Put Your Patients' Health First with Clean, Safe Waterlines

Earlier this year, Georgia became the second state, behind Washington, to put a rule in place requiring dental offices to test their dental unit waterlines quarterly. Georgia’s Dental Unit Water Quality Rule came after 3 outbreaks linked to dental offices, dating back to 2015, made patients in the state sick.

Dr. David Reznik, Chief of Dental Medicine for Grady Health System, spearheaded the rule for the Georgia Board of Dentistry, looking to Washington for guidance.

While the CDC developed waterline guidelines more than 20 years ago, directing dental offices to meet EPA drinking water standards (fewer than 500 CFU/mL of heterotrophic water bacteria), there’s no way to enforce it, Dr. Reznik said. In fact, only about 30% of dental offices regularly test their waterlines, putting patients at risk.

Dr. Reznik hopes other states will follow Georgia and Washington’s lead, and said educating dentists about the risks associated with skipping waterline maintenance is the best way to make that happen. Keeping track of testing and remediation with software like HealthFirst’s OnTraq is also key to ensuring waterlines are maintained properly.

One of the biggest concerns, Dr. Reznik said, is that the time between exposure and onset of symptoms can be very long, as much as 267 days in one outbreak, so many dentists are “missing it” if it is a problem in their practice.

“A lot of people don’t realize what’s happening,” Dr. Reznik said. “If dentists knew they were putting kids or elderly patients at risk, they wouldn’t take the chance.”

Making it a Priority

As part of the new rule in Georgia, dentists must keep logs of when they test their waterlines, how they test, the results, and what action was taken if they failed the test. That action might be shocking the waterline and then waiting 5 to 7 days before testing again. Waterlines should always be tested before shock is used, Dr. Reznik noted. He also recommends pooling samples to see if you have a problem and then, if you do, testing individually to determine where.

“This isn’t meant to punish people,” Dr. Reznik said. “We’re not going out as a board looking for this, but if there’s a complaint around a practice’s dental unit waterlines or infection control, the board can look at your logs, the same way they would look at autoclave logs.”

And if the No. 1 priority is ensuring your autoclave is sterilizing properly, waterline maintenance should be next, he said. Software like OnTraq can help you track and manage both.

“You want to make sure everything you put into a patient’s mouth is clean,” he said. “That includes water.”

Staying Compliant

There are a lot of moving parts in a dental office, Dr. Reznik said, making it difficult to keep track of everything that needs to be done. Waterline testing is easy to miss, but OnTraq from HealthFirst helps ensure you don’t.

With OnTraq, you can view your latest test results, actions that were taken, and the practice’s inventory of tests and treatment kits. It’s also easy to export test results to perform your own analysis. You can track both in-office and mail-in tests.

OnTraq keeps you in compliance. You can view dental unit waterline test results, corrective actions that can be taken, and your clinic’s current inventory of tests and treatment kits in the software. It's also easy to export test results to conduct your own analysis or to satisfy compliance requirements.

For example, if you use Sterisil Straws, OnTraq documents the day they’re installed and you can then set reminders under task management to alert you when it's time to replace the straws, Dr. Reznik said. The straws must be changed annually, so it’s easy to forget if you don’t have a system like OnTraq to remind you.

Keeping Patients Safe

If you don’t properly maintain your waterlines, your patients may get sick. All it takes to avoid this is proper testing and maintenance, ensuring you have the correct equipment installed, such as reservoirs, and following manufacturer instructions for maintenance.

OnTraq will help you document every test, result, and action taken, as well as remind you when it’s time to test again.

“The goal is to provide the safest dental visit possible for all patients,” Dr. Reznik said. “This is not meant to be a 'we caught you' situation; we just want you to test your water and keep your water clean.”