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Designing for Asepsis

When it is time to move, remodel, or build new offices, infection control should be a fundamental consideration for the whole office, and both dental professionals and auxiliaries contribute to the process. Dental office design should communicate the practice’s commitment to asepsis--a complex subject, involving all aspects of structural design. This article will focus on assigning different infection control standards to different areas of the office. 

Cleanliness and safety from infectious diseases can and should be conveyed by the appearance, organization, and functionality of an office. A useful approach to the inherently different infection potential of various office areas is to visualize three different zones: the Clinical Zone, the Employee Zone, and the Public Zone. These three Infection Control Office Zones are made up of rooms and areas grouped together by similar functions, resulting in zone-specific infection-control standards. The level of asepsis in each zone should directly influence how the space is designed and used.

 

The Clinical Zone

The Clinical Zone is dedicated to patient treatment or in direct support of patient treatment, including patient treatment rooms (ie, operatories), dental laboratories, instrument sterilization rooms/areas, X-ray procedure and processing areas, and patient recovery areas. Clinical zones require the highest degree of infection control in dental settings, including the use of barriers to protect surfaces, use of personal protective equipment, regular performance of hand hygiene, maintenance of cleanliness and disinfection with chemical cleaners and disinfectants, sterilization of instruments and equipment. Clinics should use materials and surfaces intended to withstand intermediate and low level surface disinfectants; textiles and porous surfaces should be avoided in favor of hard, nonporous surfaces. Since upholstery is neither hard nor nonporous, impervious barriers are recommended to cover dental chair upholstery, to reduce exposure to potential damage by surface disinfectants.   

Within clinical zones, cross-contamination prevention depends heavily on safe practices and training, but well-designed and sensibly located rooms can greatly encourage infection control. Dental hygienists are often called upon to contribute to hygiene operatory design; they should also be a part of planning the layout of instrument sterilization areas and other clinical areas.

Clinical zones should be designed to inhibit the contamination generated within those spaces. Hand-hygiene facilities, supplies to don and remove personal protective equipment, provisions to clean and disinfect items entering and leaving clinic areas, and nontouch operating controls of doors, cabinets, and equipment are examples of structural elements that encourage the containment of contamination.

 

The Employee Zone

The Employee Zone consists of areas used primarily by dental workers for nonpatient treatment activities, (eg, the kitchen, lounge, closets and storage, private restrooms, and private offices). Structures and aseptic practices should protect the employee zone from contamination generated in other areas and should not allow transfer of potentially infectious or contaminated materials out of the area to other parts of the office. A private entrance and immediate access to sinks, restrooms, and other employee areas without entering the clinical zone helps enforce the isolation of this area.

(Continued from page 1 )

The Public Zone

The Public Zone consists of areas of the office open to public access by patients, visitors, and other nondental workers, including the reception room, hallways, public restrooms, business offices, conference rooms, and utility areas. The surfaces in these areas are called “housekeeping surfaces,” and should be clean and sanitary, but are not subject to the same infection-control standards as the clinical zone. The surface materials should, however, withstand the use of surface disinfectants if they become contaminated with blood or other potentially infectious materials. Durable textiles (eg, those developed for hospitals and hospitality) that have antimicrobial features, moisture resistance, and are easy-to-clean can be well worth the initial investment. The visibility of the public zone allows it to communicate the purposeful level of cleanliness and implied infection-control standards of the office as well as attention to detail and implied importance of the patients. Here, the message of a clean design can be implied through the warm and inviting atmosphere and thoughtful color and materials selection, while introducing visitors to an environment dedicated to controlling disease transmission. A clean public zone is, therefore, a powerful internal and external marketing tool.

When public zones are designed for cleanliness, clinical practices and systems integrate easily throughout the office. An example is the placement of a hand-hygiene dispenser on desks, counters, or walls in the business areas, reception rooms, hallways, and conference rooms with educational signs and materials encouraging patients to perform hand hygiene.  Along with dental-specific educational materials, infection control supplies (eg, facial tissue, waste baskets, posters encouraging sanitation) will reinforce preventive behavior of patients and compliance of employees.  These important features fit best in spaces that appear clean, yet comfortable.

 

The Contiguous Zone

Contiguous Zones are rooms or areas located directly next to other areas in the Infection Control Zones, allowing uninterrupted flow and use while applying a shared level of infection-control practices. For maximum efficiency and cross-contamination control, areas or rooms within one zone should be adjacent to each other. This arrangement encourages workers to consistently observe the correct level of asepsis. Boundaries between areas with different infection-control requirements should facilitate compliance with appropriate infection-control standards. Physical barriers (eg, doors, walls, signs) are effective, and nontouch fixtures such as automatic doors to operatories make a strong statement regarding asepsis.   Zone transitions may also be indicated more subtly with changes in surfaces, materials, and finishes (eg, flooring material, wall colors, lighting).

Leaving one zone and entering another may require changes in personal protective equipment, hand-hygiene procedures, or other safety protocol. When clinical rooms are spread throughout the office with public and employee spaces in between, breaches in asepsis protocol can be a challenge. One common example of this arrangement is observed when the laboratory, instrument-processing room, X-ray–processing room, hygiene rooms, or exam rooms are separated from other dental operatories by public spaces, business areas, employee kitchens, or storage spaces. Movement between zones should be minimized where possible.

 

Conclusion

When an office is being remodeled or initially built, dental hygienists and practitioners alike should be a part of discussions regarding layout and space design. The infection-control standards necessary for operatories should be considered for all clinical and clinical-support areas. Nonclinical zones should also be designed to maximize infection control and to encourage the best asepsis practices by the whole dental team. Clean office design will communicate the practice’s commitment to patient safety, and it will invite patients to join the team in managing infectious disease transmission.  

 

 References:

  1. Molinari JA, Harte JA, Andrews N, Andrews R.  Cottone’s Practical Infection Control in Dentistry. 3rd ed. Philadelphia, PA: Lippincott Williams Wilkin; 2009.
  2. American Institute of Architects. Guidelines for the Design and Construction of Health Care Facilities.  Washington, DC: American Institute of Architects/Facility Guidelines Institute; 2006.
  3. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(R-17):1-61.
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