【推荐】口腔科牙科治疗台水路系统国外指南要求——翻译连载
本帖最后由 蓝鱼o_0 于 2011-10-26 15:13 编辑为了标准研制的需要，最近在总结国外口腔用水的标准。会将翻译成果展现给大家。当然，非常希望有兴趣的战友一起参与这项活动，将给予重奖。
【澳大利亚指南】
Waterlines and water quality
Most dental unit waterlines contain biofilm, which acts as a reservoir of microbial contamination and while biofilm in dental unit waterlines is an unknown hazard it may be a source of known pathogens (e.g., Legionella spp). All waterlines and air lines must be fitted with non-return (anti-retraction) valves to help prevent retrograde contamination of the lines. Routine maintenance of these valves is necessary to ensure their effectiveness. An independent water supply can help to reduce the accumulation of biofilm. The manufacturer's directions for appropriate methods to maintain the recommended quality of dental water and for monitoring water quality should be followed. Biofilm levels in dental equipment can be minimized by using a range of measures, including chemical dosing (e.g., hydrogen peroxide, silver ions and peroxygen compounds), flushing lines (e.g., triple syringe and handpieces) after each patient use, and flushing waterlines at the start of the day to reduce overnight or weekend biofilm accumulation. This is particularly important after periods of non-use (such as vacations and long weekends). Waterlines must be cleaned and disinfected in accordance with the manufacturer’s instructions. Air and waterlines from any device connected to the dental water system that enters the patient's mouth (e.g., handpieces, ultrasonic scalers, and air/water syringes) must be flushed for a minimum of two minutes at the start of the day and for 30 seconds between patients. Water quality Water for tooth irrigation during cavity preparation and for ultrasonic scaling should be of no less than potable standard (< 500 CFU/mL)4. It may be wise to use water in which the number of colony forming units (CFU) per mL is less than 200 when treating immunocompromised patients. CFU levels can be tested using commercially available test strips.
【翻译】
大多数牙科治疗台水系统含有生物膜，这些生物膜被认为是一些重要微生物污的储存场所。而生物膜对于牙科治疗台水路是个未知的危险源（例如，军团菌属）。牙科治疗台的水路要求必须都具有回吸阀门，以避免污染水的逆行。定期维修这些阀门非常必要，以确保其有效性。独立的供水可以帮助减少生物膜的积累。应该按照制造商的指示，并遵循相应方法对保持水质并进行监测。通过一些措施可以最低限度的降低生物膜水平的形成，包括化学加药（例如，过氧化氢，银离子和过氧化氢化合物），冲洗管路（如三重枪头和机头），这些措施用于每个患者使用后。每天开始时，冲洗管路，以减少隔夜或生物膜的积累。非使用期后，这一点尤为重要（如假期和长周末）。必须按照制造商的说明对牙科治疗台的水路进行清洗和消毒。
任何连接到牙科水系统进入病人的嘴中的设备（例如，手机，超声波倍线器，空气/水抢）在一天的开始前必须冲洗至少两分钟，病人之间使用每次必须要求空转30秒。水质在腔准备和超声波洗牙牙齿灌溉用水应不超过饮用水标准（<500 CFU/毫升）
对于免疫缺陷的病患，牙科治疗台的水中细菌总数小于或者等于200CFU/ml可能非常明智。水质监测的方法可以用商用的检测试剂。
水路和水的质量
大多数牙科单元治疗台水路中都含有生物膜，它充当着微生物感染的储存库，牙科单眼治疗台水路也是一个不为人知的危害，它可能是不知名病原体的源头。所有水路和空气的通路一定被安装了无回路的（反回缩）的瓣膜来帮助阻止通路的逆行污染。这些瓣膜日常的维护是必须的来保证它的有效性。一个独立的水供能减少生物膜的集聚。维护牙科治疗单元用水的推荐质量和监测水的质量应该遵照生产商正确方法的指导。牙科器械生物膜的程度能够通过使用一系列的措施降到最低，包括化学制剂（如过氧化氢，银离子和过氧化复合物），冲洗管道（如洁牙机或手机）在每个病人使用后，在每天开始时冲洗水路来降低隔夜或周末的生物膜聚集。
中午时间太短了，晚上回来再翻译吧！弄了一半，真不好意思！ 本帖最后由 蓝鱼o_0 于 2011-10-26 14:51 编辑
nancywhite 发表于 2011-10-26 13:26 http://bbs.sific.com.cn/static/image/common/back.gif
水路和水的质量
大多数牙科单元治疗台水路中都含有生物膜，它充当着微生物感染的储存库，牙科单眼治疗台水 ...
非常感谢您的翻译。这个我已经翻译好了。 本帖最后由 蓝鱼o_0 于 2011-10-28 09:56 编辑
【美国CDC的指南2003】
Dental Unit Waterlines, Biofilm, and Water Quality
Studies have demonstrated that dental unit waterlines (i.e., narrow-bore plastic tubing that carries water to the high-speed
handpiece, air/water syringe, and ultrasonic scaler) can become colonized with microorganisms, including bacteria, fungi, and
protozoa (303–309). Protected by a polysaccharide slime layer known as a glycocalyx, these microorganisms colonize and replicate on the interior surfaces of the waterline tubing and form a biofilm, which serves as a reservoir that can amplify the number of free-floating (i.e., planktonic) microorganisms in water used for dental treatment. Although oral flora (303,310,311)
and human pathogens (e.g., Pseudomonas aeruginosa , Legionella species , and nontuberculous Mycobacterium species ), have been isolated from dental water systems, the majority of organisms
recovered from dental waterlines are common heterotrophic water bacteria (305,314,315). These exhibit limited pathogenic
potential for immunocompetent persons. Clinical Implications Certain reports associate waterborne infections with dental
water systems, and scientific evidence verifies the potential for transmission of waterborne infections and disease in hospital
settings and in the community (306,312,316). Infection or colonization caused by Pseudomonas species or nontuberculous
mycobacteria can occur among susceptible patients through direct contact with water (317–320) or after exposure to
residual waterborne contamination of inadequately reprocessed medical instruments (321–323). Nontuberculous mycobacteria
can also be transmitted to patients from tap water aerosols Health-care–associated transmission of pathogenic agents (e.g., Legionella species) occurs primarily through inhalation of infectious aerosols generated from potable water sources or through use of tap water in respiratory therapy equipment (325–327). Disease outbreaks in the community have also been reported from diverse environmental aerosolproducing sources, including whirlpool spas (328), swimming pools (329), and a grocery store mist machine (330). Although the majority of these outbreaks are associated with species of Legionella and Pseudomonas (329), the fungus Cladosporium (331) has also been implicated. Researchers have not demonstrated a measurable risk of
adverse health effects among DHCP or patients from exposure to dental water. Certain studies determined DHCP had
altered nasal flora (332) or substantially greater titers of Legionella antibodies in comparisons with control populations;
however, no cases of legionellosis were identified among exposed DHCP (333,334). Contaminated dental water might
have been the source for localized Pseudomonas aeruginosa infections in two immunocompromised patients (312).
Although transient carriage of P. aeruginosa was observed in 78 healthy patients treated with contaminated dental treatment
water, no illness was reported among the group. In this same study, a retrospective review of dental records also failed
to identify infections (312).Concentrations of bacterial endotoxin <1,000 endotoxin units/mL from gram-negative water bacteria have been detected in water from colonized dental units (335). No standards exist for an acceptable level of endotoxin in drinking water, but the maximum level permissible in United States Pharmacopeia (USP) sterile water for irrigation is only 0.25 endotoxin units/mL (336). Although the consequences of acute and chronic exposure to aerosolized endotoxin in dental health-care settings have not been investigated, endotoxin has been associated with exacerbation of asthma and onset of hypersensitivity pneumonitis in other occupational settings (329,337).
Dental Unit Water Quality
Research has demonstrated that microbial counts can reach <200,000 colony-forming units (CFU)/mL within 5 days
after installation of new dental unit waterlines (305), and levels of microbial contamination <106 CFU/mL of dental unit
water have been documented (309,338). These counts can occur because dental unit waterline factors (e.g., system design,
flow rates, and materials) promote both bacterial growth and development of biofilm. Although no epidemiologic evidence indicates a public health problem, the presence of substantial numbers of pathogens in dental unit waterlines generates concern. Exposing patients or DHCP to water of uncertain microbiological quality, despite the lack of documented adverse health effects, is inconsistent with accepted infection-control principles. Thus in 1995, ADA addressed the dental water concern by asking manufacturers to provide equipment with the ability to deliver treatment water with <200 CFU/mL of unfiltered output from waterlines (339). This threshold was based on the quality assurance standard established for dialysate fluid, to ensure that fluid delivery systems in hemodialysis units have not been colonized by indigenous waterborne organisms (340). Standards also exist for safe drinking water quality as established by EPA, the American Public Health Association (APHA), and the American Water Works Association (AWWA); they have set limits for heterotrophic bacteria of <500 CFU/mL of drinking water (341,342). Thus, the number of bacteria in water used as a coolant/irrigant for nonsurgical dental procedures should be as low as reasonably
achievable and, at a minimum, <500 CFU/mL, the regulatory standard for safe drinking water established by EPA and APHA/
AWWA.
Strategies To Improve DentalUnit Water Quality
In 1993, CDC recommended that dental waterlines be flushed at the beginning of the clinic day to reduce the microbial
load (2). However, studies have demonstrated this practice does not affect biofilm in the waterlines or reliably improve
the quality of water used during dental treatment (315,338,343). Because the recommended value of <500 CFU/mL cannot be achieved by using this method, other strategies should be employed. Dental unit water that remains untreated or unfiltered is unlikely to meet drinking water standards (303–309). Commercial devices and procedures designed to improve the quality of water used in dental treatment are available (316);methods demonstrated to be effective include self-contained water systems combined with chemical treatment, in-line microfilters, and combinations of these treatments. Simply using source water containing <500 CFU/mL of bacteria (e.g., tap, distilled, or sterile water) in a self-contained water system will not eliminate bacterial contamination in treatment water if biofilms in the water system are not controlled. Removal or nactivation of dental waterline biofilms requires use of chemical germicides.Patient material (e.g., oral microorganisms, blood, and saliva) can enter the dental water system during patient treatment (311,344). Dental devices that are connected to the dental water system and that enter the patient’s mouth (e.g., handpieces, ultrasonic scalers, or air/water syringes) should be operated to discharge water and air for a minimum of 20–30 seconds after each patient (2). This procedure is intended to physically flush out patient material that might have entered the turbine, air, or waterlines. The majority of recently manufactured dental units are engineered to prevent retraction of oral fluids, but some older dental units are equipped with antiretraction valves that require periodic maintenance. Users should consult the owner’s manual or contact the manufacturer to determine whether testing or maintenance of antiretraction valves or other devices is required. Even with antiretraction valves, flushing devices for a minimum of 20–30 seconds after each patient is recommended.
Maintenance and Monitoringof Dental Unit Water
DHCP should be trained regarding water quality, biofilm formation, water treatment methods, and appropriate maintenance
protocols for water delivery systems. Water treatment and monitoring products require strict adherence to maintenance
protocols, and noncompliance with treatment regimens has been associated with persistence of microbial contamination
in treated systems (345). Clinical monitoring of water quality can ensure that procedures are correctly performed and
that devices are working in accordance with the manufacturer’s previously validated protocol. Dentists should consult with the manufacturer of their dental unit or water delivery system to determine the best method for maintaining acceptable water quality (i.e., <500 CFU/mL) and the recommended frequency of monitoring. Monitoring of dental water quality can be performed by using commercial selfcontained test kits or commercial water-testing laboratories. Because methods used to treat dental water systems target the entire biofilm, no rationale exists for routine testing for such specific organisms as Legionella or Pseudomonas, except when investigating a suspected waterborne disease outbreak (244).
老师们辛苦了。
现在牙科的水路是一大问题，我们可借鉴国外的一些经验。 不错的内容，抽时间仔细阅读，谢谢！ 哈哈，翻译的不好！向你学习！ 本帖最后由 蓝鱼o_0 于 2011-10-28 10:45 编辑
【美国CDC的要求】
研究表明，DUW（窄口径的塑料管链接高速水机头，空气/水 枪，和超声波洁牙机）中有多种微生物的定植，包括细菌，真菌和原虫（303-309）。受多聚糖形成的多糖粘液层保护，这些微生物可以在管路的表面定植和复制，形成生物膜。这些生物膜是微生物的重要储存库，向通过过牙科治疗台的水路释放一定的微生物。尽管口腔菌群和人类致病原，如绿脓军团菌，军团菌，非结核分枝杆菌种），已从牙科水系统分离出来的，但是水中的细菌大多数为异氧微生物。这些微生物对于具有免疫能力的人而言，致病力有限。
（临床暗示略）
水质要求
研究表明，对新安装的牙科治疗台接通水路后天内微生物数量可以达到近200000菌落形成单位（CFU）/ mL，微生物污染<水平达到10的六次方。牙科治疗台的很多因素可以促进细菌生长和生物膜形成。比如系统设计，水流速度和材料。
尽管没有流行病学证据表明牙科治疗台的水路中的治病微生物的存在成为公共卫生问题。
暴露与不确定微生物质量的病人或者牙科护理人员，尽管缺乏影响健康的证据，他们在接受感控原则时候并不一致。
因此，在1995年，ADA开始着重研究牙科水质问题，通过向提供设备，并具有水质处理能力的制造商咨询，要求未经过滤的水<200cfu/ml。这个阈值是基于透析液的质量保证标准，以确血液透析机种，在水流通过时候没有水中微生物的定植。这也是适用于建立的安全饮用水质量标准，由环保局，美国公共卫生协会（APHA）和美国水务协会（AWWA）制定;他们要求水中异养菌<500 CFU/毫升。因此，用作冷却剂/非手术冲洗水细菌应控制在最低限度，这是可以实现的，<500 CFU/ mL时，以适应由EPA,AHPA和AWWA建立的安全饮用水的标准。
蓝鱼o_0 发表于 2011-10-28 10:45 static/image/common/back.gif
【美国CDC的要求】
研究表明，DUW（窄口径的塑料管链接高速水机头，空气/水 枪，和超声波洁牙机）中有多种 ...
"在1995年，ADA开始着重研究牙科水质问题，通过向提供设备，并具有水质处理能力的制造商咨询，要求未经过滤的水<200cfu/ml。这个阈值是基于透析液的质量保证标准，以确血液透析机种，在水流通过时候没有水中微生物的定植。"我就纳闷了，透析液都是经过过滤的，为何牙科用水要未经过过滤就要达到<200cfu/ml的标准？难道美国医疗机构使用的透析液都不用过滤？ mickeypank 发表于 2011-11-16 08:10 static/image/common/back.gif
"在1995年，ADA开始着重研究牙科水质问题，通过向提供设备，并具有水质处理能力的制造商咨询，要求未经过 ...
对于可能存在免疫缺陷的病人，要求是200cfu/ml。这不是强推要求.美国推荐标准是500cfu/ml。
这也是和生活饮用水标准平行的。 蓝鱼o_0 发表于 2011-11-16 09:47 static/image/common/back.gif
对于可能存在免疫缺陷的病人，要求是200cfu/ml。这不是强推要求.美国推荐标准是500cfu/ml。
这也是和生活 ...
美国的生活饮用水标准比中国低很多嘛，我们的生活饮用水细菌菌落数标准是100CFU/ml。 中国的标准可信吗？我们的水路多长时间清洁呢？都是借鉴国外的标准。 非常感谢，很好的东东，正在学习！ 我们国家对口腔用水的研究很少，国外的文献很有借鉴价值，感谢蓝鱼版主为我们翻译这么好的文献，更加期待精彩连载～！ 新的研究指出口腔细菌有引起心脏病及脑膜炎的风险
2012-02-24 00:40 来源：丁香园 作者：邹长虹
《国际微生物分类和进化学杂志》发表的一项研究表明，一种新发现的细菌，如果进入血流，可能导致严重的疾病，考虑这种细菌是口腔常见的一种定植菌。这种细菌的发现，使科学家得以研究它如何致病并评价其风险。
这种细菌是由苏黎世大学医学微生物学研究所的研究人员发现的，以首次发现该细菌的苏黎世地区的名字命名该细菌为“加尔文葡萄球菌”。加尔文葡萄球菌是从患有心内膜炎、脑膜炎和椎间盘炎（脊柱炎症）的患者血液中分离出来的。它与其他定植在口腔的葡萄球菌株非常相似。牙龈出血可能是口腔细菌进入血液的一种可能的途径。
加尔文葡萄球菌与其他相关细菌的相似性表明该种细菌一直存在，直到现在才被发现。最近发现这种细菌具有重要的临床意义。Andrea Zbinden医师是该研究的领导者，她解释说：“必须准确识别这种细菌才能追踪它的传播。还需要开展进一步研究，明确加尔文葡萄球菌成功致病的策略。该结果将使受感染患者得到快速、准确的药物治疗。”
Zbinden医师认为，尽管这种细菌的发现，没有理由引起担心，但是，识别这种细菌并对其风险进行定量是有重要意义的。她说：“这种细菌似乎天生有就导致严重疾病的潜能，因此，临床医生和微生物学家应该意识到这一点。下一步要研究这种细菌在口腔究竟有多常见，及它所具有的风险。免疫抑制、异常的心脏瓣膜病、牙科手术或慢性疾病等是血液感染该组细菌的常见易感因素。然而，加尔文葡萄球菌的特异危险因子仍有待研究。”
感谢蓝鱼版主为我们翻译这么好的文献， 感谢版主！下半年CQI有点子了！！ 谢谢老师的分享！！{:1_14:} 谢了学习中 正缺少这方面的东东