QAPI 144 - Multiprong Interventions, Organizational Behavioral Changes, and Ongoing Monitoring Reduce Dental Unit Water Line Biofilm Growth

Background: Dental Unit Water Lines (DUWLs) supply all instruments attached to the dental chair unit, and their care and maintenance directly affect patient safety. DUWL policy and procedure did not exist. Administration tasked the infection control subject matter expert (SME) to immediately develop and implement a cost-effective DUWL policy and procedure to ensure that DUWLs culture results consistently passed and if biofilm growth resulted to promptly intervene per standards.

Methods: In June 2021, an urban, high-volume community health center dental clinic established a new DUWL policy and procedure. DUWL culture results provided the baseline data. All DUWL required shocking. The SME used science and evidenced-based interventions, professional standards, administrative engagement, education, and team building engagement strategies with the dental and facility staff to develop and implement the policy and procedure. Key metrics monitored included compliance with DUWL daily maintenance and results of periodic DUWL cultures conducted by the SME. Staff resistance occurred. DUWL culture results consistently required action. In response to these challenges, the SME sought further senior leadership support and guidance which led to the implementation of additional interventions: heightened emphasis on relationship building with dental staff; integration of activities into the department quality improvement program and fostering better department leadership relationships. These interventions resulted in increased staff participation, behavioral change, and better outcomes. Outcome measurements included: quality improvement metrics, descriptive statistics, graphs, education and competency validation, ongoing surveillance, infection control audits, staff observations and ongoing culture result monitoring.

Results: 2021 - 2023 DUWL culture results: In 2021 all results from each of the thirteen operatory DUWL required action, interventions, retraining, and/or follow up. By June 2023, all DUWL culture results were non-actionable due to department leadership engagement and staff compliance with policies and procedures.

Conclusions: A consistent evidenced based procedure that engages staff can be achieved by implementing integrated approaches.