24 March 2020

Phil King – Senior Partner

Since the outbreak of Covid-19 we have been running a skeleton service reacting to essential equipment breakdowns to enable our customers to continue to provide emergency care for their patients.

During visits we will keep our distance and any contact, to an absolute minimum. Repairs will be carried out as best as possible with a potential reduction in availability of spare parts. We carry lots of spares and I have been in communication with several suppliers this morning who have assured me they are running a skeleton staff service and aim to get required items sent out as normally as possible. Please ensure, if a visit is required (we will always try and help over the phone in the first instance), that areas are well ventilated and left as clean as possible. We will endeavour to do the same when we leave.

Update: 25th/26th March 2020 Several suppliers have either shut or partially shut their warehouse until further notice.

The safety of our customers, their staff and customers, our staff, family and friends as well as everyone in the wider community is, and will remain our priority.

The following advice is a recommendation from Armstrong Young LLP for the maintenance of various items of dental equipment that we look after, and should only be used as a guide along with your current procedures and those recommendations laid out in the manufacturer’s manuals.

For further information, please either contact Armstrong Young LLP or your service provider for specific pieces of equipment.

Whilst all equipment poses a potential threat of cross-infection etc, we have identified some areas that we feel will pose the greatest risk once these are brought back into service following a prolonged period of inactivity. These include, but are not limited to: Dental Unit Water Lines (DUWL), cup fill and bowl flush nozzles, suction motors and compressors.

We do not anticipate patient chairs, lights and x-rays suffering any adverse effects from periods of closure and simply keeping them clean as well as occasionally turning them on and moving them once in a while should keep them in good working order.

If someone is able to safely visit the practice twice a week then please see below. If you are unable to visit the practice for any reason then please see below, but also read and take note of the further advice listed.

Recommendations:

PLEASE ENSURE DURING ALL ROUTINE MAINTENANCE THAT THE CORRECT PPE EQUIPMENT IS USED

Dental Unit Water Lines (DUWL):

Where you are using an active ingredient in the waterlines such as A-dec ICX, Alpron or similar, we would recommend wherever possible to replenish the water bottle twice a week using your usual protocol, ensuring ALL outlets are flushed through (this can be achieved with either the flush switch/program on the unit or operation of the foot pedal). This is to include all handpiece outlets, 3in1 syringes (doctors side and nurses side if fitted) and any ancillary equipment attached such as scalers etc.
We suggest removing all handpieces and quick connectors during this time as well. These can be stored and autoclaved (if applicable) before first use. This should maintain a good quality in the water, until such a time when the units are put back into clinical use. Before units are returned to use you may also wish to perform a shock treatment (following the manufacturer’s instructions for use) and carry out some dip-slide testing to confirm the water is of a suitable quality.

Further advice for DUWL:

If you don’t use an active ingredient in your waterlines or you are unable to visit the practice regularly then please consider the following. Remove and empty the water bottle; reattach the empty water bottle and turn on as usual; completely purge ALL outlets (this can be achieved with either the flush switch/program on the unit or operation of the foot pedal). This is to include all handpiece outlets, 3in1 syringes (doctors side and nurses side if fitted) and any ancillary equipment attached such as scalers etc. We suggest removing all handpieces and quick connectors during this time as well. These can be stored and autoclaved (if applicable) before first use; before returning the dental unit to use perform a shock treatment (following the manufacturer’s instructions for use) and carry out some dip-slide testing to confirm the water is of a suitable quality. Resume normal protocol.

Please note that purging some types of dental systems with air can cause some small issues with dripping handpieces, but this would be a minor inconvenience in the short term and can be rectified in many cases with flushing all outlets thoroughly with water to eliminate all the air from a system. In a small number of cases a visit may be required to rectify this.

Suction Motors:

Run a cleaning solution (as per your current protocol and the manufacturer’s recommendations) through each motor twice a week (utilizing all suction hoses). Following the activation period (which should be noted on the bottle), please flush through plenty (minimum 1 litre) of clean water to prevent cleaning solutions sitting in pipes and attacking joints etc. If the cleaning solution says to leave overnight, I would suggest leaving for as long as possible but not overnight in this instance. It would also be wise to purge the water from all spittoon valves (if fitted). Please contact us for further advice if you are unsure how to do this.

Further advice for Suction Motors:

If you are unable to run the suction motors regularly there is a risk they will seize up during a period of inactivity. This can happen over a bank holiday weekend, so a period of 3 or 4 weeks could be extremely problematic. Follow the advice above but once you have flushed the clean water through, run each motor for a further 10 minutes completely dry to eliminate as much water as possible.

Please also note with most suction motors that if you are running water down spittoons, these will need to be turned on during this time.

Compressors:

Wherever possible they should be run twice a week. Turn on the compressor/s and allow to get up to pressure, check for leaks and turn off again. You can then open the drain tap if you have one and close this as soon as all moisture is removed (the air is coming out dry). There is no need to empty the tank fully. Where people have oil free compressors with driers attached we would not expect you to have any moisture in tank (and some of you may not even know where the drain tap is). If you are unsure then please either contact us or refer to the equipment manuals. Those of you that have oil filled compressors (or oil free) with no drier, it is very important to drain the water from the tank.

Further advice for Compressors:

If you are unable to run the compressors regularly we don’t anticipate many issues (although it is possible that some auto-drain mechanisms will become stuck).
Therefore follow the advice above and turn the compressors off until they are required. When turning them back on please ensure they reach the required pressure within 5 minutes or so. If they don’t (or there is an obvious leak), please contact us for further advice.

Please also note with compressors that if you are running other equipment, these will need to be turned on during this time.
Autoclaves:

Run twice a week through a full cycle if possible.

Further advice for Autoclaves:

If you are unable to run the autoclaves regularly then please refer to the manual or contact the manufacturer for further advice.

Washer Disinfectors:

Run washer disinfectors twice a week.

Further advice for Washer Disinfectors:

If you are unable to run washer disinfectors regularly then please refer to the manual or contact the manufacturer for further advice.

Reverse Osmosis Units:

Purge a good quantity of water through twice a week (use RO water for filling autoclaves and water bottles etc).

Further advice for Reverse Osmosis Units:

If you are unable to purge water regularly then it would be advisable to replace the cartridges on return to work and purge thoroughly as per instructions. Please refer to the manual or contact the manufacturer for further advice.

Handpieces:

Clean, lubricate, autoclave and store as per your current protocol. If you have any specific questions regarding this please contact the manufacturer. You may have to repeat this process before starting work again (dependant on how long the shut down continues for).

Other Equipment:

If you have a weekly protocol for dismantling and lubricating (with silicone grease) suction valves, filters, 3in1’s etc. It would be advisable to continue to do this once a fortnight if possible.

It is also worth running water into all sinks around the practice. Although this won’t cause a specific problem, if u-bends and bottle traps dry out it will cause unpleasant smells.

Any other advice:

If possible isolate the mains water to the practice when it is unoccupied.

Please let us know of any issues as soon as possible, we are expecting a large volume of work when things return to normal. This will enable us to plan as efficiently as we can do.

If you are unable to visit the practice regularly, then please try and visit a week or so before reopening to see if everything is working.

Please be patient, we will endeavour to help people as quickly as possible. For updates on how to protect yourselves please visit: https://www.nhs.uk/conditions/coronavirus-covid-19/
We appreciate your understanding through these unusual and uncertain times, and wish your family, friends and colleagues good health and keep safe.

The Armstrong Young Team