Be Prepared!

“What? When?!? How!!!?”

Ok, relax...before you freak out, this is only a test; a test to bring to light what would happen to your dental practice if your town or municipality actually did issue a boil water advisory.

A “boil water advisory” or “boil water order” is a public health directive issued by government or health officials to consumers when drinking water is (or might be) contaminated. This means that any water coming into a home or business from a municipal water source cannot be consumed, without first boiling.

So if it happened, what would the impact be on your practice? Even if you have a central water purification system, you are still required to boil water. And then what? Squirt it in your patients’ mouths with a sterilized turkey baster? I can’t imagine doing dentistry that way. If that’s not for you either, then according to the CDC, the only acceptable alternative is “if the water source is isolated from the municipal water system (e.g., a separate water reservoir or other water treatment device cleared for marketing by the Food and Drug Administration).1 In other words, the only way you can avoid practice shut down during a boil water advisory is if your dental delivery unit is equipped with self contained water bottles.  

We’ll get back to self-contained water supplies in a minute...but let’s run through some of the other things you should do to be prepared for this potential disaster. 

1. Post “DO NOT DRINK” signs on all areas of the practice where municipal water is coming in. i.e sinks, restrooms. 
2. Reschedule those patients with known immunocompromised health issues like HIV and those undergoing chemotherapy.
3. Do not wash hands in the sink, but rather use an antibacterial solution like Purell.
4. Do not use dishwashers.

And for those of you fortunate (and smart) enough to have self-contained water on your delivery systems...  

1. Fill water bottles with commercially sourced water, or 
2. Tap water can be used with a Distiller, or
3. If you have made an investment in a reverse osmosis system in your practice, this water can be used in your dental delivery unit, however (and this is a big however), you have to be completely sure the system has been maintained properly, water testing is done routinely and filters changed per manufacturer instructions. Even then, one Reverse Osmosis manufacturer states their system “is designed to remove dissolved solids from municipal source water. By definition, this includes the removal of bacteria and other contaminants down to a molecular level.” But goes on to say, “That being said, we recommend turning off the water supply to the [system] and not using it during boil water notices.”

Okay, so that gets you through the emergency. But it’s important to note that there are important steps to take after the boil water advisory has been lifted, too.

According to the CDC, your local water utility should provide guidance for flushing water lines.  After incoming waterlines have been flushed, you will need to disinfect your dental unit water lines.  Please check with your dental equipment manufacturer for specifics. Additionally...

1. Drain your hot water heater.
2. Turn on all public water faucets in your practice to begin flushing lines. The jury is still out on the length of time to flush lines (anywhere from 1 minute to 30 minutes depending on the length of plumbing lines) but, I would er toward the longer flush times.  Run water for at least 30 minutes. 
3. Drain tanks and replace all filters if you have installed a reverse osmosis system in your practice. 

These disasters can happen anytime, anywhere. Be prepared. Do yourself a favor and have water emergency protocol in place in your practice.  This is an emergency you can prepare for. First and foremost, I would encourage you to convert your existing dental delivery units to ones that will allow you to keep your practice open. Consider converting to systems equipped with self-contained water sources, such as Ergonomic Products’ entire line of Workstations.

Both Design Ergonomics and our friends at Ergonomic Products take great pains to look beyond the basics of dental delivery. An operatory is just one part of an integrated system - your Practice. Exceptional design (whether floor-plan or equipment) tries to anticipate threats such as Boil Water advisories, while optimizing (and protecting) the whole system.

Center For Disease Control Report Published November 2, 2010: Dental Offices During A Boil Water Advisory
https://www.cdc.gov/parasites/crypto/health_professionals/bwa/dental.html

Center For Disease Control Report Published December 19, 2003: Guidelines for Infection Control in Dental Healthcare Settings . https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm