/backflow-matters-think-disposable/
Dental Effluent Guidelines https://www.epa.gov/eg/dental-effluent-guidelines
Aerosols and splatter in dentistry: A brief review of literature and infection control. Harrel, S, Molinari, J, J Am Dent Assoc 2004; 135; 429-437 https://pubmed.ncbi.nlm.nih.gov/15127864/
Dental Aerosols and Spatter Amidst COVID-19. Harrel, S Decisions in Dentistry. May 2020; 6(5): 8–11. https://decisionsindentistry.com/article/dental-aerosols-spatter-amidst-covid-19/
