A few questions about what changes in infection control may happen in the year 2000 have come across my desk, and the answers are provided in this issue.
- Does our dental unit water have to be at a level of 200 microorganisms by January 1, 2000?
In 1995, the American Dental Association (ADA) recommended that equipment manufacturers and researchers improve the design of dental equipment. The goal is that, by the year 2000, water delivered to patients during nonsurgical dental procedures consistently contains no more than 200 colony-forming units (CFU) of aerobic, mesophilic heterotrophic bacteria per milliliter at any point in time in the unfiltered output water of the dental unit. In other words, the water that leaves the handpiece, air-water syringe, or ultrasonic scaler should have no more than 200 bacteria per quarter of a teaspoonful.
This recommendation was not made to dental offices, but to manufacturers of dental equipment and researchers. Recently, the FDA has cleared several products that claim to improve the microbiological quality of dental-unit water. These include filters, physical and chemical antimicrobial systems, and special water-delivery systems. Progress toward meeting the 1995 recommendation was recently reviewed by the ADA. An update on this topic, as well as a list of the FDA-cleared products, is scheduled to appear in the November 1999 issue of the Journal of the American Dental Association (JADA).
Additional reviews on this topic have appeared elsewhere (Shearer, B: "Biofilm and the dental office." JADA 1996; 127:181-186; Miller, C: "Microorganisms in dental unit water." J California Dental Association 1996; 24: 47-52). Also, the Organization for Safety and Asepsis Procedures (OSAP) can be reached for additional information at (800) 298-6727 or www.osap.org.
- Will "Y2K" cause problems with our sterilizer?
Y2K (year 2000) problems refer to the fact that some computers (and computer chips that control time functions on some equipment) may stop functioning after December 31. The concern is that they were set to read only the last two digits of the year. Thus, January 1, 2000 may be understood by such computers as January 1, 1900, causing some malfunction.
If your sterilizer displays or prints out a tape of the date, then you should call the manufacturer and ask if it is Y2K safe. If other equipment in the office might have an internal timing mechanism or if you are in doubt about whether the item is Y2K safe, contact the manufacturer. The manufacturers of your office`s computers should be contacted as well.
- How can we stay informed about future changes in infection control?
One of the best ways to stay informed about happenings in infection control is to join the Organization for Safety and Asepsis Procedures (OSAP). This is a professional organization for hygienists, assistants, dentists, researchers, university professors, manufacturers, consultants, distributors, military personnel, and anyone else interested in dental infection control. One of the main goals of OSAP is to keep its members and others current about infection control laws, recommendations, procedures, products, and breaking issues. Someone from every dental office should join this organization. Then the office can:
- Receive the highly popular Monthly Focus, a publication that provides an in-depth look at a different area of infection control each month (can be read for continuing education credit).
* Receive a quarterly report that discusses multiple issues about infection control.
* Get questions about infection control answered on the hotline.
* Have access to a variety of educational materials (books, tapes, position papers, infection control guidelines, exposure control plan) about all aspects of infection control.
- Attend regional training seminars and the annual infection control conference.
Join OSAP for $50 by calling (800) 298-6727.
- Will infection control laws be changing in the future (ADA, CDC, OSHA, and OSAP)?
Of the groups listed, only the Occupational Safety and Health Administration (OSHA) has laws about infection control. The others have recommendations. Another major difference between OSHA and the other groups is that OSHA`s Bloodborne Pathogens Standard addresses the protection of health care workers. The ADA, Centers for Disease Control and Prevention (CDC), and OSAP guidelines for infection control (which are all similar) address the protection of both health-care workers and dental patients.
The ADA guidelines are fairly current and appear in JADA 1996; 127:672-680. The CDC is a division of the U.S. Public Health Service and has published its recommendations in its own publication, Morbidity and Mortality Weekly Report 1993; 42 (No. RR-8): 1-12. CDC is in the process of updating its guidelines with the revised version likely to appear in 2000. The current guidelines from OSAP can be obtained by calling the organization`s headquarters in Annapolis, Md. These guidelines are revised every two to three years.
In summary, the future will bring about changes, and those who make an effort to stay informed will be able to anticipate and adapt to such changes.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.