Waterline Wisdom: Tija Hunter Shares Key Tips and Her Go-To System

Well, the CDC recommends that we shock once every quarter, and we test once every quarter. So what the recommendation is, is that we're testing the last day of the quarter, and we're shocking the first day of the next quarter. So one evening you're testing, the next day you're shocking. Welcome to the Phil Klein Dental Podcast. Today we're diving into a topic that's critical to patient safety, but often out of sight and out of mind. That's dental unit water lines. Even though we can't see what's happening inside those tiny tubes, what's lurking there can have a big impact on the health of our patients and our practices. Joining us is someone who knows this subject inside and out, Tija Hunter. With over 40 years of experience in clinical dentistry, Tia is the immediate past president of the Illinois Dental Assistance Association and has also served as vice president. She's here to share best practices for waterline testing and maintenance, along with simple daily steps to ensure our water stays clean and safe. Plus, she'll let us in on her go-to waterline system and a host of practical tips you can start using right away. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Tia, it's a pleasure to have you on the show. Thank you, Phil. It's a pleasure to be here. Thanks for having me. Yeah, I've heard you talk about this topic, podcast videos and so forth, and you have a tremendous amount of enthusiasm when it comes to waterline safety. So we're really happy to have you on the show. Because, you know, it's kind of under the radar in a lot of ways in people's minds. Our dental team, they know it's important, but, you know, it's not the most exciting topic, if you want to put it that way. But it sure is important. So when someone on the dental team tests the water lines in a dental office, they are primarily checking for microbial contamination. And this includes, you know, general bacteria that can grow in water. And the main goal, correct me if I'm wrong, is to keep the levels below 500 colony forming units, CFUs. And that's based on a per volume metric, which is a milliliter. Right. And that's recommended by CDC and EPA. And that corresponds to what they consider safe drinking water. So tell us about specifically what's lurking in our water lines ready to cause havoc. as far as infection, contamination, and so forth? And how do we know it's there? How do we know what's actually going on behind the scenes? Well, that's a great question because you don't know what's in your water unless you're testing. And testing becomes so important. But I want to back up a little bit. People don't even know they're supposed to be doing this. You mentioned it. It's kind of under the radar, but it shouldn't be because we have been talking about this for years. you know dental professionals every week and they're like what do you mean water lines what do you mean what do we got to do that and a lot of times they get them confused with their vacuum lines and they're like what are you talking about well we suction out our vacuum lines and i'm like no two different things so You know, first of all, it was awareness. Let's make them aware that they have to do this. But that testing becomes so important. And I do meet a lot of people that say, oh, we treat, we shock, you know, we're good on shocking. And I'm like, what are your test numbers? And they're like, well, we don't test. And, you know, our favorite saying is you don't know what's in your water unless you're testing it. So there's, you know, a lot of bad guys in our water. The most prominent. that we have found in different areas of the country is Legionella or the Legionella bacteria, better known as Legionnaires disease, as most people call it. And this has had some devastating effects, especially on children. There was a whole, you know, thing in Anaheim, in Georgia, Anaheim, California, and in Georgia, where we had some pretty significant outbreaks of this because the lack of treating, shocking the lack of protocols. So Georgia even changed the rules, you know, going into this and many other states are looking at it. So it's something that we need to be talking about. We need to bring it up so that everybody understands what they should be doing. Right. And all of this should be part of infection control protocol, right? And there should be a standard operating procedure that includes the necessity and the protocol for testing water lines. And there should be no confusion that it's the suction tubing that they're talking about. I mean, these are... like an air water syringe, right? A handpiece, a water line that feeds a high-speed handpiece. An ultrasonic scaler. Right. And what happens if a dental hygienist pulls an old ultrasonic scaler out of a drawer that hasn't been used for two years because theirs broke and that thing's been sitting there with water in it? That's really scary, dangerous, is it not? You're never going to get all the water out. You know that. So absolutely. I will tell you when we started opening back up after COVID, you know, when COVID happened, we literally walked out of our offices one day, right? We just, we were told to shut down and we walked out of our offices, probably thinking we'll be back within a few days or maybe even a week, not realizing that this was weeks long, four, six. and and sometimes it was months and so you go back into that office and the water's just been stagnant and you're just gonna start over again no you had to deal with that and so i was very busy traveling and getting people their water lines flushed and cleaned and shocked and tested before we could even see patients again it was a process yeah yeah there's no doubt about it so let me ask you this what are the risks to our Now, again, the risks go across multiple areas here. They go across the patients, team members, the practice as a business, right? Because they're legally responsible. What are we looking at as far as an office that doesn't test regularly? They have a patient that gets sick. The Department of Health traces it back. to the waterline because it's not hard to do that right because once they identify the bacteria it's been done yeah right so what what is that dental practice looking at if that happens well it's devastating um first of all none of us want to make anybody sick um in the cases of anaheim and um georgia uh nobody meant to do anything you know mean or mischievous or anything it it just happened and you know in their case it you know anaheim was over 200 children i heard before everything was said and done in the months um it's devastating to a practice first of all personally how would you feel if if you worked at a practice that that happened at you would you can't help but feel responsible And then, you know, there's a practice shutting down. There's, you know, even if it's for 30 days, you know, what do you do? I mean, it's devastating. And then being on the news. I was going to say the PR, the PR devastation. So do you recover from that? Does it recover from that? Or do they just shut down altogether, rebrand and move down the street? I mean, it's it's very devastating on all levels. And just, you know. making people sick and knowing that you know there's something you could have done to avoid that you don't know what you don't know but as oral health care professionals we should be doing the right thing. We should know what to do and when to do it. I mean, that's why we have continuing education. That's why we have these podcasts and webinars. I don't mean to interrupt you, but you just did a tremendous webinar, by the way, on VivaLearning.com titled Dental Unit Waterline Contamination, What's in Your Water. So I encourage everybody who's listening to this podcast, check it out on VivaLearning.com. Just type in Hunter in the search field and you'll find the webinar. Great job, by the way, Tija. Thank you, Phil. Do you think in your opinion that Based on the offices, you've seen that this is a real rampant problem of not testing and the water lines are really questionable. I am seeing a swing. So, you know, a few years ago, nobody, they were like, what are you talking about? And I'm going to say about 30% of the offices were doing the right thing. i'm right now at about a 50 to 60 percent of offices doing the right thing so there's still a lot of people out there that i meet and i'm i'm in practices either virtually or in person every week and so i see firsthand and ask them questions and and you know just what is it what are we using what's our protocol um unfortunately uh a lot of them don't have a protocol they just say oh this is what we do and it really it needs to be something written it needs to be something that's followed um it needs to have you know in my practice when i was practicing it was the first of every month you know i mean you really need to be strict about it so that you're um staying on top of it the offices the offices that are not complying with this are they doing it because they don't have the education they want to do it or they're so busy with so many other things, they just don't allocate the time or the resources. More of it is that they just don't know. They don't know what they don't know. Because when you find out, when I show you what's in your wallet, water and I have pictures. They're like, oh my gosh, I had no idea. And then they want to do it. They want to find time to do it. They want to make time to do it. And I can help them with the protocol. And then I just basically hand it to them and it's easy for them to do that. I'm sure that there are offices that don't have time. I mean, we are busy, busy offices and I'm sure there are people that don't have time, but I'm going to say the majority of the time, people just don't know what they don't know. Yeah, so moving to the next question, and it's talking about, you know, I'd like to know your opinion about best practice. What is the best practice currently, modern day dentistry, for cleaning water lines? You know, it's a three-part answer. So number one, we've got to treat the water every single day. Whether you're using a straw filtration system, whether you're hooked up to city water and you have a filtration system where your water comes in, You're treating it with some type of tablet every single day. There's a treatment. And so that's the first thing. We've got to treat the water every single day. Of course, use the best source water that's available to us. The second thing is, is that we have to test the water because we have to know if what we're doing works. So we have to be sure that we're testing the water. um we're keeping those test results for five years so for someone who hasn't even started testing yet they're like oh my god what do you mean i'm supposed to have these for five for the last five years you know the cdc has been talking about this since the 1990s And they wrote it in their 2003 guidelines. But we're just really kind of now in the last five years, especially since COVID, talking about this. And then the third component of that is the shocking, because you test before you shock all the time. If you shock before you test, you're always going to have great numbers. But we want to know where we're at. So it's a three-component thing. A lot of people will say, oh, we shock with this. Well, what they're showing me is a treatment. It's not a shock. So it's understanding what the different products are and how they work and in what order you use them in. Yeah. And what do you say to someone that says, well, we've been doing it with diluted Clorox or sodium hypochlorite. We don't need all these extra accessories that as far as we're concerned. I've talked to a microbiologist and they say that if you run this through your water lines, you're not going to have any problems with bacteria. What's your answer to that? Well, I would be interested. I always tell them, what is your chair manufacturer saying about that? What is your sales rep saying about that? Because, I mean, you can ruin your equipment by putting that in. And so human error is huge. And I met one office who put straight Clorox bleach and they didn't dilute it like you talked about. And I've heard of the diluting. But so, you know, you've got to understand the products you're using. um and how to use them correctly and what that manufacturer because now the chair manufacturers now these units are coming with the ifus on what you should do and what you shouldn't do you know before we didn't see that well now we're seeing these new chairs come out and saying you need to you know you know use this product or a product that works compatible with this not bleach right so what we're saying is that the advanced materials now that are antimicrobial that protect our water lines also have to protect our equipment, right? Absolutely. Right. So that's a big thing. And now there's also a lot of discussion about compatibility within the system itself. And I know in restorative dentistry, we have that discussion all the time, but I wasn't aware that that applied to waterline maintenance products, but it does. So tell us about compatibility, what you mean by that. And then I want to ask you about specific products that that you could recommend because our listeners i mean we're not here as an infomercial but our listeners will ultimately send us hundreds of emails saying that was a great talk by tia but i don't know what i don't know what to buy yeah so we i do want to make a suggestion and they could take it for what it's worth but at least they could hear it from you and it will save us a lot of time answering those emails but anyway so let's talk about compatibility Compatibility is huge and it's with anything that we use. I mean, you don't use a bond unless it's compatible with your composite, just like you said. So the products that work together the best. um are the products made by the same company so you know you're you're wanting to use um you know a product soul medics if you're using the um the treatment then you want to use the shock you want to do you know you want to use their products all together compatibility is huge those products are made to work together and you know i talk about this a lot, you know, in amalgam separators. What are you flushing your vacuum system with? Well, it should be the product that's best suited for your amalgam separator. And we all know Solmedix is like, has the market cornered on the best amalgam separator. So are you using that particular product? Because they know they work together. And that's huge. That's what we want to use. Yeah. Now, another reason for that, and correct me if I'm wrong, is that there's no finger pointing if you use the same system. Because if you call the technical support team for a company that's selling you something and you say, you know, I put the shock in and then I did this and now I'm getting problems with my equipment. And they're going to say, well, which shock did you use? Well, I used your maintenance stuff, but I used a different company's shock. And they'll blame it on that. And then if you call the other company, they'll say, well, it's the maintenance material that's messing up your chair. So you do rule out a lot of confusion and finger pointing. You want to get rid of those headaches and minimize your stress. take out the variables by working with the same company on a given chore. Waterline maintenance is kind of like a task. So that's a good reason for compatibility, but even more so based on what you said, which is they actually chemically work better together. So getting into the materials themselves, you're a big fan of Stericil, Stericil straw in particular. Tell us what that is. It is a straw filtration system that goes into the water bottle, the self-contained water bottle that is hooked up to the unit. And it is a filter, most common one. We use it for a whole year. We've got it on there for a whole year so that it's doing its thing. And it's the best because then you don't have to worry about it. You don't have to, you know, you're not putting a tablet in all the time. As long as you follow. And you will hear me talk about manufacturer's instructions for use a hundred times because it's so important that you're following that. So by hooking that up, it's kind of like now, wow, I don't have to think about it for a whole year. And then you're going to put it on your calendar when you're going to change it. That is the best thing. Like we talked about earlier, we're busy. We don't have time to do a lot of stuff. I like a one and done for a while that I don't have to worry about it. Right. So that's straw. sits inside the bottle, treats the water for a year. And how often are you shocking the system along with that maintenance? Well, the CDC recommends that we shock once every quarter. And we test once every quarter. So what the recommendation is, is that we're testing the last day of the quarter and we're shocking the first day of the next quarter. So one evening you're testing, the next day you're shocking. Again, we do that so that we get our true numbers that we have. We're not getting some other numbers, we're getting true numbers. And that's got to be in-office testing, right? Because it would take more than a day to get those results back if you sent them out. Well, yes, yes, absolutely. And there's both. There's in-office testing, which I do recommend. for three this is just my recommendation my personal opinion i recommend the once a year sending it off getting our numbers seeing what those numbers are the ra testing r2a testing and then the other three times a year we can do the in-office testing and i love fast check it's amazing 15 minutes are you kidding me that's crazy amazing So that's the one where it has the two lines, if two lines show up, you've got a negative, it's a bad result. Yes, it's a pass or fail. Okay. That's why I like once a year that we send off that R2A testing just so we know what our actual numbers are. That's going to come back with a whole printout of all kinds of things that's in our water and what that actual number is. You mentioned earlier 500 colony forming units per milliliter or less. So it will tell us, are we at 499 or are we at 10? And so I always, that's my recommendation, my personal recommendation, do that once a year so you know what your numbers are. Okay, so you got the quarterly testing. And you want to obviously test before your shock. And you also want to shock quarterly because that's CDC guidelines. So my question is, if you're doing that and you're following protocol, let's say with the Stericill system using the straw, is it very unlikely that your CFU count exceeds 500? Well, first of all, if you're doing it properly. and following those manufacturer's instructions for use. Because once you take that straw out after the year, you're supposed to shock your system then before you put on a new straw. I find when people follow the protocol, and I'm big on a written protocol, I just don't want a he said, she said. I want a written protocol. And so if you're following the protocol, you're going to have very few problems. And honestly, the people I see have the biggest problems are the people that are hooked up to city water. um or the people that aren't following the protocol they're not shocking um every quarter they're you mean yeah and they're not testing they're like oh so even if one quarter they missed a shock and yeah that person was out on vacation they waited a whole nother quarter to to do the shock that test could come back as a as a failure and so it's it's typically human error which is causing a failure if you use the system properly it's almost a hundred percent that you're gonna keep and maintain your water lines. Absolutely true. Absolutely true. Now, how does the shock work? What does that entail? Well, the shock system is really easy. Again, instructions. And I can't say that enough because we're humans and we don't like to look at instructions. we like to throw them down so read the instructions of you know whatever product that you're using and how long does that shock have to sit in the line is it 15 minutes is it 24 hours is it 72 hours what what product are you using and they're all different so you want to make sure that you are you know following it and like you said it's human error if something happens generally what we find it it is human error that's causing that so you want to make sure you're following it and you're leaving it in the lines and running it through the lines the way it tells you to do it. Does that mean it has to be done after all the patients leave for the day? Oh, absolutely. Absolutely. Some of them are 24-hour shocks. So you have to leave it set in there for whatever period of time it tells you to. So yes, this is something we're doing not when we're seeing patients, usually on a Thursday or Friday night. Right. That's what I was going to say. You're going to carry that over the weekend to be sure. Oh, yeah. So when you get done testing and it's a pass, and then you shock, and then let's say it's over the weekend, and then you come back on Monday morning, there's nothing more to do on those water lines. Is that right? No, get to work. That's it. Do you run the air water syringe for a few seconds between each patient? You're supposed to. What the CDC says is they want it run one and a half to two minutes in the morning to kind of flush everything. The stagnant water is really the issue. When you come in in the morning, let's say, you know, a Tuesday morning, that water's been sitting there not moving all night long. When the water's not moving is where the bacteria builds up. So the CDC recommends we flush one and a half to two minutes, everything, air water syringe, high speed handpiece line, piezo, ultrasonic scaler line, that we run those for one and a half to two minutes to kind of flush that water out and that we're doing it 20 to 30 seconds. seconds in between each patient. So that really just kind of keeps the water flowing and moving along. That's an important step to do. It's a step I find a lot of people don't know they're supposed to do, but it's such a very important step to keep that water moving. Right. Now, would you recommend a dental practice owner to have one person held to account for all of this? I mean, let's say it's a fairly busy practice. Let's say there's... Let's say there's six operatories and you got a nice little staff running around doing all their thing. Who do you assign this responsibility to so that it's documented? And by the way, do you need to document that you flushed out this stuff every morning? Does that have to be documented as well? I don't necessarily do that. It is in the protocol. I don't necessarily document that. I do recommend that every office have an OSHA coordinator and an infection control coordinator. I want those two people to be two separate people. I don't want it to be the same person. We have a lot to do already. So let's spread the love. That one person doesn't necessarily have to do everything, but I want them to oversee it. to make sure it is getting done, to check with Sally, to check with Mary, to check with Tammy, to make sure that all of these things are getting done. But that documentation is key. It holds us accountable. You know how time flies. I mean, you know, you could say, oh my gosh, I had my teeth cleaned two months ago. Well, really it was 10 months ago. And so it holds us accountable. And when we document that and we can look back on it and go, oh my gosh, I should have done that by now. Or, oh, we have to do that next week. It absolutely holds us accountable. And when it is right, then we know who's not educated enough and that we need to educate them more when it wasn't done correctly. Right. And God forbid we have a surprise visit from the Department of Health. Oh, yes. They're going to ask for your OSHA manual and all your documentation for. And I assume all this waterline testing and documentation needs to be. in some sort of manual right digital or in print that they could look at and get access to quickly yeah Yeah, that's really important. And I'm old school, so I like a book. I like the print that we can actually physically take it out and see it. Yeah, yeah, I'm with you on that too. I've given up Post-its, but I do like to have some books in front. I'll never give up my Post-its. Yeah, my wife is literally slowly giving up Post-its, which it's amazing. She must love 3M or something. I don't know what the attachment is there. No pun intended. So tell us about how to create. in a few minutes, a protocol that works for the practice so that there is a minimum risk of human error. We kind of covered that already. And the office can function with peace of mind regarding their waterline safety. Right. Well, start with your protocol. Start with your treatment. What is required of your treatment? What type? of treatment are you using? Are you using a tablet? Are you using one of the straw filtration systems? Are you hooked up to city water and you have a filtration system where the water comes in the building? So start with that. What do we have to do with that and how often do we have to do it? Now let's talk about testing because it goes in this order. What do we have to do to test? What are the requirements of the test? particular test kits that we're purchasing how do we do that are we doing the in-house or are we doing the um the one we send off uh and then talk about the shock and then get the instructions for that you can very easily create your own protocol just by going off of those three Very important task, but writing down the instructions on how you do them. And then, of course, recording all of that and then making sure you're keeping it all. And again, those test results for five years. If you were to start a new practice or you move to a new practice or you're an affiliate with the option to buy it or whatever, but you have some skin in the game in a new dental practice, you would look for a system that is totally compatible. from start to finish. You're a big fan of CellMedix's system. Absolutely. What's the main reason you're sold on them? They have been around a long time and they have done their research. And so when it comes to their products, their products are superior. And for me, I've used them for years. I've been in dentistry for 44 years. I've used their products. years. And I just think that what they invest in their products, I also believe in their customer service. They have amazing customer service for teams, for offices that are like, oh my gosh, why am I not passing? You can call them. Their customer service is amazing. Yeah, that is very important. In a world where you have to push one and, you know, if we go here and there. I say that I've done, you know, we're on our, I don't know, 700th episode already close to it on the Phil Kline Dental Podcast Show. And I talked to so many key opinion leaders and they are so adamant about the importance of customer service. Because when you're in a hectic situation in a dental practice, You need to get an answer and you actually get somebody that could get on the phone and troubleshoot with you and say, okay, you know, tell me about your system. Tell me this. When did you do it last? When's your last documentation? Okay, here's what we should do. Close that operatory down for 48 hours and this is what you should do. I mean, it's, you know. That's huge. Huge, huge. Yeah, yeah. And that's, to me, that's really important because a lot of these products. I don't know anything about Solamedics' products chemically. I'm sure it's very good and it works. Otherwise, you wouldn't be talking about it and people wouldn't be using it. But I'm sure there are other companies that have possibly similar products that could reach the same end goal. But, you know, I can't be sure. But the technical support part of it is a major, major deal. And their track record. They have a very good reputation, which is really important. As I said, they've been around for years. I mean, they pretty much, you know, when you've been around that long, you know what you're doing. You don't stay around a long time if you don't know what you're doing. That's not what my wife says, man. She's kept me all these years. Yeah, she's kept me all these years. All right. You take care. Thank you. You don't look like you've been practicing 44 years. hats off to you you're doing something right you don't and i don't even have makeup on today so good for you all right have a great evening thank you so much thank you Phil