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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Six strategies for building an infection control process that's as efficient as it is effective.
The term “shortcut” has sort of a sloppy, lazy connotation. But there is no shame in wanting to do something faster, more effectively and, ultimately, more efficiently. Especially when the infection prevention is concerned, practices must have optimal processes and procedures in place to ensure staff and patient safety.
Here are six ways that can help ensure a clean, effective workflow.
Something as simple as making sure all the necessary items and tools are on hand smooths out the wrinkles in one’s workflow.
“It may be pretty basic, but one of the really important things to consider is having the infection prevention items readily available,” Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Mass., says. “Because if you have your tools of safety ready to go, things are going to go much more smoothly. If you have a stethoscope in one operatory or safety eyewear in one operatory or a particular type of mask in one operatory, have these in each operatory. If you’ve got a sensitive mask because one of your staff members, one of your assistants, needs a sensitive mask, have them in each operatory. That way, you’re not taking a pause to get up and get these items repeatedly throughout the day. You don’t want to slow down the time it takes to complete a procedure because you’re not prepared.”
The expense of those items is easily offset by the speed and efficiency they afford.
“Sometimes, items like your safety eyewear, will become damaged, and now you’ve got a backup pair,” Moore observes. “Having a box of masks and then just splitting that box in half and having that stack of half in a closed cabinet or a drawer isn’t really going to cost you more, and they’ll be ready, because you may have someone that uses a larger mask. You may have someone that’s a little bit more petite and you may have someone with a specific sensitivity. So you may be buying three different types of mask and can you keep a sample of each in each operatory. It’s very similar to gloves. Almost every operatory will have a variety of sizes of gloves or different glove materials, depending on who is working out of that operatory.”
There are other items, of course, she recommends stocking in each operatory.
“Each operatory should have its own container of hand sanitizer, its own supply of disinfecting wipes,” Moore adds. “Even having, say, a stethoscope in each operatory. That way, you can have a stethoscope ready to go. You can clean it appropriately and put it away until you need it next. You don’t want to have to go through three different operatories, hunting for what you’re looking for, especially when other staff are practicing or are working with patients.”
That notion of having everything readily accessible applies to important paperwork, as well.
“It’s also a great idea to have all of the documents that you need,” Moore says. “Have them ready. Have the manufacturer’s instructions for use for your sterilizer, for your ultrasonic, and, of course, your safety data sheets. If you have them at the ready, you’re less likely to take a shortcut, because you know where to get the information or the answer to your question when you’re doing something. For instance, if you don’t know how much solution to put in the ultrasonic. Well, if the book is handy, instead of taking a guess, you’ve got the information.”
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One path toward workplace efficiency that infection prevention consultant and speaker, Jackie Dorst, RDH, BS, recommends in the 5S System. It is a methodology for organizing spaces such that work can be performed efficiently, effectively and safely. The 5S System emphasizes putting everything where it belongs and keeping the workplace clean, making it easier for people to do their jobs, without wasting time or risking injury. The tent poles of the system are:
“In simple terms, the 5S methodology helps a workplace remove items that are no longer needed (sort); organize the items to optimize efficiency and flow (straighten); clean the area in order to more easily identify problems (shine); implement color coding and labels to stay consistent with other areas (standardize); and develop behaviors that keep the workplace organized over the long term (sustain),” Dorst explains.
While the system was initially developed to address manufacturing facilities, this system lends itself just as well to dental practices.
“When I was first introduced to it, my thoughts were, ‘Oh yes, this applies to the sterilization area and it applies to all of our infection control procedures in a dental office,’” Dorst observes. “This is the efficiency that we’re looking for. Most efficiency protocols are focused on manufacturing facilities because, of course, they need to implement efficiency to stay profitable. We can take the same 5S System and implement it with our infection prevention protocols and our sterilization, improving efficiency, saving ourselves time and ensuring that the right thing is done each time we process instruments or clean and disinfect the operatory.”
The Steri-Center should also be laid out with efficient workflows in mind. A disorganized sterilization area is a bottleneck that introduces inefficiency and the potential for cross-contamination.
“The sterilization room has five workstations,” Dorst observes. “Those five workstations must go in sequence so that you don’t cross-contaminate. Workstation number one is where you bring all of your dirty items and you throw away your biohazardous waste and put the items in to be clean. Workstation number two is if you’re using an ultrasonic, is the sink area where you rinse those instruments.
“Workstation number three is where you package clean instruments,” she continues. “You inspect them to make certain that all the debris has been removed from the instruments and then you package them into pouches or wrap the cassettes with CSR wrap. Workstation number four is the sterilizers. Station number five is where sterile instruments are stored inside cabinets or drawers. CDC specifically states that sterile instrument packages should be stored inside of a cabinet or inside of a drawer to prevent contamination of the exterior of the package. Working from station one to station five improves efficiency and prevents cross-contamination.”
She observes that many practices are redesigning their sterilization centers to better address those efficiency bottlenecks, but those redesigns require two precious commodities – money and space.
“A lot of offices are doing a sterilization remodel, and one of the remodel challenges is that the older sterilization rooms just don’t have enough square footage to put in the workstations that are needed,” Dorst says. “So we have to remove a wall or in some way add a little bit more square footage to prevent cross-contamination and put in an efficient sterilization process. Remodeling is expensive, but needed. It can be a huge cost for the project. When a doctor calls me and says, ‘I need to remodel my sterilization room,’ I usually tell the doctor, right up front, it’s going to be a $25,000 to $100,000 project, depending on the extent of the remodel and the new equipment needed.”
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The importance of ensuring everyone knows what they need to know can’t be understated.
“Education is your key strategy.” Moore says. “This is going to be likely to prevent your staff from taking shortcuts, because they’ve been educated on what the risks are and how they can potentially affect them or their patients. Knowing why a particular practice exists will likely cause them to be more apt to follow these recommendations. Education will pay you back, and it doesn’t mean that you have to take a three-hour session to go through this. This can be done in bits. It could be a lunch meeting; it could be, ‘I’m sharing a newsletter with some information’. There’s a variety of ways to get this education piece across. But, in the end, essentially it’s going to make everything run that much more smoothly.”
That educational component can be obtained both through the infection control coordinator’s own initiative, as well as from outside sources.
“It’s good to look to the experts, if you don’t have that expert in your place of employment,” Moore says. “That can be attending live educational sessions, that can be doing a course online with somebody from an organization like OSAP. There are other company websites that have great resources, like Dentalcare.com and Colgate, and there are other sites that have good quality education.”
The operatories within a practice are best processed by following the same cleaning and disinfection procedure. Having a standardized procedure ensures nothing is overlooked.
“The dental office needs to standardize how the operatory is cleaned and disinfected, so that the entire team is doing the same steps, the same way, each time,” Dorst says. “That’s for efficiency, and it’s also noticed by patients. Patients will see if they go into, say, the hygiene room and the hygienist is using barriers on the light handle and on specific equipment. And then when the patient has to go to the doctor’s operatory for a procedure for a crown or a filling and they don’t see those barriers on the light handle, then they could question, ‘Is this room clean or sterile?’ So there does need to be consistency throughout the dental office for all of the operatories.”
That process goes beyond perception. Having a standard process ensures effectiveness and efficiency.
“When procedures are standardized, then you don’t have lapses or oversight,” Dorst says. “That’s important in team training. Everyone knows how long the brand of disinfectant they use needs to stay wet to kill the microorganisms; which surfaces are they going to place barriers on; how they are going to clean and disinfect contamination the same way each time. Otherwise, there’s a risk for oversights or lapses.”
She also emphasizes the need to have the processes and procedures memorialized in writing.
“The lapse that we’ve seen in the offices is they don’t have a written plan,” Dorst says. “It’s just been word-of-mouth transfer of information. Having a written plan and having a checklist for each of the protocols that are done in infection prevention ensures that there are no oversights or breaches.”
All practices should name an infection control coordinator who can help efficiently guide the organization in its infection prevention efforts. That person serves as the local expert and can help optimize the practice’s efforts.
“Having an infection control coordinator in your practice is critical,” Moore says. “If there’s something that they’re not aware of, they will be able to take the time to find the information that you need. So instead of having a couple of people in the office trying to figure something out, you’ve got one point person that can go and find it, so you are saving time; you’re not taking a shortcut; you’re not finding misinformation.”
That point person can help ameliorate any damages caused by breaches.
“We don’t want to run the risk of injuring staff or patients,” Moore says. “We know that when someone’s not looking closely at these details, if there is a breach, these breaches get out in the media and that can be very, very damaging. So I think that this is a position that is emerging.”
Look for that position to evolve with the codification of duties, knowledge and responsibilities.
“OSAP and Dental Assisting National Board, Inc. (DANB) are in the process of completing a certification,” Moore says. “This is something that I believe will be really important to infection prevention coordinators in the future. This is a very comprehensive, educational program. It will give people the core knowledge that they need. And then having that core knowledge and having access to a very comprehensive list of references will allow them to better educate the rest of the staff in the office. It’s not that you can’t get this core information and these references, but this was a really nice package of having everything together, and you do actually earn a certification, which is going to elevate your practice.”
There’s nothing lazy or sloppy about maximizing one’s infection prevention efforts. Utilizing best practices the guarantee safety is observed and maintained is a great way to safeguard patient and staff safety.