1,107
Views
1
CrossRef citations to date
0
Altmetric
Research Article

First water safety plan approach applied to a Dental Clinic complex: identification of new risk factors associated with Legionella and P. aeruginosa contamination, using a novel sampling, maintenance and management program

ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon & ORCID Icon
Article: 2223477 | Received 21 Mar 2023, Accepted 06 Jun 2023, Published online: 16 Jun 2023

References

  • Ji XY, Fei CN, Zhang Y, et al. Evaluation of bacterial contamination of dental unit waterlines and use of a newly designed measurement device to assess retraction of a dental chair unit. Int Dent J. 2016;66:208–14. doi: 10.1111/idj.12225
  • Volgenant CMC, Persoon IF. Microbial water quality management of dental unit water lines at a dental school. J Hosp Infect. 2019;103:e115–e117. doi: 10.1016/j.jhin.2018.11.002
  • Baudet A, Lizon J, Martrette JM, et al. Efficacy of BRS® and Alpron®/Bilpron® disinfectants for dental unit waterlines: a six-year study. Int J Environ Res Public Health. 2020;17. 1–9. doi:10.3390/ijerph17082634
  • Spagnolo AM, Sartini M, Cristina ML. Microbial contamination of dental unit waterlines and potential risk of infection: a narrative review. Pathogens. 2020;9:1–11. doi: 10.3390/pathogens9080651
  • Tuvo B, Totaro M, Cristina ML, et al. Prevention and control of Legionella and Pseudomonas spp. Colonization in dental units. Pathogens. 2020;9:1–12. DOI:10.3390/pathogens9040305
  • Coleman DC, O’Donnell MJ, Shore AC, et al. Biofilm problems in dental unit water systems and its practical control. J Appl Microbiol. 2009;106:1424–1437. doi: 10.1111/j.1365-2672.2008.04100.x
  • Odonnell MJ, Boyle MA, Russell RJ, et al. Management of dental unit waterline biofilms in the 21st century. Future Microbiol. 2011;6:1209–1226. doi: 10.2217/fmb.11.104
  • Luo J, Porteous N, Sun Y. Rechargeable biofilm-controlling tubing materials for use in dental unit water lines. ACS Appl Mater Interfaces. 2011;3:2895–2902. doi: 10.1021/am200576q
  • Kettering JD, Stephens JA, Muñoz-Viveros CA, et al. Reducing bacterial counts in dental unit waterlines: tap water vs. distilled water. J Contemp Dent Pract. 2002;3:1–11. doi: 10.5005/jcdp-3-3-1
  • Liaqat I, Sabri AN. Effect of biocides on biofilm bacteria from dental unit water lines. Curr Microbiol. 2008;56:619–624. doi: 10.1007/s00284-008-9136-6
  • Stone ME, Kuehne JC, Cohen ME, et al. Effect of iodine on mercury concentrations in dental-unit wastewater. Dent Mater. 2006;22:119–124. doi: 10.1016/j.dental.2005.04.009
  • Costa D, Mercier A, Gravouil K, et al. Pyrosequencing analysis of bacterial diversity in dental unit waterlines. Water Res. 2015;81:223–231. DOI:10.1016/j.watres.2015.05.065
  • Szymańska J, Sitkowska J, Dutkiewicz J. Microbial contamination of dental unit waterlines. Ann Agric Env Med. 2008;15. 173–179. doi:10.1080/02615470120107068
  • Blake GC. The incidence and control of bacterial infection in dental spray reservoirs. Br Dent J. 1963;115:412–416.
  • Fujita M, Mashima I, Nakazawa F. Monitoring the decontamination efficacy of the novel Poseidon-S disinfectant system in dental unit water lines. J Microbiol Immunol Infect. 2015;50:270–276. doi: 10.1016/j.jmii.2015.05.006
  • Kohn WG, Harte JA, Malvitz DM, et al. Guidelines for infection control in dental health care settings - 2003. 2004. doi:10.14219/jada.archive.2004.0019
  • Cristina M, Spagnolo AM, Sartini M, et al. Evaluation of the risk of infection through exposure to aerosols and spatters in dentistry. Am J Infect Control. 2008;36:304–307. DOI:10.1016/j.ajic.2007.07.019
  • Lauritano D, Nardone M, Gaudio RM, et al. Risk assessment of colonization of Legionella spp. in dental unit waterlines. Oral Implantol. 2017;10:283–288. doi: 10.11138/orl/2017.10.3.283
  • Pankhurst CL. Risk assessment of dental unit waterline contamination. Prim Dent Care. 2003;10. 5–10. doi:10.1308/135576103322504030
  • Castellano Realpe OJ, Gutiérrez JC, Sierra DA, et al. Dental unit waterlines in quito and caracas contaminated with non tuberculous mycobacteria: a potential health risk in dental practice. Int J Environ Res Public Health. 2020;17:1–11. DOI:10.3390/ijerph17072348
  • Cicciù M. Water contamination risks at the dental clinic. Biology (Basel). 2020;9:12–16. doi: 10.3390/biology9030043
  • Pankhurst CL, Coulter WA. Do contaminated dental unit waterlines pose a risk of infection? J Dent. 2007;35:712–720. doi: 10.1016/j.jdent.2007.06.002
  • Ricci ML, Fontana S, Pinci F, et al. Pneumonia associated with a dental unit waterline. Lancet. 2012;379:684. doi:10.1016/S0140-6736(12)60074-9
  • Atlas RM, Williams JF, Huntington MK. Legionella contamination of dental-unit waters. Appl Environ Microbiol. 1995;61:1208–1213. doi: 10.1128/aem.61.4.1208-1213.1995
  • Schönning C, Jernberg C, Klingenberg D, et al. Legionellosis acquired through a dental unit: a case study. J Hosp Infect. 2017;96:89–92. DOI:10.1016/j.jhin.2017.01.009
  • Walker JT, Marsh PD. Microbial biofilm formation in DUWS and their control using disinfectants. J Dent. 2007;35:721–730. doi: 10.1016/j.jdent.2007.07.005
  • ECDC. Infection prevention and control in dentistry. 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/directory-guidance-prevention-and-control/core-requirements-healthcare-settings-1 [Consultato aprile 26, 2023].
  • Italian National Institute of Health. Italian guidelines for prevention and control of legionellosis. 2015. Available from: http://www.salute.gov.it/imgs/C17pubblicazioni2362allegato.pdf
  • Emilia-Romagna Region (2017). Regional guidelines for surveillance and control of legionellosis. Delibera Della Giunta Regionale 12 Giugno 2017, N. 2017; 828.
  • ESGLI. ESGLI Guidance for managing Legionella in dental practises during the COVID-19 pandemic. 2020. 1–5. Available from: https://www.escmid.org/fileadmin/src/media/PDFs/3Research_Projects/ESGLI/COVId_buidling_water_system_guidance_27_3_20_v4_DS_pk.pdf
  • Ricci M, Rota M, Scaturro M, et al. Indications for the prevention of Legionella risk in dental unit waterline during COVID-19 pandemic. Version May. 2020;17:1–9. Rapp. ISS COVID-19 n. 27/2020.
  • Khajezadeh M, Mohseni F, Khaledi A, et al. Contamination of dental unit water lines (DUWL) with Legionella pneumophila and Pseudomonas aeruginosa; a Middle East systematic review and meta-analysis. Eur J Microbiol Immunol. 2022;12:93–99. doi: 10.1556/1886.2022.00023
  • EN ISO 19458:2006. Water quality—sampling for microbiological analysis. 2006.
  • Legislative decree No. 31, Feb 2001 Implementation of the water quality directive 98/83/EC relative to water quality intended for human consumption. 2001. pp. 1–21. Gazzetta Ufficiale n.52 of March 3rd 2001, supplemento ordinario n.414. Gazzetta Ufficiale n.52 of March 3rd 2001, supplemento ordinario n.414: https://www.gazzettaufficiale.it/eli/id/2001/03/03/001G0074/sg
  • ISO 11731:2017. Water quality — Enumeration of Legionella. 2017.
  • Pascale MR, Mazzotta M, Salaris S, et al. Evaluation of MALDI–TOF mass spectrometry in diagnostic and environmental surveillance of Legionella species: a comparison with culture and Mip-Gene sequencing technique. Front Microbiol. 2020;11:1–12. doi:10.3389/fmicb.2020.589369
  • Gaia V, Fry NK, Afshar B, et al. Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila. J Clin Microbiol. 2005;43:2047–2052. DOI:10.1128/JCM.43.5.2047-2052.2005
  • Ratzow S, Gaia V, Helbig JH, et al. Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains. J Clin Microbiol. 2007;45. 1965–1968. doi:10.1128/JCM.00261-07
  • UNI EN ISO 16266:2008. Water quality—detection and enumeration of Pseudomonas aeruginosa—Method by Membrane Filtration. 2008.
  • Petti S, Vitali M. Occupational risk for Legionella infection among dental healthcare workers: meta-analysis in occupational epidemiology. BMJ Open. 2017;7. 1–10. doi:10.1136/bmjopen-2016-015374
  • Mills SE. The dental unit waterline controversy: defusing the myths, defining the solutions. J Am Dent Assoc. 2000;131:1427–1441. doi: 10.14219/jada.archive.2000.0054
  • Association AD. ADA statement on dental unit waterlines. J Am Dent Assoc. 1996;127(2):185–186.
  • Department of Health (DH), England. Health Technical Memorandum 01-05: Decontamination in primary care dental practices. 2013, 1–86.
  • Legislative Decree No. 81. Implementation of article 1 of the Law of 3 August 2007, n. 123, concerning the protection of health and safety in the workplace. OJ. General Series n.101 of 30-04-2008—Suppl. Ordinary n. 108 April 9 2008 http://www.normattiva.it/atto/caricaDettaglioAtto?atto.dataPubblicazioneGazzetta=2008-04-30&atto.codiceRedazionale=008G0104¤tPage=1
  • Directive (EU) 2020/2184. Directive (EU) 2020/2184 of the European Parliament and of the Council of 16 December 2020 on the quality of water intended for human consumption, 431/1. 2020. Gazzetta Ufficiale dell’Unione Europea del 23.12.2020.
  • Legislative Decree No. 18, Feb 23. Implementation of Directive (EU) 2020/2184 of the Parliament European Parliament and of the Council of 16 December 2020 on the the quality of water intended for human consumption. Gazzetta Ufficiale - serie Generale. 2023;55:3–81. https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2023-03-06&atto.codiceRedazionale=23G00025&elenco30giorni=false
  • Istituto Superiore di Sanità. Guidelines for the assessment and management of risk associated to water safety in internal plumbing systems in priority and non-priority buildings and in certain vessel according to Directive (EU) 2020/2184. Ad hoc working group on water safety in intern internal water distribution systems in buildings and certain ships 2022. Rapporti ISTISAN 22/32 (in Italian). 2022;xiv:161.
  • Araujo M, Andreana S. Risk and prevention of transmission of infectious diseases in dentistry. Quintessence Int. 2002;33:376–382.
  • Barbeau J, Tanguay R, Faucher E, et al. Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62:3954–3959. DOI:10.1128/aem.62.11.3954-3959.1996
  • Barbeau J, Ten Bokum L, Gauthier C, et al. Cross-contamination potential of saliva ejectors used in dentistry. J Hosp Infect. 1998;40:303–311. doi: 10.1016/S0195-6701(98)90308-5
  • Barben J, Schmid J. Dental units as infection sources of Pseudomonas aeruginosa. Eur Respir J. 2008;32. 1122–1123. doi:10.1183/09031936.00072808
  • Kimura S, Tateda K, Ishii Y, et al. Pseudomonas aeruginosa Las quorum sensing autoinducer suppresses growth and biofilm production in Legionella species. Microbiology. 2009;155:1934–1939. DOI:10.1099/mic.0.026641-0
  • Ouellet MM, Leduc A, Nadeau C, et al. Pseudomonas aeruginosa isolates from dental unit waterlines can be divided in two distinct groups, including one displaying phenotypes similar to isolates from cystic fibrosis patients. Front Microbiol. 2014;5:1–11. doi: 10.3389/fmicb.2014.00802
  • Tuttlebee CM, O’Donnell MJ, Keane CT, et al. Effective control of dental chair unit waterline biofilm and marked reduction of bacterial contamination of output water using two peroxide-based disinfectants. J Hosp Infect. 2002;52:192–205. DOI:10.1053/jhin.2002.1282
  • Walker JT, Bradshaw DJ, Fulford MR, et al. Microbiological evaluation of a range of disinfectant products to control mixed-species biofilm contamination in a laboratory model of a dental unit water system. Appl Environ Microbiol. 2003;69:3327–3332. doi: 10.1128/AEM.69.6.3327-3332.2003
  • Ryan MP, Pembroke JT, Adley CC. Ralstonia pickettii: a persistent Gram-negative nosocomial infectious organism. J Hosp Infect. 2006;62. 278–284. doi:10.1016/j.jhin.2005.08.015
  • Lizzadro J, Mazzotta M, Girolamini L, et al. Comparison between two types of dental unit waterlines: how evaluation of microbiological contamination can support risk containment. Int J Environ Res Public Health. 2019;16:1–14. doi: 10.3390/ijerph16030328
  • World Health Organization. Guidelines for drinking-water quality; 2011. pp. 876–883. doi:10.1007/978-1-4020-4410-6_184
  • Hoogenkamp MA, Brandt BW, de Soet JJ, et al. An in-vitro dynamic flow model for translational research into dental unit water system biofilms. J Microbiol Methods. 2020;171:105879. doi: 10.1016/j.mimet.2020.105879
  • Abu Khweek A, Amer AO. Factors mediating environmental biofilm formation by Legionella pneumophila. Front Cell Infect Microbiol. 2018;8:1–10. doi: 10.3389/fcimb.2018.00038
  • Assaidi A, Ellouali M, Latrache H, et al. Role of biofilms in the survival of Legionella pneumophila to sodium chloride treatment. Iran J Microbiol. 2021;13:488–494. doi: 10.18502/ijm.v13i4.6973
  • Berlanga M, Guerrero R. Living together in biofilms: the microbial cell factory and its biotechnological implications. Microb Cell Fact. 2016;15:1–11. doi: 10.1186/s12934-016-0569-5
  • Buckingham-Meyer K, Miller LA, Parker AE, et al. Harvesting and disaggregation: an overlooked step in biofilm methods research. J Vis Exp. 2022;1–11. doi:10.3791/62390-v
  • Mazzotta M, Salaris S, Pascale MR, et al. Occurrence of Legionella spp. In man-made water sources: isolates distribution and phylogenetic characterization in the Emilia-Romagna region. Pathogens. 2021;10:552. doi: 10.3390/pathogens10050552
  • Portal E, Descours G, Ginevra C, et al. Legionella antibiotic susceptibility testing: is it time for international standardization and evidence-based guidance? J Antimicrob Chemother. 2021;76:1113–1116. doi:10.1093/jac/dkab027