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Legionella and Other Bacterial Respiratory Infections from Oxygen Concentrators with Humidifiers and Nebulisers in Dental Practice

Introduction


Most of our customers associate Legionella bacteria with showers and hot water. Dentists understand that their dental water lines are also at risk of contamination. However, it's important to be aware that these sneaky bacteria can lurk in other medical devices in your practice as well.


During our surveys, we frequently encounter various equipment used for treatments or sedation. Recently, oxygen concentrators with humidifiers, CPAP machines, and nebulisers have come onto our radar. These devices, often tucked away in the stock room and rolled out only when needed, can pose significant risks if not properly maintained and sterilised.


A disclaimer is needed here: we are not experts in sedation, and this article is not intended to advise on which equipment should be used. However, as we are the "Water Police," we cannot ignore the fact that these devices can pose a risk for bacterial respiratory infections if not properly cared for. Proper maintenance and sterilisation are crucial to preventing the proliferation of harmful bacteria and ensuring a safe environment for both patients and staff.

One significant pathogen of concern is Legionella, a bacterium known to cause severe respiratory illness. This blog aims to shed light on the risks of Legionella and other bacterial infections, how they proliferate in medical devices, and the best practices to mitigate these risks.


The Risks of Legionella in Dental Practice


Legionella pneumophila is the bacterium responsible for Legionnaires' disease, a severe form of pneumonia. It thrives in water systems and can become aerosolised, posing a risk when inhaled. In dental practices, oxygen concentrators with humidifiers and nebulisers create an environment where Legionella can grow if the equipment is not properly sanitised.


There have been many cases of Legionellosis linked to the use of medical devices. To list a few:


  • In 2015 A 67-year-old woman with diabetes was diagnosed with Legionella contracted from improperly maintained continuous pressure oxygen mask

  • During 12 month period 12 out of 48 patients developed fatal pneumonia following admission to hospital in Torino. All were administered oxygen from contaminated devices. Oxygen machines and nebulisers were filled with tap water which contained Legionella pneumophila sg1.


How Legionella Spreads


Legionella bacteria thrive in warm, stagnant water. In medical devices such as oxygen machines, the risk arises when:


  • Oxygen concentrators use humidifiers to moisten the air delivered to patients. If these humidifiers are not regularly cleaned, they can become breeding grounds for bacteria.

  • Nebulisers, which turn liquid medication into a mist for inhalation, can also harbour bacteria if not sterilised between uses.


When contaminated devices aerosolise the water, they can release Legionella into the air, which can then be inhaled by patients and staff, leading to infection.


Other Bacterial Respiratory Infections


While Legionella is a significant concern, other bacteria can also pose risks. These include:


  • Pseudomonas aeruginosa: A common bacterium found in water that can cause respiratory infections, especially in immunocompromised individuals.

  • Staphylococcus aureus: Including MRSA (Methicillin-resistant Staphylococcus aureus), which can cause severe respiratory infections.

  • Klebsiella pneumoniae: Known for causing pneumonia and other types of infections.


Sources of Contamination


These bacteria can contaminate medical devices in various ways:


  • Biofilm Formation: Bacteria can form biofilms on the surfaces of components such as inside humidifier water bottles and nebulisers. Biofilms are resistant to cleaning and can release bacteria into the air or liquid.

  • Poor Maintenance: Infrequent or improper cleaning and disinfection can allow bacteria to proliferate.

  • Contaminated Water Supply: Using non-sterile water in humidifiers or nebulisers can introduce bacteria into the system.


Best Practices for Prevention


To minimize the risk of bacterial respiratory infections from oxygen concentrators with humidifiers and nebulisers in dental practices, it is crucial to follow strict maintenance and disinfection protocols.

Regular Cleaning and Disinfection


  • Daily Cleaning: Humidifiers and nebulisers should be cleaned daily with appropriate disinfectants, wiped clean and left dry.

  • Between Patient Use: Devices should be sterilised between patient uses to prevent cross-contamination.

  • Water Replacement: Use sterile or distilled water in humidifiers and replace it daily.

  • Weekly disinfect the units as per manufacturer guidance - Bottles and all the tubbing should be removed and cleaned. Replace the tubbing every 6-months


Maintenance Protocols


  • Scheduled Maintenance: Follow manufacturer guidelines for regular maintenance and replacement of parts. This will include filter cleaning and filter replacement (at least quarterly)

  • Inspection: Regularly inspect equipment for signs of biofilm or other contamination.


Legionella in dental practice

Staff Training


  • Training Programs: Implement comprehensive training for staff on proper cleaning, disinfection, and maintenance procedures. Document all procedures including detailed instructions on how the system should be left if not used for extended period of time and how to safely restart the unit.

  • Awareness: Ensure that all staff members are aware of the risks of bacterial infections and the importance of stringent hygiene practices.


Environmental Controls


  • Water Quality: Ensure the water supply used for medical devices is free from contamination. Do not use tap water! Purified or distilled water only should be used.

  • Temperature Control: Maintain water systems at temperatures that inhibit bacterial growth.


Conclusion


While we do not advise on whether specific equipment should be used, it is clear that if devices like oxygen concentrators with humidifiers and nebulisers are necessary in dental practices, they must be properly maintained. The use of these devices comes with the risk of bacterial respiratory infections, particularly from Legionella. By adhering to rigorous cleaning, disinfection, and maintenance protocols, dental practices can significantly reduce these risks and ensure a safe environment for both patients and staff. Continuous education and awareness are key to preventing the proliferation of harmful bacteria and maintaining the highest standards of care in dental practices.

Your Legionella risk assessment must cover the risks associated with these units. This should be a detailed assessment completed by a competent person  - not a “tick box” exercise.


If you have any questions about this blog or any other Legionella related worries our consultants at The First Principle Group are here to provide answers and support.




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