During the past year, the coronavirus disease 2019 (COVID-19) pandemic has forced dentists to reevaluate their approach to safety. Dental teams have had to change how they schedule, extend appointment times to allow for more vigorous cleaning and update personal protective equipment (PPE) protocols, all while performing other infection control (IC) tasks.
Trying to get it all done can pose challenges to other critical areas such as productivity and patient experience. Efficiency is crucial. Adding protocols and tasks designed to enhance safety is not enough. Practices must consider how best to perform procedures. It starts with determining the minimal time needed for tasks that must be completed daily to keep everyone safe, says Gary Morgan, vice president and a senior compliance advisor for SafeLink Consulting.
“It’s kind of a time study,” he says. “You need to figure out how much time it actually takes to do this so you know how many patients you can move through efficiently, without causing yourself to have to stay longer at the end of the day or dealing with disgruntled patients who had to wait longer because you haven’t planned everything out efficiently. I see that struggle every day.”
To be successful, you must find that balance. It might seem daunting, but with the right training, guidance, and a clear plan, it certainly is possible.
Education, Training, and Reevaluating
Once you and your team members understand the reasons behind new protocols, implementing them will be easier, says consultant Marie Fluent, DDS, who is a member of the Organization for Safety, Asepsis, and Prevention (OSAP) and an IC expert. Such understanding comes from education and training. That means providing safety training as part of the onboarding process and evaluating staff performances throughout the year, says consultant, trainer, and speaker Karen Daw. Training should go beyond checking off boxes on a list; rather, proficiency must exceed minimum requirements or whatever guidance a product manufacturer offers. Team members should be able to complete the same tasks the right way every time, which might require comprehensive continuing education courses or bringing in a consultant.
Of course, this does not just apply to COVID-19 safety protocols. Now is the time to question everything that has been done and to think about what can be improved, says compliance/risk management specialist Linda Harvey. Team members need to find better, more efficient ways of completing tasks and to effectively incorporate new protocols and procedures into their workflow. “If you go back and look at HIV/AIDS, that really shifted our approach to safety in the dental setting,” Daw says. “Here is another opportunity for us to reevaluate whether the systems we have in place are working for us.”
Develop a Plan
A key to improving efficiencies is normalizing steps put into place to enhance safety, Daw says. You must adjust without compromising the quality of care or productivity, making it routine.
“Adapt these practices so they become habits and don’t take extra time,” says Luci Perri, owner and president of Infection Control Results. “It’s the same as getting up in the morning and brushing your teeth. It takes time but you don’t think about it because it’s just part of your normal routine.”
If you are uncertain about where to begin, you might consider partnering with a consultant, Daw says. Doing so can offer a fresh perspective on what is working and what is not and help you form a plan to improve efficiencies and grow your bottom line.
Whether working with a consultant or just with the team, developing standardized procedures will lead to better patient care, Harvey says. These procedures will ensure tasks are completed the same way every time, which reduces the possibility of error.
As policies are changed or added, write everything down, Dr Fluent says. Make it easy for team members to find protocols so that there is no confusion. You might consider appointing an IC coordinator to ensure policies are followed, Dr Fluent adds. This person should stay up to date on the latest regulations and policies from various organizations, which are constantly evolving, and train, educate, and encourage the rest of the staff as recommendations change.
Of course, whomever you assign to this position—whether it is a dental assistant, office manager, or hygienist—still has a primary job and could use help with these new responsibilities, says Chantel Willis, associate director, SBU, instrument management and infection prevention for HuFriedyGroup. That is where a solution like the GreenLight Dental Compliance Center by Hu-Friedy comes in.
GreenLight is an online portal that houses everything a practice needs for an efficient IC program, Willis says, and creates policies for optimal safety, saving time. With GreenLight, team members can find resources from the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), and other organizations, along with any policies and protocols the practice has developed. The portal can be accessed for questions, training videos, patient communication forms, and other resources designed to ensure team members are in compliance and running their IC program as efficiently as possible.
The compliance hub also helps with onboarding, giving new employees a place for information they need about your practice’s IC protocols, Willis says. Whether bringing someone in for a few days or full-time, having standardized procedures ready and accessible is a huge time-saver. You can also send new employees training materials they can review before their first day.
“You have to have standards. You have to have a benchmark for how the practice will operate and expectations for your staff,” says Jessica Wilson, business development manager for IMS at HuFriedyGroup. “Every practice should look at their mission statement, vision statement, and brand and ask, ‘Who do we want to be? How do we want to show up, and where does compliance fit as far as safety for my staff and the patient experience?’”
Dr Fluent also encourages dentists to join OSAP. It’s the only IC organization dedicated to dentistry, she says, and is a great resource. Right now, all the information on OSAP’s website and its COVID-19 toolkit are available for free. This includes access to guidelines from the CDC, OSHA, the World Health Organization, EPA, and state dental organizations.
Instrument sterilization remains an area that could use an efficiency boost in many practices. Sterilizing can take time. It is critical to streamline the process for the sake of productivity goals and patient experience.
Morgan suggests having 1 employee dedicated to sterilizing instruments each day. If you have too many individuals in an area, they can obstruct one another and add confusion to the process. Putting 1 worker in charge of sterilization activities eliminates this problem and helps ensure no one has to wait for a clean instrument before being able to begin a procedure. For smaller practices, Morgan recommends determining the best time for sterilizing instruments to enhance everyday efficiency.
- Some disinfectant sprays need to set for as long as 10 minutes before being effective, although others only require 1 minute, consultant Gary Morgan says. Finding sprays that are effective against COVID-19 in less time can do wonders for efficiency.
- The standards you have for productivity should apply to safety as well, consultant and speaker Karen Daw says. That mentality will make you more efficient when it comes to safety tasks.
- Virtual Sterilization Observation
Through this service, HuFriedyGroup customers can submit photos and talk to a team member about challenges with sterilization, Jessica Wilson, business development manager for IMS, says. Customers then receive an analysis that points out opportunities for improved efficiency and compliance.
- Disposable Products
Single-use products eliminate the need for cleaning, adding efficiencies to a practice. Disposable high-volume evacuation valves are an example, Luci Perri of Infection Control Results says. Team members do not have to worry about sterilizing them between patients, saving time.
It is also a good idea to consider the size of your sterilizer, Perri says. If you use a tabletop steamer, evaluate how much it can hold versus how many instruments you need to sterilize each day. You might find it does not have enough capacity for how busy you are and that it is time to invest in a bigger system. Doing so saves time so that team members can focus on patients.
Using instrument management cassettes like the IMS from HuFriedyGroup eliminates steps in the sterilizing process, Willis says, making it more efficient and safer. With the IMS, team members do not need to handle contaminated instruments; they are rinsed, washed, dried, packaged, and stored in the cassettes. There is no sorting through instruments in cluttered drawers to find what is needed. Everything is color-coded and easy to identify. All of this saves between 5 and 10 minutes per procedure. The protected instruments last longer, which also reduces costs. “Reprocessing instruments is critical for the practice, but it’s not a revenue-generating procedure,” Willis says. “So the more time it takes, the more time it takes away from you doing other things.”
Handling Sharps Injuries
Reprocessing instruments in cassettes reduces the likelihood of sharps injuries, Willis says, enhancing safety and reducing the spread of blood-borne pathogens. Team members are not handling the contaminated instruments directly or sorting through instruments in drawers. Everything is properly spaced, packaged, and ready when needed chairside. “The less time spent around sharps and contaminated items,” Daw says, “the lower the risk and liability and overall cost to the practice in the long run.”
Although the goal is to avoid sharps injuries as much as possible, chances are they will happen from time to time—making it critical to have a protocol in place, Morgan says. Have all forms ready and accessible. The quicker you react, the quicker an employee can be treated. Morgan also suggests making sure everyone knows first aid protocols in case of an incident. This is something many offices may overlook.
“Every dental practice or clinic should have a blood-borne pathogens plan,” Perri says. “If someone gets stuck with a sharp or gets a splash of blood or body fluid on their skin or in their eyes, you’ll know exactly what to do. You also need to have a plan for who will determine whether the exposure requires medication.”
To ensure everything is running properly, it is important to implement quality measures in sterilization and IC areas, Harvey says. Those measures range from properly maintaining your dental unit waterline to loading cassettes correctly to conducting biological monitoring in your sterilizer.
Although 1 person should be responsible for each task, it is critical for everyone on the team to be trained, Harvey says, so tasks are never left undone if someone is out of the office. Just a few months ago, Harvey received a frantic call from a client who realized no one had been running the biological monitoring tip in the autoclave; they had been running only the chemical indicator tip. “When those errors happen, it puts the practice in noncompliance with CDC guidelines,” she says, “and many times not compliant with state laws.”
In a busy practice, it is easy to forget steps or to try seemingly harmless shortcuts to save time. Although you want to be efficient and productive, you must perform all the necessary steps in every procedure. Otherwise, you put patients and team members at risk and waste time dealing with problems that skipping steps can cause.
Follow Manufacturer Instructions
Not understanding manufacturer instructions for the various products used for IC also can cut into efficiency, Harvey says. It is important for team members to understand how a product works, why they are using it, and how it is supposed to be used.
“It can happen with something as simple as disinfectant wipes,” says Daw. “When team members read the label, they might discover they have a 2-step product that requires cleaning the surface, wiping it down, and then letting it sit for 5 minutes. You need to make sure you’re using it properly. If you don’t have minutes to wait, find a product with a shorter contact time.”
Investing in low-maintenance products also will help boost efficiencies so you stay more focused on patients and productivity, Daw says. Find high-quality products that eliminate steps in a procedure or reduce the amount of monitoring needed.
Disinfecting Surfaces Efficiently
Before COVID-19, many practices had protocols and policies for wiping down common areas of the office that may or may not have been followed closely, Dr Fluent says. Now it is mandated, which requires more time.
Writing down policies that indicate which surfaces need cleaning and how often enhances compliance and improves efficiency, she says. Removing items like magazines and toys from reception areas also helps limit what needs to be wiped down, speeding this crucial task. Alleviating clutter and adding barrier protection in the operatories limits the time needed to clean between appointments, improving patient flow. Whichever disinfectant you use should be on the EPA’s List N to confirm it is effective against COVID-19, Dr Fluent says.
Properly Handling PPE
Practices not only need protocols for donning and doffing PPE, but also for storing it, Morgan says. It is critical that team members know how to handle gowns and shields after removing them so there is no cross-contamination.
Many team members hang gowns in different places or place them on something, Morgan says, making them hard to find, which wastes time and exposes them to cross-contamination. Dentists need to designate a home for all PPE so it is easily accessible and can be reused.
“I’ve seen someone hang up one gown and then someone hangs another gown on top of it. Now you have an exposed area touching the inside of an area that somebody is going to put on,” Morgan says. “I see that with face shields too. They hang 2 face shields together, contaminated side to not-contaminated side. It’s a challenge but you have to be cognizant of when you’re doing that.”
Of course, PPE must be removed more often, and hands washed more frequently, so ensuring everything the dentist and assistant need is in place before starting a procedure is crucial for improving efficiencies, Wilson says. If any instruments are missing, someone must get up, take off their PPE, get what they need, and put all the protective gear back on—wasting time and money. An IMS that makes instruments easy to identify helps with this.
A New Way of Scheduling
COVID-19 has made scheduling more of a challenge and less efficient. For social distancing reasons, many dentists are asking patients to wait in their cars before appointments. That means practices must be more structured in how they accommodate patients, Morgan says, keeping them safely moving.
“The hardest part is controlling that flow. So, first thing in the morning, practices have 3 or 4 patients coming in and have to handle that by either going vehicle to vehicle and checking them in or having them come in 1 at a time,” Morgan says. “If you don’t plan that properly, it will start to add to your time during the day. If your practice opens at 8 and you don’t open your door until 8, you’re already behind the game.”
Dental teams also must now make time for pre-screenings, Morgan says. Instead of sending automatic reminders, many are now contacting patients directly to ask whether they have been exposed to COVID-19, which takes more time. One way to make this more efficient is to leave a recorded message or send a text asking patients to call back if they have had any symptoms and need to reschedule an appointment.
Improve Efficiencies and Grow Your Bottom Line
Safety has always been a focus in dental practices, but COVID-19 has really brought it to the forefront. In addition to what they have always done, dentists are now implementing protocols and procedures to keep everyone safe and at ease while they are in the practice. But doing so efficiently is the key to staying productive and providing patients with the best care possible. It comes down to finding that balance. The practices that can do this will have the most success.