Training for oral healthcare providers may not adequately prepare them to engage, let alone supervise, dental unit waterline (DUWL) infection control, according to research published in the Journal of the American Dental Association.
Survey results revealed significant gaps in knowledge and practice that could potentially harm patients, the authors wrote.
"Improvements in communicating and ensuring engagement in best practices are needed when it comes to DWL infection control," wrote the authors, led by Rashad Vinh of the ADA Science and Research Institute's Department of Evidence Synthesis and Translation Research (J Am Dent Assoc, June 2024, Vol. 155:6, pp. 515-525).
The study entailed a cross-sectional online survey that was developed with two distinct paths: one for individuals involved in hands-on infection control activities and another for those in supervisory roles. The survey was distributed to dentists, dental hygienists, and dental assistants, with a sample size of 200 participants from each profession.
Both groups answered six multiple-choice questions about personal and ongoing education or training in DWL infection control followed by two open-ended questions to gather additional insights. Dental assistants were asked one extra question about their training.
The results showed that 85% of respondents believed DWL infection control was important for patient care. Over half (61%) reported having a policy and procedure manual for maintaining and testing DWLs, and 56% reported having a designated person who oversees DWL infection control.
Regarding DWL maintenance and testing, 72% of respondents reported feeling mostly or completely confident in their employer's ability to test and maintain DWLs. However, 36% reported no issues with maintenance, and 34% reported no issues with testing. When asked about common problems impeding regularly maintaining DWLs, respondents cited time constraints, lack of guidance, staff shortages, and financial issues.
Furthermore, among those involved in hands-on DWL infection control, 15% were unaware of the need for or did not keep maintenance and testing records. Of those maintaining records, 31% kept digital records, 43% had digital results from an outside lab, and 55% kept written records, according to the results.
Regarding infection control protocols, 30% engaged consultants, while 14% relied on office staff knowledge. Protocols commonly used materials from dental unit manufacturers (66%) and DWL treatment product manufacturers (68%). Only 56% had protocols for failed tests, and 54% followed U.S. Centers for Disease Control and Prevention (CDC) recommendations, though only 45% accurately indicated this compliance in states that follow CDC guidance, according to the survey.
However, the study had limitations. The findings are based on self-reported data, which were not verified. Additional documentation and increased engagement in DWL infection control best practices would be beneficial, the authors wrote.
"Although good intentions are appreciated, better approaches to DWL infection control information dissemination and strategies to engage oral health care providers in best practices are needed," they concluded.
