Properly Maintained Vacuum Systems can Help Infection Control

Since 2020, there has been greater a greater focus on the necessity for containing the byproducts of aerosol-generating procedures. But that, of course, isn’t just because of Coronavirus disease 2019 (COVID-19) concerns. Vacuum systems have been clearing the air and protecting dental healthcare personnel for decades. And, in order for them to do their job effectively and efficiently, they must be properly maintained.

Fundamentally, vacuum systems work very simply, but require proper maintenance. Dr. Jonathan Rudin, DDS, MS, MPH, is a safety and infection control consultant at San Diego Healthcare Compliance, and he explains how they work.

“Basically, there’s the saliva ejector — what you would call a low-speed or small-volume device, to take fluids out of the mouth,” Dr. Rudin says. “Then there’s the high-volume evacuation system that captures both fluids and aerosols. Both systems need to be cleaned out periodically. Debris enters and biofilm forms on the inside of the tubing. These colonies of microorganisms contribute to a very unsanitary situation. Then are also filters – or traps – that are designed to prevent major chunks of debris from arriving at the central vacuum system. Those traps have to be cleaned out.”

Read the Directions

As with any piece of equipment in the dental practice, maintenance and upkeep starts by following the device manufacturer’s instructions for use.

“Where there are concerns about bloodborne pathogens or airborne pathogens, the vacuum system needs to be properly maintained so it performs its best without interrupted service,” Mary Bartlett, President of SafeLink Consulting says. “The first step would be to obtain a copy of the manufacturer’s operating manual and then make a checklist of the maintenance steps. Some may be daily, others monthly, semi-annually or annually. Appoint individuals who will be responsible for these tasks and create a maintenance log so there is a visual accountability. Of course, having a log is not going to ensure that the tasks are being performed, so the office manager or dentist should also be responsible for checking these logs periodically. This is an expensive item to purchase for the practice, and without it there’s very little patient treatment that can be performed.”

While the basic steps are common, the process is not necessarily the same for systems from different manufacturers.

“There are different units, made by various manufacturers, and the instructions specific for each unit need to be followed,” Dr. Rudin says. “It gets down to the frequency of cleaning out the vacuum lines and the composition of the plastic tubing material that’s used. That’s where the instructions for use come into play and why it is important to follow the protocol that’s been developed for that specific equipment by the dental unit.”

It’s not just infection control considerations that affect the device’s overall safety. Consider the device’s potential as a fire hazard.

“Very often, when I conduct a safety inspection of a dental practice, I see the mechanical room also used as the storage area for other items,” Bartlett says. “This is a piece of equipment that has moving parts and is powered by electricity. Sparks could occur, therefore, do not store any flammables, corrosives, or combustibles in the room with this equipment. Quick access to the equipment in an emergency situation is also a concern when the path to the equipment is not clear.”

Follow a Schedule

Like owning a car or a house, an ounce of preventive maintenance is worth a pound of system repair. Vacuum systems have prescribed maintenance to which it must be regularly tended.

“The major daily task to be performed is flushing the vacuum lines,” Bartlett advises. “Here again, reach for the manufacturer’s manual and also look for any warnings posted on the equipment itself. For instance, a dry vacuum system may require you to use a non-foaming cleaner to keep the tank rinsed and clean. If you have an amalgam separator installed on your vacuum system, you shouldn’t use bleach or chlorine to clean the vacuum lines.

“In some cases, the vacuum system may be turned off during the day,” she continues. “In order for the system to process what’s remaining in the lines, manufacturers usually recommend that you only turn it off during the work day if you will not be using it for a period of 15 minutes or more.”

The frequency and extent of the maintenance procedures will depend on the manufacturer and the unit.

“The solids collector, commonly referred to as the main trap, should be checked at least monthly, or more often if recommended by the manufacturer,” Bartlett says. “As far as disposal of this filter, it should be disposed of in an amalgam recycling container, if the dentist removes fillings that contain amalgam or still uses amalgam for fillings. This would also be recycling the chairside traps and the amalgam separator filter once it’s full. A warning if you decide to change the amalgam separator filter yourself is to leave the vacuum pump running. I’ve seen, firsthand, what can happen if the pump is turned off during this procedure, and it’s not a pretty sight. When changing just the solids collector, follow the manufacturer’s instructions, but usually they state to turn off the vacuum pump. Always wear gloves when changing the solids collector, but full PPE should be worn when changing the filter in the amalgam separator, i.e. gloves, mask, face shield, safety eyewear, and a gown.”

Know the Signs

While it is important to stay on top of routine maintenance, it's also important to be aware of red flags.

“There are signs of problems with this type of equipment, such as low suction, no suction, excessive suction, pump not running, or a noisy pump,” Bartlett says. “Usually the manufacturer’s manual will provide troubleshooting tips for these types of issues, so check the manual and follow those instructions as you may be able to correct some of these without technical support. A noisy pump, however, would typically require technical support. Other visual problems could be a loose or abnormally worn belt. The vacuum pump may also have a solenoid water inlet strain that has to be checked and cleaned.”

Whether the system presents with a problem or not, safety protocols must be followed when maintaining the system.

“When I think of the word ‘performance’, there is the mechanical performance of the unit and the behavioral performance of the people maintaining the system,” Dr. Rudin says. “People need to practice really scrupulous hygiene when cleaning out the system, because of both the chemical being used and the biohazardous nature of the system. Wear full PPE, including utility gloves. When cleaning the lines at the end of the day be sure to draw up the solution along with air. That combination will help to create the turbulence that will scour out the lines.

PPE should also be worn when cleaning the filter or trap disposal system.

“Those are the collection points for the major gunk that can accumulate in the system,” Dr. Rudin continues. “As you can imagine, that biohazardous material can splatter, so if somebody is cleaning out the traps and wearing only eye protection and exam gloves they could end up having an exposure incident where biohazardous material enters their body. For this reason, I recommend being fully protected with PPE. Since cleaning the lines can occur at the same time as cleaning the filter, personnel should wear as much protection as possible while taking care of both those tasks.”

No matter which system the practice uses, proper usage and maintenance is critical for its effective, efficient, and safe use. That means following manufacturer’s instructions for use on the timeline that they stipulate.