by Mary Govoni, CDA, RDA, RDH, MBA
The evacuation system is an essential component of most dental procedures. When it is functioning properly, life is good for the clinical team and patients. But a decrease in volume causes stress and inefficiency for everyone.
Maintaining the system, as with most of the equipment in a dental facility, is critical to proper functioning. Cleaning the suction lines and changing the solids collectors (traps) must be performed regularly to maintain proper functionality. But there seems to be some confusion as to whether to clean or disinfect the suction lines -- or perhaps both. If you use products that may be incompatible with the evacuation system or that may cause a reaction with contents of the solids collectors, it is important to understand the appropriate protocol.
Research has shown that there is a small possibility of cross-contamination from backflow from the low-volume suction lines used for the saliva ejector. The saliva ejector is most commonly used in hygiene treatment rooms, where hygienists will instruct patients to close their lips tightly around the saliva ejector tip to efficiently remove fluids.
The first study that demonstrated the backflow potential was published in 1993. As recently as 2006, the Centers for Disease Control and Prevention issued a guideline about the use of saliva ejectors. The CDC stated that patients should not be instructed to close their lips tightly around the saliva ejector, and that suction lines should be disinfected daily.
Suction lines in the hygiene treatment rooms should be cleaned every day with an evacuation system cleaner to remove blood and debris, and a disinfectant that is compatible with the evacuation system should be run through the tubing. The low-volume suction lines should be disinfected between patients.
Using a small amount of a waterline cleaner/disinfectant between patients is a good choice since the waterline cleaner/disinfectants are compatible with the evacuation system. Additional information regarding this guideline is available at www.cdc.gov/oralhealth/infectioncontrol/faq/saliva.htm.
It is always a good idea to check with the manufacturer of the evacuation system to verify which disinfectants are compatible with the system. (See below regarding chlorine-based products.) Another option is to use a saliva ejector tip that has a backflow prevention mechanism built in. Two such devices are the Safety Saliva Ejector from Crosstex and the Safe-Flo valve from RJC Products.
It is important to note that the backflow phenomenon has not been demonstrated in high-volume suction lines. This does not necessitate disinfection of these lines after each patient. But cleaning the high-volume suction tubing at the end of each day is important. Since debris can accumulate and clog the lines, an evacuation system cleaner should be used daily and shock treatment done periodically to keep the system running effectively.
Many of the evacuation system cleaners, such as BioPure from BioPure Products, Sultan Purevac and Pro E-Vac from Certol, Sani-Treet Green and Sani-Treet Green from Enzyme Industries, VacuKleen E2 from Heraeus Kulzer, Vacusol Ultra from Biotrol, SlugBuster from Ramvac, and Vac Attak from Premier, have enzymes that facilitate cleaning of debris from the tubing.
These products have also been tested for compatibility with evacuation systems. In addition, there are several shock treatments available to remove accumulated deposits not removed by daily cleaning. These products include VacuShock from TriCom Dental Products, and Bio-Pure System Restorative from Bio-Pure Products.
Chlorine-based products should never be used in the suction lines since the chlorine can cause corrosion of metal components in the system. Oxidizers have been shown to cause mercury to be released from amalgam particles, which can cause water contamination.
Disposable suction traps should be changed weekly or more often if they become clogged. The used suction traps should not be discarded in the trash since they contain amalgam particles. A licensed medical/hazardous waste hauler should be used to dispose of the traps, as well as amalgam capsules since they may have traces of mercury left from the mixing process.
It is always best to consult the manufacturer of your dental units and evacuation system for recommendations on which cleaning and disinfecting products to use with equipment. You know the old saying: "An ounce of prevention is worth a pound of cure."
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.
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