biostream® ZERO: Water hygiene in the dental practice is often underestimated.

Hygiene requirements for the reprocessing of medical devices:

The recommendations for drinking water in dental treatment units are defined by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM) and are clear. The dangers of germs in treatment units are well known.

As early as May 2015, the State Dental Association of Thuringia published an information sheet entitled „Hygiene inspections and controls in accordance with medical product legislation in dental practices“ – among other things, this addresses the water-carrying systems of treatment units. The Baden-Württemberg State Health Office (BW) also addresses the problem of germs and biofilm formation in its leaflet „Information on water-carrying systems in dental treatment units (dental units)“.

Based on the health authority’s own experience (LGA BW), it is recommended to have water samples taken about every six months to a quarter, depending on previous findings, and to have them tested not only for colony-forming germs – but also for Pseudomonas aeruginosa, since this germ is held responsible for biofilm formation. „Examinations for Legionella need not be carried out more often than once a year if the previous findings did not provide corresponding evidence of germs,“ the LGA BW also informs.

Against these dangerous biofilms, biostream® ZERO has already been used in (dental) practices for years. You too can effectively combat germs, viruses and bacteria in your dental practice. The active ingredient of biostream® ZERO is also approved for use in so-called bottle care systems.

FEEDBACK FROM THE DENTIST’S PRACTICE:

Dentists regularly inquire with biostream® GmbH when findings of e.g. Legionella have been detected in the treatment units and ask how to effectively combat these viruses. The treatment unit must be disinfected as quickly as possible to avoid interruption of operation. Unfortunately, often the support from the dental depots does not bring the expected solution to the problems, because precisely there is not the understanding and knowledge on the subject of „disinfection of drinking water in treatment units“. And if you take a closer look, hydrogen peroxide solutions are recommended, for example, which, however, are not even mentioned as disinfectants according to the current drinking water regulations.

Our cooperation with dentists has shown that there are numerous problems in the area of disinfection of treatment units. In the following, we report on some cases that may also be familiar to you. (We will regularly add to these examples).

Case 1:
A dentist from Göttigen, who has been dealing with the topic of „disinfection of treatment units“ for years, had a problem with Legionella after switching to the Bottle Care system. After using biostream® ZERO according to our dosage recommendation, no more legionella could be detected. The dentist was very satisfied and informed us of this at short notice. After one week, however, a recontamination of the treatment unit was detected and the dentist’s feedback was accordingly negative. The effectiveness of biostream® ZERO for disinfecting dental treatment units was questioned.

Since this recontamination with Legionella within one week after application of biostream® ZERO is extremely unusual and has never occurred before, our assumption was that there must be so-called dead lines directly in the treatment unit. Dead lines are line sections at the end of which no pick-up device is connected.

The dentist then contacted his dental depot and asked whether there were dead lines in his dental unit (treatment chair). The answer from the dental lab was „No!“. The dentist then requested a detailed on-site examination of his unit and agreed that if NO dead lines were detected, he would cover the cost of the examination of his dental unit. If dead lines were detected, the dental depot was to cover the cost. The dental depot agreed and a complete examination took place on short notice. It was discovered that there were 2 x 30cm water lines in the dental unit that had been installed for the operation of a second treatment unit. However, since the dentist did not need a second treatment unit on the chair, this had not been installed, but the 2 x 30cm water hoses were still present.

And it was precisely these hoses that had ensured that disinfection did not work: perfect disinfection of the treatment centers can only work if ALL lines carrying drinking water can be wetted with disinfectant.

Disinfection is not possible with dead lines! Why?
In the case of dead lines, a disinfectant cannot enter the water line. It is therefore a dead end. There is no flow that can flush a disinfectant into this dead line. For this reason, even biostream® ZERO could not control Legionella in the dead lines in the case just described.

In accordance with the agreement between the dentist and his dental depot, the dental depot naturally assumed the costs for the inspection of the treatment unit. After removal of the 2 x 30cm dead lines, no more legionella could be detected.

GERMS IN DRINKING WATER AT THE DENTIST DESPITE REGULAR DISINFECTION BY DENTALDEPOT

Have you ever wondered why you contact your dental depot contact person for disinfection of your dental units / dental chairs at regular intervals, why he then carries out the disinfection at your premises and why, nevertheless, during an official inspection or test by the health department or the trade supervisory office, objections are found which result in the decommissioning of your dental units?

Our experience with some (not all!) dental depots has shown that they rely only on the disinfectants recommended by the dental unit manufacturers. These disinfectants are 80% based on the active ingredient hydrogen peroxide. However, hydrogen peroxide is only mentioned in the drinking water regulations as a weak OXIDANT and from a purely chemical point of view – according to DVGW guideline W291 – it can only be as effective as the active ingredient used in the biostream® products if it is used in a concentration 25 times higher.

Then it’s a simple math problem: multiply the current price of your disinfectant by 25 and see how much you pay for a 250ml bottle of biostream®-ZERO.

PERMANENT DISINFECTION OF WATER AT THE DENTIST

Surely you have ever wondered if the problems with water disinfection at dental units could not be solved simply by permanent disinfection. Here, however, the legislator and other institutions concerned with the valuable commodity of drinking water took a stand early on:

• The German Technical and Scientific Association for Gas and Water (DVGW) says in its information magazine (Link) e.g.:
  „A permanent, prophylactic, chemical/electrochemical disinfection of drinking water in drinking water installations that are set up and operated according to the rules of technology is neither necessary nor sensible. Permanent chemical disinfection of drinking water […] does not comply with the generally accepted rules of technology. It also contradicts the minimization requirement of the Drinking Water Ordinance (TrinkwV 2001) [6].“
• In the Drinking Water Regulations (Link) , the following is written about permanent disinfection, among other things:
  „Treatment substances that are added according to letters b and c and remain in the drinking water as intended must be limited in the quantities of treatment substances used to the extent necessary to achieve the treatment objective, in accordance with the minimization requirement.“
  The question then arises as to how you are to prove which dosage must be dosed in order to achieve the treatment objective. If the same quantity is constantly added, it may happen that disinfectant is added even though contamination is NOT present, which would not correspond to the above-mentioned definition.
• In the S2k recommendation (Link), which was developed by the professional societies German Society for Hospital Hygiene (DGKH), German Society for Dental, Oral and Maxillofacial Medicine (DGZMK), German Society for Oral and Maxillofacial Surgery (DGMKG) and also the German Dental Association (BZÄK), German Working Group for Hygiene in Dentistry (DAHZ) and others, the following key sentence can be found:
  „Even when operating a central disinfection system, the manufacturer’s specifications of the treatment unit regarding the compatibility of the external and internal disinfection system, the material compatibility and the „minimization requirement“ of the Drinking Water Ordinance must still be observed. The latter states: „Treatment substances should only be added to the drinking water during treatment for compelling hygienic or technical reasons, and always only to the extent absolutely necessary (minimization requirement) and under optimum conditions.“

Permanent disinfection or permanent disinfection in dental chairs can be problematic

As you could read, there are clear statements about permanent disinfection. The German Dental Association (BZÄK) as co-editor of the S2k recommendation underlines the statement „Aufbereitungsstoffe should only be added to drinking water during reprocessing for compelling hygienic or technical reasons, always only to the extent absolutely necessary (minimization requirement) and under optimal conditions.“  

And now, as a dentist, you can ask yourself how you are going to argue to the health department or the trade supervisory office that you are STILL adding a disinfectant (e.g., machine-controlled by a BLUE* system), although at the same time you CANNOT STILL prove that you have regular contamination that makes the continuous use of chemicals necessary.

Our solution for you: Without the use of expensive dosing technology, you can effectively disinfect your dental units quite simply with the mostly existing rinsing programs! Here, it is only necessary to replace the existing products or those recommended by the manufacturer (mostly based on hydrogen peroxide) with biostream® ZERO.

Although we do not actively advertise in dentists‘ media and are not a participant in the „International Dental Show (IDS)“, we were able to convince numerous dental depots and also dentists – without advertising – of the effectiveness of our product biostream® ZERO.