Waterline Contamination Risks—and How Autoclave Automation Keeps You Compliant and Protected

If somebody were ever to ask, like, are you performing the proper maintenance to keep your, to make every, you know, dental visit a safe dental visit to steal the term from the Association for Dental Safety, it's all right there in the machine for you. And I think when we see those visible reminders, like my oil change, like time for my oil change, you see that you're like, oh, yeah, I got it. I'm on it. Welcome to the Phil Klein Dental Podcast. In today's episode, we're focusing on a critical topic for both patient safety and the protection of your dental practice, and that's infection control. As regulations become more rigorous and patients grow more aware of clinical standards, it's essential for dental teams to stay ahead, and that's where technology and automation are making a real difference. We're joined today by Amanda Hill, a nationally recognized expert in infection control, who shares the latest advancements in sterilization and compliance tools. From preventing waterline contamination to ensuring every sterilization cycle is accurately documented, Amanda explains how the right technology can help your team maintain high standards, avoid costly errors, and deliver safer care across the board. And I do want to mention that Amanda presented a terrific webinar on Viva Learning on July 9th. You can watch the on-demand version of that at your leisure. The title of it is the top three infection control mistakes you probably don't know you're making. So if you missed it, you could find it on VivaLearning.com. Type in HILL, H-I-L-L in the search field. You'll see the webinar. I highly recommend it. 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. Amanda, thanks for joining us. Bill, it's so great to be back again. Thanks for having me. Yeah, we're very happy to have you on the show, and it's been a while, and I'm glad to have you back. So when it comes to infection control and prevention, dental water lines often fly under the radar. yet they pose significant risks if not properly maintained. So can you share with our audience some of the hidden dangers associated with poor waterline maintenance and why this is such a critical area in today's infection control environment and how dangerous it can be if we let this go unchecked? Absolutely, Phil. You know, water is, dental unit waterlines somehow have become my passion. I call myself the waterline warrior. And it's really, Something that wasn't on, I think, many of our radars, which is why I still think it's kind of that missed thing, right? People still unaware of it. But we have states now coming in and now regulating testing. So it's not even just guidelines. It's not even recommended. Like we have Georgia just regulated waterline testing. And so I think why it is not on the radar is because it feels new to people. it's not new we've known this science for a while but what is happening is i think with medicine we're getting better at figuring out the why behind illnesses so we're seeing more and more infections occur i don't think it's because more and more infections are occurring i think it's because we're getting better at Knowing the knowing the why behind an infection. So what can happen is when you are using water that's over 500 colony forming units. per milliliter per the EPA standard, you are now putting your patient at risk for an infection from Pseudomonas or Legionella, Mycobacterium abscessus. And that can and has occurred in both children, in elderly, and really people that are more immunocompromised and more susceptible to infections. And that's happened through different surgeries and it's happened through pulpotomies and things like that. So this is something that we need to be aware of. so that we know that the water we're squirting in our patient's mouth is always safe and that we're not going to cause a subsequent infection. So those were tied directly to a dental visit. Yes. Yeah, I mean, medicine's gotten so good now that they can get the DNA of the infection and go back to the water lines and be like, whoa. This is the same DNA. Like they can tie it that easily. So then there's no like, oh, it might have been somewhere else. No, this is it. So when you're getting into this kind of legal territory, when the DNA match provides conclusive evidence that undeniably pinpoints where the patient was exposed to the pathogens, it's like a slam dunk for the prosecuting attorney. That's really serious. So what's the ramification typically for the practice that was responsible for? contaminated water lines. Well, of course, there's a huge malpractice lawsuit that happens, right? And, you know, offices have to pay often disclosed sums of money. I couldn't tell you what they are because typically that's hidden away. But what happens to the, and certainly reputation and, you know, what hits the news cycle. But patients, these aren't just like, oh, I got a little like, you know, infection and now I'm going to take some antibiotics. Patients have lost jaw structure. They've lost permanent teeth. They've been facially disfigured. One of the treatments for mycobacterium obsessus is this really strong antibiotic that they use for leprosy, and it causes hearing loss. And so these are long-term ramifications for these patients. It's not just a simple like, oh, I was down for a couple days. This is lifetime, life-altering, life-changing infections. Yeah, life-threatening. Tell me that it's not that prevalent before we go on in this podcast episode, that this is so rare that it's not something that patients have to worry about on a regular basis. But nevertheless, dentists should still be extremely stringent on infection control regarding their water lines, which is you're now the warrior of that. What is the prevalence? You know, it's a hard question to answer because let's say I live in the state of Virginia. And last year, I was contacted by a lawyer for a dentist in a waterline case. And so a child had been infected from directly tied to the dental unit waterlines, and I got to give testimony. in this case right but then this case settled fast the moment like the moment the dentist actually it was fascinating when the dentist when the assistant was being deposed um the lawyers you know asked the assistant like okay and when was the last time you tested your water lines and the assistant was like uh i don't know and the dentist immediately like you know of course assuming that this is happening not happening and so this case settled fast so This case never hit the news cycle. This case never showed up anywhere. No one would know about this case unless, like, I only knew about it because the lawyers called me. So that settlement was contingent upon an NDA? Exactly. Okay, so they're not supposed to say anything. I think there's more cases than we know. Yeah, and also the dental office is vulnerable to a disgruntled employee, someone who wants to be vengeful back to the practice when they know very well that... the, you know, criteria, the protocol for infection control on that waterline is not being complied with. So they're opening themselves up to a lawsuit internally through OSHA. Yeah. And I got to tell you, Phil, I hear from dental professionals, you know, team members, often they'll message me, they'll DM me and say, hey, I took your course and I know I'm supposed, we're supposed to do this and this and this, but my doc says, no, what do I do? Yeah. So don't ever put yourself in that position. You're really making yourself vulnerable and you're leaving your business unprotected from a lawsuit from an employee. Of course, a patient too. So you gave a Viva Learning webinar, Amanda, I think it was July 9th. this year is very good. The title is the top three infection control mistakes you probably don't know you're making. In that webinar, you touched on some common sterilization missteps, things like wet packs, cycle interruptions, or even overloading the machine. Which of these mistakes do you see most often in the field? And what are their implications for patient safety? I think most of the ones that you mentioned actually stem back. to wet packs because wet packs can occur if you interrupt that cycle hey guys we need that special handpiece oh it's in the sterilizer oh just open it right and so it's not completed the cycle or you know you you over pack the sterilizer and the you know, the packs can't ever get dry. It's kind of like if you overpack your washing machine and, you know, not everything gets clean, right? It comes out dirty. And so really, I think one of the big ones is wet packs. And the reason why wet packs matter, people are like, well, it went through the sterilizer. It's fine. If something's coming out wet, it's actually not sterile. And the reason that is, is because the paper, you know, that paper pack or that, you know, paper wrapping, when it, when the steam comes in, it actually, like opens up pores in the paper it opens it and then the steam can come in and then it needs to dry to close the pores back up and if it doesn't close it remains susceptible to new infection new you know microbes getting in there and then making that that device that's inside not no longer sterile and so I think wet packs is a huge one and and one of the things that I love about mid mark sterilizers and we'll get into this i'm sure in a minute but they have this new system that when you go to open a load when the when the autoclave is done it actually asks you on the screen are the packs dry And you hit, yes, the packs are dry. And it's a great reminder for us all in our busy, busy, busyness. Like, oh yeah, dry pack, yep. And if they're not dry, why? And let's figure that out and let's brainstorm that and let's troubleshoot that before all of a sudden we're all using instruments that are sterile. Now, when you hit that button, does the machine know who is actually pressing, yes, they're dry? Is there a login for that cycle? There is a login, yes. Okay, so there's accountability built into this. Exactly. Exactly, which is really key. Yeah, well, absolutely. And if the dental assistant or whoever's in there in the sterilization center knows there's accountability, they're not going to blindly hit the button because they need to go on with whatever they're doing. They're going to say, I'm held to account for making sure that these instruments are dry. Now, the post-sterilization reinfection of the instruments, that happens when they're wet in the wet packs when they're taken out, right? Because inside the actual chamber, Even if they're wet or damp, it's still a sterile environment. Absolutely. Right. But when they're handled or taken out, you're saying it's post-sterilization reinfection of that. pack exactly or maybe you take that pack out and you you know you set it on top of your autoclave which you probably shouldn't do you need to store it properly and how like what all is floating in the aerosols somebody comes in and coughs somebody sneezes so so the the integrity of that pack is is deprecated once it's damp and it has to dry so there's a process though in the in the way the system works where it makes it it dries these packs right before you can open it Exactly. Yes. So you let the entire cycle complete, goes through the drying cycle. Think about it's like your dishwasher. If you ever like, you know, you pull out something early from the dishwasher and it's hot and it's wet still, right? It never went to the dry cycle. Well, a sterilizer needs to go through that dry cycle so that, you know, that that pack can dry so it can close back up. And again, one of those accountability perks that that new midmark has is if you interrupt a cycle, Like you decide like doc, it's favorite handpiece. You know, there's only one. And he's like, I don't care. Grab it. Again, you have to put in your initials. You have to, if you're interrupting a cycle, it says. items aren't sterile are you sure you want to do this and you have to put in your initials and then open it like you i mean talk about accountability so then if you and then you'll get a report that shows like hey these you had a bunch of cycle interruptions and that's a great way to let an office know like hey why are we getting cycle interruptions do we need to order another handpiece does someone on our team not understand the sterilization process like why this matters why you have to get through the dry cycle and so i think it's a great way to not only teach but but then also a way for everyone to understand that sterilization. Yeah, all these different automated features that come with this equipment that could preclude a problem, a human error is worth its weight in gold. If you do see dampness in those packs when the cycle is finished, that should say, okay, it's time to troubleshoot why this is happening. Exactly. Okay. Yeah, I could see why you're into this. This is kind of cool, this infection control cell. Yeah. It's more interesting than endodontics doing root cancer. That's what I did my whole career. Oh, yeah. I fell asleep as a dental assistant during those. Yeah, they all do. Every assistant I ever had, we're like thinking about something else, trying to talk to me. I'm trying to focus, and they're telling me about the picnic they were on or the concert they went to. And I said, I'm just trying to stay awake, Phil. I'm just trying to stay awake. Am I the only one that has to be paying attention to this actual procedure? Pretty much. So let's talk about documentation, Amanda, for a second. Documentation is absolutely essential when it comes to infection control, not only as a regulatory requirement, but as a critical safeguard for patient safety. What are some of the most common documentation shortcomings you see in dental practices? And what can teams do to prevent them? Probably the first shortcoming when it comes to documentation is not documenting. Right? There's actually a lot of documentation that needs to be done in order to be compliant. And I got to tell you, it feels a little like busy work if you don't understand the why behind the documentation. You're like, really? I got to write down the temperature of the autoclave every time. I got to write down that it came to pressure every time. Like, I got to notice that those indicators changed every time. Like, can't we just assume that happened? But the problem is, is when we don't do those documentations when we don't like write those things down then there's we miss the failures we miss we miss those things that happen and and documentation is also what's going to save you if there ever is indeed you know god forbid some kind of lawsuit or some kind of question and when you can say yep here's our spore test nope we check our temperature every time like here's our logs but Some of these documentation requirements, I almost feel like for a small practice are impossible. I mean, unless you have somebody that has that time to stand and stare at the autoclave to say, oh, yeah, came to temperature up, came to pressure. It's really hard to be able to be compliant yet. Compliance is the key to knowing that things are sterile and knowing that your practice is covered. And so it's kind of a tough thing, and I see why people don't do it, but it's really one of those things that's going to save you in the end. But thankfully, there is a solution. Yeah, tell us about the solution. So there is now all of these features in some of the newer autoclaves. The Midmark 11, oh my goodness, like it will track. All of this for you. So you no longer need an autoclave watcher. And Phil, right now with, you know, gosh, team turnover, right? Isn't that like the topic of du jour, right? Just a shortage of staff. Like you can't get anyone. So even if you have an infection control coordinator in ICC, that person is usually... Delegated that position along with something else they do in the practice and they can't stand there and watch the autoclave Is that what people did in the past the older units where they had no I think people didn't do it. Or I think the people that were doing it were more FQHCs and, you know, things like that, where you had somebody that it was just their job to be in sterilization. Now, you know, your regular practice, you know, typically it's your dental assistant who's also busy assisting the dentist. They don't have time to stay in it. Or maybe in the past, maybe in the past, they would do it every 10 cycles. Maybe. And if the thing was running fine every 10 cycles, they would assume. The nine cycles in between were also running fine. I mean, maybe they did that. Yeah. So what does it do, this machine from Midmark, as far as documentation where, let's just say that there was a lawsuit, God forbid, and somebody sued our practice and the attorney said, I need to see all the documentation from that entire day where that patient was being treated. What do I do to the machine to get this data out of there so that I could present it to an attorney? Yeah, it is all stored right there in the machine. And you can even have a thumb drive that has it. It can go to the cloud, too, if you want it to. Like, you have some options on how you want to do it. But it records that time, that temperature, that pressure. It records that whole, yes, like, when I opened it, they were dry. It records, you know, that I'm the... It even, it even, Phil. Like, right now, my car is getting an oil change. And you know why my car is getting an oil change? Because the light came on that reminded me. that it's time for the oil change, which I can't remember in my busy life that it's due, right? It even, this machine even tells you that maintenance is due. And so you check every day that you did your daily maintenance and you put in your initials, your weekly maintenance to put in your initials. It shows you little videos on how to change the gasket. So there's no like hunting for like, where's that instruction manual? Like what? When was the last time we did that? Oh, we've had so much turnover. I don't remember, right? It's all in that. And so if somebody were- ever to ask like are you performing the proper maintenance to keep your to make every you know dental visit a safe dental visit to steal the term from the association for dental safety it's all right there in the machine for you and i think when we see those visible reminders like my oil change like time for my oil change you see that you're like oh yeah i got it i'm on it so it's great that the autoclave automatically logs this critical information about how the autoclave is performing. But if there are some problems, let's say the temperature doesn't get to where it's supposed to be or the instruments aren't drying properly, how does it alert the office that these issues are going on in the cycle? It shows you beautifully on the panel. And in fact, the panel is so nice and easy to read. You can read it from like even my 50-year-old eyes that I took, I had to go to DMV and get an eye test yesterday. That eye test is getting harder, Phil. I don't know why. I did that two weeks ago. In Texas, it was every 10 years. Now it's every eight years. He said, I'll see you in eight years. And I said, eight years? I thought I had 10 years. He goes, nope, eight years. The eye test was tough. I just took it too, just recently. That O and the D, they should never have the O and the D next to each other. That's tricky. But this one, you can see from so far away. Like I could see it. I'm sitting in my op. The autoclave is far away. Like I can see, first off, I can see the progress bar. So I know like, ooh, okay, it's still red. It's not ready. It's not ready. And then it turns green. But you could also, if there was an error, that's going to show up and you're going to see it. You cannot miss it. So typically, Amanda, with technology that offers a lot of features, it gets a little complex to work with, and the learning curve could be pretty steep. What's it like with this particular model? You're talking about the mid-mark, I think you mentioned mid-mark 11. Is this something that needs a lot of training on? Do we have to prepare a staff member to really understand the nuances of this, or is this a pretty easy and fast learning curve? I totally get what you're saying. No, all of it just goes in this step by step by step. It's just how, it's so intuitive and it's exactly how you would think to do it. Oh, press that. Okay, next press that. So there's no like, okay, open this, open this, go here, click through here and then do this to find that cool feature. No, they all just, it's just part of the sterilization. So five minutes, five minutes, you could teach me how to use this. Absolutely. So I want to pivot a second back to Waterline. contamination. I know we were talking about autoclaves right now. We'll get back to it in a second. But we didn't talk about testing. What's the key thing to make sure your water lines are up to speed and they're not contaminated? Quarterly. That's how you know whatever protocol you've chosen is going to work. The only way to know is to test it because you're not going to see it. You're not going to smell dirty water. You're just not going to know until... And if you get a test back that's not positive on a quarterly basis, that means that that water is not up to speed for quite a while because it could be as far as three months prior. Yep. Okay. So you got to get your ducks lined up very quickly and get to work. Yeah. Absolutely. So as we wrap up this podcast, Amanda, and it's been very enlightening, I'd like you to just give us some final thoughts. on how newer technologies on the horizon that include smart automation tools built into it, like what we discussed today, how that really helps us manage infection control prevention, helping us become more compliant, allowing us to do things that were just really kind of impossible to do in the past, considering that many of us have small teams and we have a very busy practice. I think technology can be that. team member that we can't find or we can't afford or we can't, you know, bring on. It's that system of checks and balances, which we know that. you know, the, the best thing in infection control is strong protocols, strong, you know, standard operating procedures. And so all of these technologies, whether they be, you know, something like with the Midmark sterilizer that, you know, helps you remember the steps or these online dashboards that many of the companies now have that you can, you know, record your, your spore testing or your waterline testing or things like that, that allow you to have that system and, and. I think one of the big things that this technology is bringing in is it allows the practice owner the opportunity to take a glance and make sure it's happening. Because like I mentioned that case in Virginia where the doctor was like, what? I assumed it was happening. Imagine had he had just this dashboard that he could look at, you know, periodically and be like, oh, good, this is all happening. Or, you know, instead of just assuming something's happening. And so it's a great way to keep everyone accountable, even when you have that small team. Yeah, I think it's almost a necessity now for dental practice to assess where they are in technology. Just from the standpoint, of course, we care about the patient's well-being. That's the number one priority. We're health care providers. But in a litigious world where people are vulnerable to lawsuits, there's going to be a time where standard of care is at a level where if you do not have some automated tools to take care of these things, even more important for small practice because you don't have the staff to worry about the things that you're talking about. If you don't take on the responsibility to update your equipment, in a way, and I hate to use the word negligent, you are kind of negligent. And I know that's a little strong because we don't want to force people to go buy a new autoclave because some new feature came out. I mean, that we're not asking for. But like you said, Amanda, if a practice is not able to, they just don't have the resources to do the things that they should be doing to ensure the health of the patient. infection control and prevention is not up to speed in my opinion that could be used against them in a litigious case and they could the judge could say listen you could have purchased this equipment but you have equipment that's 15 years old So you're charging the patient for dental services, but you're not providing them the assurance that they are. being cared for in a meticulously clean environment, the best you can get it. So you're subpar. Do you agree with that? Absolutely, I agree with that. Yes, that no longer is the excuse. There's no way we can do this. Technology is really coming in and helping offices figure out how you can be compliant. So use this technology to your advantage and allow it to help you run your practice safer and smoother. Thank you, Amanda, for joining us on the show today again. And thank you to our audience for listening. We'll see you on the next episode.