Written by: Marie T. Fluent, DDS, CDIPC, FACD
Introduction
A vital component of any infection control program is quality assurance—efforts aimed at ensuring consistent, predictable, and reliable performance, and ultimately, improved patient safety. As technological advances are made, manufacturers introduce new products to enhance infection control and quality assurance endeavors. An example is FASTCheck15—an in-office dental unit waterline test designed for dental practices to quickly and easily monitor their waterlines by detecting water bacterial levels exceeding 500 CFU/mL in 15 minutes.
AN ANALOGY
Chemical Integrators for Added Quality Assurance in Sterilization Monitoring
A parallel analogy is the use of a chemical integrator to monitor the sterilization process. The gold standard for assessing sterility is a biological monitor—also known as a spore test. Most dental facilities utilize mail-in spore testing where the test envelope is sent to a laboratory for incubation. Team members receive test results within several days due to shipping time plus time for incubation. Thus, there are several days of uncertainty where dental personnel are unaware whether recently processed instruments are safe for patient care, and breaches may occur. To prevent this, a specific type of chemical indicator may be added within the autoclave cycle—a Type 5 chemical indicator, also known as an integrator.
Integrators react to all 3 critical parameters of sterilization—time, temperature, and pressure. When the integrator has passing results, clinical personnel may be confident that their autoclave chamber built up adequate pressure, became hot enough, and stayed hot long enough. This added step of quality assurance (adding a chemical integrator to the autoclave cycle) ensures that instruments are safe for patient care while team members await spore test results.
FASTCheck15 as a Quality Assurance Measure
While spore tests are the gold standard for assessing sterility, R2A laboratory testing is the gold standard for waterline testing. According to the OSAP (ADS) Whitepaper on Dental Unit Water Quality: “laboratory testing using standard agar plate test methods can provide more accurate count than in-office test kits, provide better baseline measures and provide an external validation of in-office monitoring program.”
R2A water samples are mailed into a laboratory and incubated on an agar plate allowing bacteria to grow and form colonies which are then counted. Team members typically receive results of laboratory water tests within 5 to 7 days. Thus, there is a period of uncertainty where dental personnel may not know whether their dental unit water meets drinking water standards. In this period, FASTCheck15 may be used as a tool to quickly, efficiently, and cost-effectively screen dental unit water. This added effort allows for immediate verification and early detection of failures, reduced costs and disruption to patient care, and improved patient safety.
If the FASTCheck15 screening test fails, further action is needed. General recommendations include shocking the waterlines per manufacturer’s instructions and retesting waterlines. Team members should follow recommendations for maintenance and shock products. If tests continue to fail, team members may troubleshoot for excessive biofilm buildup, improper maintenance protocols, or problems with source water. Dental personnel may consult with a dental waterline specialist for further help if needed.
A Key Component of Waterline Protocol
FASTCheck15 may be viewed as a screening tool, quality improvement measure, and an essential component of a comprehensive waterline protocol. The overall program includes having policies and procedures in place following CDC guidance and state-specific requirements if indicated, ensuring staff training, and consulting with the manufacturer of the dental unit for selection and use of compatible germicidal agents. Waterlines should be tested regularly and results documented and maintained.
Waterline Testing Frequency
The OSAP (ADS) Whitepaper on dental unit water quality states that dental waterlines should be monitored monthly to view trends and compliance. Units which have a good trend after 2 months may be tested quarterly. Yet, too much can go wrong with systems such that extending beyond quarterly testing is not recommended. Erratic testing results may indicate the need to test more frequently and dental units that have intermittent use may require more frequent testing.
Sterisil recommends testing dental unit waterlines via mail-in laboratory R2A testing on a quarterly basis, and FASTCheck15 monthly. In addition to use as a screening tool, FASTCheck15 may also be used after lifting of a boil water notice, recent test failure (after shocking), installation of new equipment, after extended periods of downtime, after changes to manufacturer IFU or clinic protocols, following maintenance or repair of dental unit, and changes or repairs in plumbing.
Conclusion
FASTCheck15 may be used as a dental unit waterline quality assurance effort to ensure consistent, predictable, and reliable performance, and compliance with regulatory requirements. When incorporated into a comprehensive waterline program including waterline maintenance, shocking of waterlines, routine testing, and documentation, FASTCheck15 will ultimately lead dental teams to providing safe water for routine dental care and improved patient safety.
For more information, visit solmetex.com/fastcheck15.
References and Resources:
- American Dental Association: https://www.ada.org/resources/ada-library/oral-health-topics/dental-unit-waterlines (accessed 4-10-25)
- 2003 CDC Guidelines for Infection Control in Dental Health Settings: https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf (accessed 4-10-25)
- 2016 Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care: https://www.cdc.gov/dental-infection-control/media/pdfs/2024/07/safe-care2.pdf (accessed 4-10-25)
- OSAP Whitepaper on DUWL: https://www.osap.org/assets/docs/resources/toolkits-topics/dental-unit-water-quality-organization-for-safety-asepsis-and-prevention-white-paper-and-recommendations-2018.pdf (accessed 4-10-25)
- Association for Dental Safety: https://www.myads.org/topics-dental-unit-waterlines-duwl (accessed 4-10-25)
ABOUT THE AUTHOR
Marie Fluent, DDS, CDIPC, FACD, is a graduate of the University of Michigan School of Dentistry. Her dental career spans 35 years and she now lectures, writes and consults extensively on infection control, OSHA compliance, eye safety, and antibiotic stewardship in dentistry. Dr. Fluent is passionate and deeply committed to improving dental infection control and patient safety. She has educated thousands of dental professionals and students nationally and internationally through her writing, webinars, and invited lectures.
