title: Comparison of the ActiDes-Blue and CARELA HYDRO-DES technology for the sanitation of contaminated cooling water systems in dental units.
abstract: BACKGROUND
  The hygienic-microbiological control of 6 dental units being in use for the past 16 years revealed a significantly increased microbial contamination of their cooling water system. In order to comply with the requirements of the drinking water directive ("Trinkwasserverordnung"), the commercially available production system ActiDes, producing on-site ActiDes-Blue which is based on hypochlorous acid (HOCl) and generated by anodic oxidation, was investigated.
  
  
  METHODS
  Water samples from the 6 contaminated dental units were examined for the total number of colony forming units (cfu), contamination with molds, L. pneumophila and P. aeruginosa. The control period for the total colony count was 4 weeks (8 samples/unit). The subsequent application phase of the ActiDes-Blue procedure was 6 months (31 samples/unit). Additionally, the redox potential and the pH value were measured.Futhermore, the decontamination agent CARELA HYDRO-DES, a two component agent based on H(2)O(2) with the addition of a mixture of sodium hydrogen sulphate and sulphuric acid in an aqueous solution effective at 0.1% and higher, was applied in a unit that had been put out of service for a month before. Before application, the system was first filled with a 5% solution of the alkaline pre-cleaning agent CARELA Solvent for bacterial slime; the system was left with this solution for 1 h. The pre-cleaning agent was then completely displaced from the system with tap water and a decontaminating solution of 5% CARELA HYDRO-DES and left in place for 1 h.
  
  
  RESULTS
  Drinking water quality level was reached only twice during the control phase. The average values of the dental units ranged between 3,633 CFU/ml and 29,417 c/ml. During the application phase, drinking water level could be achieved in 11 water samples. In another 6 water samples a total colony count of <150 cfu/ml was reached. The average values for the dental units' total colony count ranged between 529 cfu/ml and 87,450 cfu/ml. No significant differences between the control phase and the action phase could be demonstrated. During the control phase, contamination of the water samples with a mold was noticed so that examinations for molds were carried out beyond the scope of the drinking water directive. For this parameter as well, no significant differences between the phases of the study could be shown.The Legionella load of the dental units was low. L. pneumophila were yielded in only 4 out of 130 water samples. During the control phase, twice colony counts at 50 cfu/1,000 ml and 110 cfu/1,000 ml were measured. During the action phase, counts with Legionella spp. could be measured at 5 cfu/1,000 ml for one unit only. Also, with 1-10 cfu/100 ml, the P. aeruginosa contamination was low. During the application phase, it ranged between 0-7 cfu/100 ml.Redox potential and pH value showed a slight decrease during the application phase.Before treatment with CARELA Solvent and CARELA HYDRO-DES, the initial contamination of the total count of bacterial colonies was 1,432 cfu/ml at 22°C and 846 cfu/ml at 36°C as well as >1,000 cfu/100 ml for molds. 1 h after the decontamination, no bacteria and molds could be detected in 1,000 ml of tap water. Despite the fact that the unit was not used any longer, after 7 d the bacterial colony count was 3 cfu/ml at 22°C and 2 cfu/ml at 36°C while molds could not be detected. Even after a rest time of 14 d only 167 cfu/ml or 42 cfu/ml could be yielded. Molds were further not cultivable. A material damage could not be observed.
  
  
  CONCLUSIONS
  Pertaining to the ActiDes technology's effectiveness, it has to be pointed out that the dental units investigated were those used for dental students' teaching and therefore were clearly less frequently used than clinically used units in a dental practice. This resulted in distinctly longer stagnation periods which favored formation of biofilms.
  
  
  CONCLUSIONS
  In summary, the ActiDes technology and ActiDes-Blue showed not to be sufficiently effective for the sanitation of contaminated water reservoirs in dental units under aggravated conditions of repeated and longer periods of non-use in connection with longer water stagnation periods. In comparison, the biofilm was sustainably eliminated through the combined application of CARELA(®) Solvent for Bacterial Slime with subsequent decontamination using CARELA(®) HYDRO-DES.
authors.affiliation: Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kramer
authors.forename: Sandra
authors.initials: S
authors.lastname: Lemanski
authors.forename: Kathleen
authors.initials: K
authors.lastname: Demond
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian