by NOEL BRANDON KELSCH, RDHAP
My son Brice recently called me from New York to ask me if he could drink the water there. I do love to tell my son what to do, but I knew it was not in his best interest to listen to me. I simply was not qualified to answer his question. He had just endured the hurricane in New York and I did not know if the water was safe or not. After researching the situation, I gave him a number to call.
We all need to know if the water we're using is safe for patient care in the event of an emergency. Water supply interruption can happen anytime for a variety of reasons. Our resources need to be in place before an emergency takes place. An emergency water supply plan (EWSP) can make all the difference in uninterrupted patient care, and ultimately patient and staff safety. The Centers for Disease Control has prepared a document to guide everyone. (http://www.cdc.gov/healthywater/pdf/emergency/emergency-water-supply-planning-guide.pdf)
There will be little interruption in patient service if you use this guide. It is a roadmap to the process of response and recovery.
Because water from the affected public system should not be delivered to the patient during a boil-water advisory, many dental procedures cannot be performed. Alternative water sources, such as separate water reservoirs that have been cleared for marketing by the FDA, can be used. However, if the alternative water source were to flow through a dental operatory unit previously connected to the affected public water supply, the dental operatory unit water lines should first be flushed and disinfected according to the manufacturer's instructions.2
Each of us can prepare for disaster by having information in place before a disaster happens. Having a plan can make all of the difference in addressing the questions on water safety. RDH
Boil water alert and the dental setting
The public water system can periodically become contaminated. The public will be told that they must boil the water before they drink it because it is unsafe to drink. This can happen as a result of failure at the water processing plant, a positive test for pathogens in the water, water main break, natural disaster, and more. In one case in Milwaukee, the city system became contaminated with Cryptosporidium parvum and over 40,300 people became ill.1
So what should a dental office be doing if a boil-water advisory happens? The CDC provides the following guidelines:
Actions to take while a boil-water advisory is in effect
- Water should not be delivered to patients through the dental unit, ultrasonic scaler, or other dental equipment that uses the public water system. This restriction does not apply if the water source is isolated from the municipal water system (e.g., a separate water reservoir or other water treatment device cleared for marketing by the FDA).
- Patients should rinse with bottled or distilled water until the boil-water advisory has been cancelled.
- During these advisory periods, tap water should not be used to dilute germicides or for hand hygiene unless the water has been brought to a rolling boil for >1 minute and cooled before use.
- For hand hygiene, antimicrobial products that do not require water (e.g., alcohol-based hand rubs) can be used until the boil-water notice is cancelled. If hands are visibly contaminated, bottled water and soap should be used for hand washing. If bottled water is not immediately available, an antiseptic towelette should be used.
When the advisory is cancelled
- The local water utility should provide guidance for flushing of water lines to reduce residual microbial contamination. All incoming water lines from the public water system inside the dental office (e.g., faucets, dental equipment) should be flushed. No consensus exists regarding the optimal duration for flushing procedures after cancellation of the advisory; recommendations range from one to five minutes. The length of time needed can vary with the type and length of the plumbing system leading to the office.
- After the incoming public water system lines are flushed, dental unit water lines should be disinfected according to the manufacturer's instructions.
1. MacKenzie WR, Hoxie NJ, Proctor ME, et al. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med 1994;331:161–7.
NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.
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