Table 3.
Preventive and corrective measures implemented in the internal quality plan for the control of Legionella contamination in the dental health care setting.
| Control measures and management of the dental units | Use of deionised water instead of mains water in supplying the dental unit waterlines. | |
| Application of a protocol of continuous and periodic disinfecting treatment of dental unit waterlines | ||
| Allow the outlet water from syringes and turbines to run for several minutes at least once a day if dental unit is not used. Flush out for 20-30 seconds after each patient and for several minutes before the daily start of the clinic work (CDC, 2003) | ||
| Regular microbiological monitoring of the waterlines (at least once a year) | ||
| When necessary apply chemical shock to the dental unit waterlines (on the basis of microbiological monitoring) | ||
| Record any maintenance work (ordinary and extraordinary) and results of monitoring. Check that the all the control measures are implemented | ||
| Protocols of treatment introduced for the dental units with independent water supply systems | by Castellini Company | Continuous disinfection with hydrogen peroxide (concentration: 0.06%) |
| Daily cycle of treatment with a disinfectant product generating peracetic acid, peracetyl ions and hydrogen peroxide equivalent to 0.26% of peracetic acid (Rely+On Peracilyse): the product is put inside the external dental unit bottle at the end of the clinic day, left for 10 minutes and then rinsed out | ||
| by A-dec Company | Continuous disinfection with ICX® (use concentration: 0.01%) | |
| Weekly cycle of treatment with an alkaline based peroxide agent (Sterilex Ultra, Sterilex Corporation, Maryland, USA) used at concentration of 0.5%: the product is put inside the external dental unit bottle at the end of the clinic day, and left overnight; the solution is then rinsed out in the morning | ||
| by Eurodent Company | Continuous disinfection with Calbenium® (use concentration: 2%). | |
| Corrective measures in case of contamination | Shock treatment (dental units with independent water supply system): | |
| Sterilize the supply bottle and suction needle | ||
| Add 300 ml of hydrogen peroxide 3% to the bottle | ||
| Activate the dental unit and press the water button 4-5 times allowing the hydrogen peroxide to exit | ||
| Leave it to rest for 10 minutes | ||
| Remove the bottle with the residual hydrogen peroxide and replace it with another sterile bottle containing hydrogen peroxide 0.06% | ||
| Let the water run from the instrument to rinse the waterlines | ||
| Check the results both immediately after decontamination and periodically to verify the efficacy of the adopted measures |