The design of your instrument processing area can have serious benefits or consequences for your practice.
Most dentists overlook it. It is usually an afterthought; a side note. But that is a big mistake. The fact is the design of your instrument processing area has serious benefits or consequences for your practice’s efficiency.
“Dentistry is a small business. There must be a flow so you can see more patients and treat each patient efficiently,” Dr. Erinne Kennedy, DMD, says. “If everyone is falling on top of each other trying to get ready for the next patient, that’s not going to work out well.”
Cathy Klein, instrument processing product manager at Midmark, agrees that the design of the instrument processing center is crucial for the overall environment at the practice.
“When things are laid out properly, and the team has what they need, and they have the right flow and education, it sets the tone of the office. And likewise, if we see turmoil in that space, it emanates throughout the whole practice,” Klein says.
We spoke to Dr. Kennedy, Klein, and other experts to uncover the important considerations for improving the efficiency of your instrument processing center and ultimately, the efficiency of your practice.
Change your thinking about the instrument processing center
Dr. Kennedy, who is on staff at Boston’s North End Waterfront Health, explains that instrument processing can often be a side note to most dentists. Doctors concentrate on clinical dentistry instead.
“It can easily be an afterthought,” she says. “If you are renovating an older space, it is easy to focus only on where the operatories need to be placed, and then the instrument processing area ends up in a closet.”
Chantel Willis, associate director, SBU for instrument management and infection prevention at Hu-Friedy, thinks that doctors should change their thinking about the instrument processing center.
“The sterilization area is the heart of the practice; everything is coming in and out of that area,” she says.
Willis shared a colleague’s comparison of the instrument processing area to the kitchen in a restaurant. An adequate kitchen in the right location with the proper flow and appropriate equipment is vital to the restaurant’s success. The busy staff is in and out of there while serving customers, and they need the right dishes at the right time. The restaurant owner wants the team out taking care of their customers, not waiting around in the kitchen.
“It’s the same idea with sterilization area,” Willis says. “That’s your hub. If you are efficient there, it will affect the rest of the practice.”
Up next: Involving the entire staff...
Get input on the design from the people who use it the most
Kara Vavrosky, RDH, in Vancouver, Washington, and an editor and writer for Modern Hygienist, encourages doctors to get input from back-office staff when designing the instrument processing area.
“The hygienists and dental assistants are most likely to be the ones sterilizing instruments, so their feedback in design is imperative,” she says.
Vavrosky speaks from experience. At her first practice, the dentist built a new office without any feedback from the back-office team members. Having never worked in the sterilization room, he overlooked many design elements that could improve flow and follow infection control protocols. When organizing supplies after the move, Vavrosky and the team saw that built into the counter on the clean side was the ultrasonic shaker-and that was just one example.
“It all could have been worked out if he simply asked us to give feedback on the design,” she says.
Allocate an adequate budget for the equipment
Designing the proper instrument processing area requires a bigger budget than most practices devote to it. Willis says many times doctors spend their budget on other clinical technology, so they look to save in the instrument processing center with a smaller ultrasonic bath or sterilizer. However, when equipment is too small, staff overloads the unit or runs it several times a day to reprocess instruments needed for the work load.
“It sets practices up poorly from the beginning, and it sets them up poorly for the future as they bring in more patients,” Willis says.
Not only is the practice suffering, but also the team experiences more stress when dealing with inadequate equipment, Klein says.
“When the patient sits down, all the dentist wants is for the instruments to be there. If there isn’t enough capacity in the instrument processing center, then the person who is responsible for processing instruments is always running behind and stressed out,” Klein explains.
Although reprocessing instruments doesn’t generate revenue for the practice, investing in the sterilization area will improve profitability.
“The more efficient that area can be means the less time you have to spend performing labor-intensive tasks and the more time you spend chairside and doing more value-added activities that can bring in revenue for the practice,” Willis explains.
Make it clear where clean and dirty instruments belong
Tina Clarke, RDH, MED and assistant professor at the Oregon Institute of Technology, teaches infection control. She says clinicians and staff forget about supplying a clear, physical delineation between the clean and dirty zones, which reduces the risk of cross-contamination with instruments and the trays that hold them. The clinic where Clarke works uses red tape for the dirty zone and green tape for the clean zone, with a transitional zone between them.
“Often, sterilization areas are in the same u-shaped room, and you are transitioning from infected instruments all the way over to sterile. So, some demarcation will show where is that imaginary line of clean to dirty,” Clarke says.
Up next: Reducing cross-contamination...
Go with the flow
From the standpoint of cross-contamination or infection control, the CDC recommends setting up the instrument processing protocol to flow through in one direction. Furthermore, Willis says, tight spaces can contribute to cross-contamination. Willis endorses thinking about the general setup from dirty to clean and ensuring that every section-cleaning, packaging, sterilization and sterile storage-is identified, no matter the size or configuration of the space. This easy enhancement can be accomplished immediately.
Dr. John Flucke, technology editor and chief dental editor of DPR, says the sterilization room in his first practice was like a studio apartment kitchen you would have had in college. The cramped space and lack of counter space led to some flow problems. When he built his practice’s new location in 2007, he designed a large sterilization room with a proper flow. Starting at the left-hand side is the dirty area, then the ultrasonic built into the counter next to a sink, followed by a wrapping and bagging station and the handpiece maintenance system. Next are two steam autoclaves and a STATIM G4. Last is an instrument holding system that has a pullout door with stainless steel baskets inside.
“You put the instruments in right when they come out of the autoclave. They are safe and secure, not out where they can be contaminated,” Dr. Flucke says. “It allows us to stay on task and keep everything running in an orderly fashion.”
Clarke also recommends using instrument cassettes in your flow. Clarke says they save time because they are already organized and enhance the safety for your staff by containing the instruments, reducing the risk of getting poked by one.
"You just put it back in the cassette, clean it up, sterilize it,and then it’s good to go for the next patient,” Clarke says.
Keep it visible to improve the patient experience
Dr. Kennedy recommends picking a location that is visible to the patient. Her parents practice dentistry in Ohio, and their instrument processing room is in a central location patients walk by to get to the operatories. Dr. Kennedy says seeing the processing center reassures the patient-an aspect that she values.
“As a patient, when I walk in somewhere and it’s clean and sterile, I feel more comfortable,” she says.
Write it down and train everyone
One the most common mistakes our experts see is that there are no written protocols or training for those who handle instrument processing.
“The CDC recommends that everyone should have written instrument processing and overall infection control protocol written down,” Klein says.
Klein rarely sees any in the practices she visits. What’s more, Klein says, most of the people who are processing instruments didn’t receive any formal training, but instead were trained by their predecessor. Without written protocols or official guidelines from the CDC or OSHA, she says, there is no way to know if they are doing it correctly. Klein recommends referring to the CDC guidelines or organizations like OSAP to learn the proper protocols and then determine what the practice needs from there.
Willis believes that in addition to exploring these resources, the practice should appoint an infection control coordinator.
“Having the proper flow, clear protocols and someone identified as the infection control coordinator who is in charge of training and ensuring all the protocols are followed is a hot topic now. It helps an office stay compliant,” she says.