Puttaiah Raghunath, Svoboda Kathy K H, Lin Shih Ming, Montebugnoli Lucio, Dolci Giovanni, Spratt David, Siebert Jeff
Department of Diagnostic Sciences, Texas A and M University System Health Science Center, Dallas, TX 75246, USA.
J Contemp Dent Pract. 2012 Jan 1;13(1):1-10.
This study addresses the efficacy of an automated decontamination protocol using the germicide 'tetra acetyl ethylene diamine (TAED) perborate' (Farmec SpA, Italy). The germicide TAED perborate protocol is used in the Castellini Dental Units fitted with an Autosteril unit (an automated device that can cycle 0.26% TAED perborate solution and sterile water for cleaning the water system between patients and overnight). Prior to testing the Autosteril and the 0.26% TAED perborate protocol on the Logos Jr Dental Unit (Castellini SpA, Italy), TAED perborate was used on a dental unit water system simulation device.
A dental unit water system simulation device equipped with four dental unit water systems and with naturally grown and mature biofilm contamination was used in this study (three treatment units and one control). One treatment group used a simulated 5 minutes contact with TAED perborate and sterile water for irrigation; the second used a simulated 5 minutes contact with TAED perborate and 2 ppm ClO2 for irrigation; the third used a simulated 5 minutes contact with TAED perborate and municipal water for irrigation. The control group used municipal water for irrigation with no cleaning/disinfection protocols. This protocol was repeated for 30 cycles. Laser scanning confocal microscopy (LSCM) was used to study the effects on natural and mature biofilms, and R2A agar used to quantify heterotrophic plate counts in the effluent irrigant. Antimicrobial efficacy was evaluated by challenging TAED perborate with microbes and spores (M. smegmatis and B. subtilis). Deleterious effects of the germicide were evaluated on metal and nonmetal parts of dental unit water systems. Heterotrophic plate counts using R2A agar and LSCM of the lines were conducted to assess biofilm and microbial control.
Baseline water samples showed mean contamination >5.6 log10 cfu/ml. After initial cleaning, all three groups maintained mean contamination levels of less than 1.1 (SD <0.3) log10 cfu/ml. LSCM of baseline samples was positive for live biofilm in all groups. At the end of the study, viable biofilm was only present in the control. In the microbial challenge test, all vegetative organisms were killed within 30 seconds of contact, while spores were killed within 5 minutes. Corrosion was seen in metals used in US-manufactured dental unit materials, while not observed in those used in the Castellini Logos Jr dental unit.
In this study, the TAED perborate protocol was effective in biofilm control and control of dental treatment water contamination. Use of sterile water or 2 ppm ClO2 along with TAED treatment also controlled planktonic contamination effectively.
Environmental biofilms contaminate dental unit water systems over time and affect the quality of dental treatment water. Contaminants include environmental biofilms, microbes, including gram-negative rods and endotoxins in high doses that are not of acceptable quality for treating patients. There are many germicidal protocols for treating this contamination and one such is the prescribed use of TAED perborate used in conjunction with sterile water for irrigation in the autosteril device, an integral component of the Castellini dental units for between patient decontamination of dental unit water systems. This study was conducted on an automated simulation dental unit water system to test the TAED perborate protocol's efficacy on naturally grown, mature environmental biofilms, it's efficacy on microbes and spores and it's effects on materials used in dental unit water systems. This translational research addresses both microbial control and material effects of TAED perborate in studying efficacy and possible deleterious effects and simulated use in dentistry. Currently, this antimicrobial use protocol is followed worldwide in the Castellini dental units that are used in day-to-day dental patient care.
本研究探讨了使用杀菌剂“四乙酰乙二胺过硼酸盐”（意大利法尔梅克公司）的自动去污方案的效果。在配备自动消毒装置（一种可循环使用0.26%四乙酰乙二胺过硼酸盐溶液和无菌水，用于在患者之间及夜间清洁水系统的自动设备）的卡斯泰利尼牙科设备中使用了四乙酰乙二胺过硼酸盐杀菌剂方案。在对意大利卡斯泰利尼公司的Logos Jr牙科设备上的自动消毒装置和0.26%四乙酰乙二胺过硼酸盐方案进行测试之前，先在牙科设备水系统模拟装置上使用了四乙酰乙二胺过硼酸盐。
本研究使用了一个配备四个牙科设备水系统且带有自然生长和成熟生物膜污染的牙科设备水系统模拟装置（三个处理组和一个对照组）。一个处理组模拟使用四乙酰乙二胺过硼酸盐和无菌水冲洗5分钟；第二个处理组模拟使用四乙酰乙二胺过硼酸盐和2 ppm二氧化氯冲洗5分钟；第三个处理组模拟使用四乙酰乙二胺过硼酸盐和市政用水冲洗5分钟。对照组使用市政用水冲洗，不进行清洁/消毒方案。该方案重复30个周期。使用激光扫描共聚焦显微镜（LSCM）研究对自然和成熟生物膜的影响，并用R2A琼脂定量冲洗液中的异养平板计数。通过用微生物和孢子（耻垢分枝杆菌和枯草芽孢杆菌）对四乙酰乙二胺过硼酸盐进行挑战来评估抗菌效果。评估了杀菌剂对牙科设备水系统金属和非金属部件的有害影响。使用R2A琼脂进行异养平板计数并对管线进行LSCM检测，以评估生物膜和微生物控制情况。
基线水样显示平均污染>5.6 log10 cfu/ml。初始清洁后，所有三个组的平均污染水平均保持在低于1.1（标准差<0.3）log10 cfu/ml。所有组基线样本的LSCM显示活生物膜呈阳性。在研究结束时，仅对照组存在有活力的生物膜。在微生物挑战试验中，所有营养型生物体在接触30秒内被杀死，而孢子在5分钟内被杀死。在美国制造的牙科设备材料中使用的金属出现了腐蚀，而在卡斯泰利尼Logos Jr牙科设备中使用的金属未观察到腐蚀。
在本研究中，四乙酰乙二胺过硼酸盐方案在生物膜控制和牙科治疗水污染控制方面是有效的。使用无菌水或2 ppm二氧化氯与四乙酰乙二胺过硼酸盐处理相结合也能有效控制浮游污染。
随着时间推移，环境生物膜会污染牙科设备水系统，并影响牙科治疗水的质量。污染物包括环境生物膜、微生物，包括革兰氏阴性杆菌和高剂量内毒素，这些对治疗患者来说质量不合格。有许多杀菌方案用于处理这种污染，其中一种是规定在自动消毒装置中使用四乙酰乙二胺过硼酸盐并结合无菌水进行冲洗，自动消毒装置是卡斯泰利尼牙科设备用于患者之间牙科设备水系统去污的一个组成部分。本研究在一个自动模拟牙科设备水系统上进行，以测试四乙酰乙二胺过硼酸盐方案对自然生长、成熟的环境生物膜的效果、对微生物和孢子的效果以及对牙科设备水系统中使用材料的影响。这项转化研究在研究效果、可能的有害影响以及牙科模拟使用方面涉及了四乙酰乙二胺过硼酸盐的微生物控制和材料影响。目前，在日常牙科患者护理中使用的卡斯泰利尼牙科设备中，全世界都遵循这种抗菌使用方案。
