Design a Safer Practice

Introduction

Safety is a critical factor in patient and teammate care. Maintaining team confidence and building patient trust is as important as ever. Ensuring safe workflow and the highest standards of infection control within your practice can help sustain your business. This document examines how practice design, the right equipment, and the right processes can support your goals to improve workflow and help prevent infection every day.

Opportunities to ensure safer workflows can be found throughout your practice. Two important, usually high-traffic, environments are the sterilization center and operatories. Start in these spaces as you design a safer practice.

Sterilization Center

5-STEP INSTRUMENT PROCESSING WORKFLOW

1. Receiving + Cleaning: Reusable instruments, supplies, and equipment should be received, cleaned, and disinfected in one section of the processing environment. Handpieces should be cleaned on both the outside and inside.
2. Preparation + Packaging: Cleaned, dried instruments and other supplies should be inspected for residual debris and damage, assembled into sets or trays, and wrapped or packaged for sterilization.
3. Sterilization: The sterilization area should include the sterilizer and related supplies with adequate space for loading and unloading. Follow the instructions for use (IFU) for each instrument.
4. Monitoring/Sterility Assurance: Mechanical, chemical, and biological monitoring should be used to ensure the efficacy of the sterilization process. Results must be recorded.
5. Storage: The storage area should be adequately sized, closed or covered, and located apart from contaminated instruments in an area protected from moisture. Supplies and instruments should not be stored under the sink.

Design a Safe and Efficient Workflow

A team may enter and exit the sterilization area 80-120 times or more each day. Efficiency and risk reduction are essential. Multiple ways exist to lay out an effective sterilization center following the CDC's recommended dirty-to-clean workflow. The layout and location depend on available space. Straight-line and galley-style layouts are common. A minimum of 10-12 feet of linear space is recommended for a single-doctor practice with up to 5 treatment rooms, adding 2 feet per additional doctor or 2-3 treatment rooms. For maximum efficiency, the sterilization center is recommended to be centrally located, no farther than 3 operatories away.

Common Layouts:

• Galley: Workspaces on two opposing walls with a single traffic lane. Allows easy access and efficient workflow using a linear flow.
• U-Shaped: Provides ample space for multiple cleaners and sterilizers. Ample surface areas allow more team members to multitask.
• Straight-Line: Perfectly suited to a 5-step workflow, maximizing efficiency for effective infection prevention.
• L-Shaped: Maximizes use of available space where elbow room is limited, allowing effective and safe instrument processing.

Diagram Key: 1. Receiving + Cleaning, 2. Preparation + Packaging, 3. Sterilization, 4. Monitoring/Sterility Assurance, 5. Storage.

Build Patient Confidence with a Safety Showpiece

A well-designed sterilization center can be a valuable marketing tool to reassure patients about safety. Clear windows can allow patients to observe from a safe position. Krystal Gillis, DDS, noted increased workflow speed and faster instrument turnover. Ileana T. Toro, DMD, stated, "Safety is our best marketing tool." She explained that a large window in the sterilizing room allows patients to see effective practice and trust that everything is sterile, turning unique design into word-of-mouth marketing.

Treatment Room Safety

Patient safety is vital, as is the health of your team. A significant 78% of dental professionals suffer from neck, shoulder, and/or lower back pain, and 34% of lost workdays are due to work-related musculoskeletal injuries. OSHA estimates the average cost per incident for such injuries is $64,000.

Designing your treatment room for better ergonomics and workflow

A treatment room measuring approximately 10 feet, 4 inches wide by 12 feet deep provides adequate space for most ideal configurations. Start with the dental chair (typically 6 feet long), then add ideal spacing and equipment. This includes a back cabinet (17.5 to 24 inches deep), space between the back cabinet and chair head (24 to 30 inches), space at the foot of the chair (18 inches), side cabinets (18 inches deep), and ADA clearances (32 inches on either side of the chair for accessibility). These dimensions and layout support ideal workflow and ergonomics by including maneuverable space around the chair and placing delivery units, work surfaces, and the oral cavity within reach.

For a deeper dive into health risks, consult the white paper "4 Reasons to Take Ergonomics Seriously."

Design for Clinical Workflow

Cabinetry placement and design should support proper ergonomics. Planning around 120 square feet per operatory is recommended to accommodate equipment, work surfaces, ADA clearances, maneuverability, and ergonomic positioning. Smaller rooms can limit cabinetry and work surfaces, impeding workflow.

Dual Entry Operatory Considerations:

• Start with the dental chair (typically 6' long) as the center.
• Keep 32" of space in at least one doorway per ADA recommendations.
• Consider 32" of space between the chair and side cabinet on at least one side for entry and exit.
• Add side cabinets (typically 18" deep) and a treatment station (17.5" to 24" deep) for storage and instruments within reach.
• Add 24" to 30" between the treatment station and the fully reclined head of the chair for comfortable work from the 10 o'clock to 2 o'clock positions.
• Add 18" at the toe of the chair to maintain clearance for staff, equipment, and horizontal travel when raising the chair.

Midmark design experts can assist in creating functional spaces optimized for workflow, including equipment sizing, layout, upholstery colors, and cabinetry finishes.

Protect Patients from the Moment They Sit Down

Welcoming patients into a clean environment sets a good first impression. Asepsis-friendly upholstery, like Midmark's Ultraleather, can be used on waiting room chairs and dental treatment chairs. Ultraleather is made of high-performance polyurethane materials engineered for durability and resistance to cleaning and disinfecting challenges. Adhere to IFUs for upholstery and equipment to promote a long product life, as disinfectants can degrade upholstery.

Dental chairs move in multiple ways, which can be dangerous. The Elevance Dental Chair features a Child Lockout System to disable electronic controls, preventing unintentional use. Buttons and brake release pedals are inoperable when locked, preventing possible injury to children. Elevance Dental Chairs also have collision protection: if safety switches bump an obstacle, the chair stops moving and raises slightly. Safe environment design also ensures sharps safety. A sharps container should ideally be in every operatory, located as close as possible to the area where used disposable syringes, needles, scalpel blades, and other sharp items are used.

Regular handwashing is crucial for removing germs and preventing spread. Minimize contaminant spread by having an adequate number of sinks available.

Keep the Dental Delivery Unit Safe

Waterline maintenance is necessary to control heterotrophic bacteria levels, guided by local or regional standards. Delivery unit waterline treatments include tablets and straw/cartridge-based systems. Cartridge systems may perform better in keeping bacteria levels in check and preventing waterline clogs. Regularly monitor lines; if levels exceed desired limits, perform a shock treatment. Experts recommend monthly monitoring, adjusting frequency based on test results. Routine flushing of waterlines between every patient is recommended by the CDC. Extra flushing may be needed with tablets, as undissolved particles can obstruct lines. Flushing maximizes water flow and pushes particles through.

Cabinetry and Surfaces

Control Contaminants Hiding in Plain Sight

The risk of contamination from surfaces is constant. Cabinetry and countertops can harbor pathogens, making material choice critical. Durable, aseptic cabinetry and surfaces should withstand water, steam, and heavy use in sterilization areas and treatment rooms, and be easily disinfected.

Midmark Recommendations for Effective Infection Control:

• Aseptic, non-porous counter materials (e.g., solid surface, quartz).
• Heat-and-moisture-resistant cabinet surfaces and materials.
• Easy-to-clean, bactericidal cabinet and drawer handles.
• Seamless polystyrene drawers and seamless panels.

Compare Cabinetry

Compare Quality: Midmark Clinical-Grade Cabinetry vs. Generic Consumer-Grade Cabinetry

Midmark steel-constructed Synthesis cabinetry with solid-surface or quartz countertops resists delamination or chipping and features durable aseptic polystyrene drawer liners. Hands-free dirty storage and foot pedals for waste disposal can be integrated. Touchless faucets and anti-microbial handles offer additional infection control. Standard consumer-grade millwork uses square-edged laminate stripping, creating sharp corners and potential delamination. Door edges can unseal, becoming susceptible to moisture and bacteria. Seamless drawers made from lightweight, moisture-resistant material like polystyrene are best for cleanup. Industrial-grade particle board or medium-density fiberboard substrates minimize shrinkage and expansion, preventing warping. Veneered plywood and lower-density boards perform poorly in humidity, allowing contaminants into compromised areas.

Mechanical Room / Air Quality

Reduce Airborne Risks

Dental air compressors and vacuums are essential for handpieces and evacuation. While safety protocols address all pathogens, there is a new focus on airborne pathogens. The CDC recommends ensuring indoor spaces are properly ventilated to reduce exposure to infectious respiratory droplets. This can be enhanced by filtering the air used during treatments.

Midmark PowerAir Oil-Less Air Compressors feature a 0.01-micron coalescent filter designed to provide clean air, capturing 99.9997% of compressed air contaminants. This filtration is 500-times greater than the industry standard and can trap many bacteria, most dust, and some viruses.

Diagram Description: A graphic illustrates particle sizes in microns. The largest circle represents a human hair (50 microns). Subsequent circles show typical sizes for respiratory droplets (5 microns), dust particles (2.5 microns), bacteria (1 micron), and viruses (0.06 microns). Many dental compressors filter air to an industry standard of 5 microns. Midmark PowerAir compressors use 500x greater filtration with a 0.01-micron coalescent filter, shown as the smallest circle.

For patients concerned about indoor procedures, knowing the air is well-ventilated and filtered may provide reassurance. Adding high-volume evacuation (HVE) tools requires adequate vacuum pump speed to support their use. Consult Midmark resources or sales teams for equipment needs.

Imaging

Safely Gain Treatment Insight

Treatment plans begin with preventative oral care, where safety must be considered, especially with radiation from imaging. X-ray safety focuses on radiation exposure. While dental imaging radiation is low compared to environmental exposures, its effects are cumulative. Limiting exposure makes a difference.

Following FDA and ADA guidelines at the point of care during imaging procedures helps ensure the lowest radiation dose for specific exam needs and improves outcomes through accurate diagnoses. Implementing proper cleaning techniques and using protective sheaths on digital sensors between uses, as recommended by the manufacturer, properly protects patients from contamination.

The ALARA (as low as reasonably achievable) Principle minimizes patient exposure. ADA guidelines for prescribing dental radiographs help reduce overutilization and excessive radiation, while preventing underutilization for inadequate diagnoses.

Patient Categorization for Imaging:

• Type of visit (new or recall)
• Dental status (child with primary or transitional dentition, adolescent, or adult dentulous or edentulous)
• Risk category for caries, periodontal disease, or growth and development assessment

From this, the right dose can be determined, balancing patient safety and comfort. Direct digital sensors offer the lowest dose. Easy-to-use intraoral X-rays (IOs) with preset technique factors, adjustable for the right dose, are also available. Use IOs with the smallest focal spot, such as 0.4 mm, for the lowest dose and sharpest images.

Staying Informed

It is important to understand safety implications for your practice and appoint someone to regularly review local, state, and federal standards. Key agencies creating standards include the American Dental Association (ADA), the US Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC). Enforcement agencies include the Occupational Safety and Health Administration (OSHA), the Joint Commission, and local authorities.

For assistance navigating these standards, consult the Association for Dental Safety (ADS), which provides infection prevention and control education, training, and credentialing. Midmark sales and marketing teams have earned certificates of course completion from the OSAP-DALE Foundation in Dental Infection Prevention and Control.

Midmark looks forward to designing better, safer care with you.