Whether we realize it or not, the design of the world around us is one of the most powerful influences in our lives. Space design—including the design of your dental practice—not only affects moods and emotions, but movement and behaviors. When done right, practice design can subconsciously spur behaviors that enhance safety, well-being, and infection control. Design is a fundamental way to promote asepsis and efficiency if it’s layered with smart spatial arrangement and engineering controls.
The state of sterilization
The dental industry has adopted sterilization practices per the Centers for Disease Control and Prevention (CDC), which recommend a safe, dirty-to-clean workflow.1 Sterile processing is divided into four parts to ensure this:
1. Receiving, cleaning, and decontamination—Debris and contaminants are removed through scrubbing/ultrasonic cleaning
2. Preparation and packaging—Instruments are sorted and wrapped for sterilization
3. Sterilization—Instruments are loaded, processed, and cooled in a mechanical sterilizer
4. Storage—Wrapped instruments are kept safe from contaminants in a closed cabinet
The prefabricated sterilization centers manufactured by dental equipment companies are designed to make this process intuitive and seamless, with dedicated cabinets, surfaces, and storage (i.e., “a place for everything, and everything in its place”).
A two-room solution for sterilization and clean supplies
Hospitals and health-care facilities also use this universal dirty-to-clean workflow, but with a key enhancement: confining decontamination procedures to a closed, designated room with negative air pressure that is separate from an adjacent clean workroom. The recommendation came in 2018 from the Facility Guidelines Institute, the widely recognized organization responsible for developing safe and effective health-care design standards. Concerns had been raised that one-room sterilization layouts made it difficult to ensure proper workflow and safe airflow.2 While dentistry was exempt to allow flexibility, it’s interesting to consider how a two-room solution could be beneficial.
Imagine a scenario where dental sterile processing steps one through three occur in a closed room with a door on each end to drive one-way traffic. Closed spaces boost the effectiveness of freestanding air purifiers—such as the EnviroKlenz Mobile Air unit—or make it possible to achieve negative air pressure to safely contain and exhaust contaminated air. Step four, or the storage of sterilized instruments, is beneficial in a separate, adjacent room with a pass-through window for safe transfer of clean cassettes when removed from the sterilizer. By hospital standards, a clean storage room should contain positive air pressure, or an increased supply of clean air as compared to surrounding spaces. Separation allows staff to retrieve clean instruments and supplies without having to enter sterilization, thereby reducing the risk of cross-contamination via air or surfaces.
Clean supply storage enhancements
Speaking of clean supplies, apart from keeping them in a space separate from sterilization, having a smart method for organization promotes safe habits while boosting efficiency. Supply storage is often an afterthought in practice design, but the right system saves time, steps, and sanity. Bulk storage of personal protective equipment (PPE) and other supplies should be kept off the ground on shelving. For smaller supplies that are ready to unpackage, clear, tip-out bins allow staff to take quick, visual inventory when locating what they need or determining what to order. Organization is a practice that requires some work and maintenance, but it’s easier to drive desirable behavior when things like visibility, access, frequency of use, and restocking are considered at the onset.
Planning for more PPE
In light of the COVID-19 pandemic, a dental hygienist in full PPE is indistinguishable from a surgical nurse. So what can dentists learn from hospitals about designing for extra PPE? For starters, consider a donning room that contains a hand-washing sink or sanitizer, and shelving and bins to keep PPE orderly. Bench seating and a mirror make applying PPE more comfortable. When supplies are organized and within reach, and a space supports required actions with ease, it encourages staff to establish and maintain good habits. Traditionally, donning rooms are designed with positive air pressure. If this isn’t feasible in your practice, the important takeaway is that donning should be performed in a clean space, away from potential contaminants. A high-quality air purifier can help, and soiled PPE should never be worn or disposed of in a donning room.
Current CDC guidelines instruct dental practitioners on the proper sequence for donning and doffing PPE. Disposable gowns or reusable protective clothing should be removed within the operatory,3 but then what? Widespread use of these extra layers creates an influx of soiled trash or laundry that must be dealt with safely. Hospitals utilize soiled holding rooms where contaminated items can be safely contained until they’re disposed of or laundered. If your practice is concerned about the cost and availability of disposable PPE, reusable gowns are a great alternative, whether laundered on-site or by a third-party linen company.
Designing for desired processes
Whether at work or at home, we adapt to the confines of our space. This happens subconsciously. When it comes to the dental environment, it’s important to recenter around why and how we’re making concessions—especially with the added complexities of safety during a global pandemic. Take inventory of the spaces in your practice and how they’re being used; be scrutinous and give yourself permission to make modifications. Don’t compromise your processes to suit your space. Instead, feel empowered to design spaces that seamlessly support the safe practices you desire. The rewards—efficiency, infection control, and peace of mind—far outweigh the investment.
1. Guidelines for infection control in dental health-care settings—2003. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. 2003;52(RR-17) https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
2. Wright P. FGI requirements for sterile processing facilities. Health Facilities Management. April 18, 2019. https://www.hfmmagazine.com/articles/3620-fgi-requirements-for-sterile-processing-facilities
3. Guidance for dental settings. Centers for Disease Control and Prevention. Updated August 28, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
Benco design manager MELISSA SPRAU, NCIDQ, brings over a decade of commercial and hospital design experience to the dental industry. As a licensed interior designer with a background in health-care facilities planning and design, her approach combines best practices for health and safety with the details required to support positive patient and caregiver experiences. Sprau coaches practitioners to discover their brand and infuse it into the built environment, aligning quality of space with quality of care.