Good Infection Control Requires Room to Work

In a lot of ways, the dental practice’s sterilization center is just like a kitchen. In one regard, it’s where all the utensils (instruments) are cleaned (and sterilized). But another way that the two are alike is that if there isn’t enough room to get around, it’s hard to do one’s job.

Unlike a kitchen, however, not having enough space isn’t just an inconvenience – it leads to inefficiencies and the potential for injury.

Dangers

While it is nice to have enough room to work, there are also safety and compliance concerns to be cognizant of.

“If we look at the guidance that’s put out by the Centers for Disease Control (CDC), they’ve defined what we’re looking for in a central processing or sterilization area,” Joyce Moore, BSDH, RDH, CRCST, CDIPC, DISIPC, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts says. “In a typical situation, we’re looking for a receiving area, that includes cleaning and decontamination; and then we have a separate space for preparation and packaging; then sterilization; and finally, storage. So, if we have an area that’s small and laid out well, these things may happen pretty fluidly. If we have a large, spacious area and the workflow is not great, then that can be an issue. But however you look at it, we want to avoid cross-contamination and promote efficiency, and reduce the risk of injury. Instruments can cause harm to the people working in the space. In addition to that, if your facility follows a regulatory agency, they may have specific expectations they expect you to meet. They may have expectations about how things are laid out and what their expectations are there.”

But most of all, having enough room to work reduces the chances of injury.

“You could have personal risks if people don’t know the flow, even with things like sharps injuries,” infection prevention consultant Dr Katherine Schrubbe, RDH, BS, MEd, PhD says. “If people aren’t carrying out the set protocols for safety in those steri-centers – for instance, utility gloves, which are a must – and at a lot of practices, you see staff aren’t wearing them in their steri-center. Occupational exposure injuries are a big deal; not wearing appropriate personal protective equipment (PPE) in those areas can increase the risk. ‘Oh, I’m in a hurry. I don’t have time.’ ‘It’s cramped in there.’ ‘Oh, I didn’t wear my safety goggles.’ What if you have a splash of ultrasonic solution? That’s an occupational exposure injury that will now require follow-up and time away from the practice. There are chemicals in the steri-center, as well as contaminated sharps, all which pose risk of occupational exposure injury to who’s ever in that room working.”

Shoehorning

Too often, the practice’s sterilization center design and location might feel like an afterthought. Rather than giving it appropriate planning and consideration, the center is often assigned a repurposed space.

“Some practices, especially if they’ve created a new space, have been very thoughtful in allotting space so workflow goes well,” Moore observes. “But more often than not, what I see is that many dental practices have repurposed space. They may have taken a storage closet or an operatory and they’ve made it their sterilization area. Those tend to be undersized spaces.”

Ideally, the sterilization center will be thought out and planned for well in advance.

“If you have the opportunity to do a fresh start, I would say that you should work with a reputable dental supplier or builder and be ready not to skim on your sterile center, because this is the hub of everything that goes on in that practice,” Dr Schrubbe says. “If we don’t have sterilized instruments, we’re not seeing patients, period. Additionally, it’s always good to try and have a steri-center centralized in the office space.”

“For the sterilization center, we need to ideally think and plan for that a little bit more carefully,” Moore adds. “And when I think about that, I’m considering a number of things: The location of the sterilization center should be centrally located, because that’s really ideal. You want to have everybody in the area to have the ability to get to that space pretty quickly. Size is important, and I think it’s driven by how many people you’ll have in the space. If you have a dedicated person taking care of instrument reprocessing, then you may not need as much space as if you have each practitioner in and out of the area. And then proper lighting and counter space, in addition to the cabinetry and the equipment. When I think about that space, I’m thinking about volume of people and volume of instruments being reprocessed.”

Making the most

It would be nice to have a lot of room for the practice’s infection prevention efforts, however the fact of the matter is that the space may just not be there, but you still must make the best of whatever situation.

“The key is to have really good efficiency and protocols in that workspace,” Dr Schrubbe says. “Everybody knows the program. Everybody knows, ‘All right. I have to walk down the hall to get there, and this is the protocol in the room.’ The recommendation in any kind of sterilization center is to have 2 doorways – an in and an out – so you have a good flow. You should have at least a 4-foot space, so that if there’s 2 people in your steri-center, you’re not going to bump into each other. You’re able to walk by each other in that four-foot space. Everybody’s got to know where the flow is from contaminated to clean instruments. And sometimes, in a situation like that, it might even be more efficient to have one staff member man a smaller center, if you feel like things are a little bit tight and cramped. That way, there’s one person that’s reprocessing instruments all the time. And then you have that consistency, and you don’t have bottlenecks of people trying to get in and out.”

That efficiency, Moore observes, starts even before anything gets to the sterilization area.

“In order to make that space more efficient and safer, we want to make sure that the first thing we do in the operatory is get rid of all of our disposable, contaminated materials – especially sharps,” she says. “Because ideally, your sharps containers are in each treatment room, so you can dispose of that hazard. So, we’re not taking that to the sterilization area and risking an injury in that space, because we’ve already disposed of it.

And then, of course, we are transporting the instruments that need to be reprocessed in a sealed, puncture- and leak-proof container, so when you’re going into that space, you transport those instruments that need to be reprocessed in a safe manner. And then, of course, you can always stack those up. Instead of having a whole counter full, you’ve got some stacking going on to, to help keep that area open.”

Finding room

Is it possible to find more room in the practice for infection control? Yes.

“There’s always an opportunity,” Dr Schrubbe observes. “The steri-center is so important to the practice. Maybe it’s worth sacrificing an office, if there’s an extra. Maybe there is a way to reconfigure some hallway space or a consult room. The steri-center has to be a priority in the practice. I’ve seen practices where the steri-center is very small, because years and years ago, we didn’t have the kind of equipment that we do now. And so, practices are sometimes forced to look for that extra space, to have a steri-center that will be more efficient.”

“If we’re going to focus on the sterilization area, we should think about making sure we buy appropriate cabinetry and racking,” Moore adds. “There is cabinetry where you can have 2 sterilizers, one above the other, and then cabinetry for supplies. These cabinets aren’t necessarily something you’d buy at a big box store. You don’t want to use wood; you want to use material that can be cleaned and is heat-resistant. As far as using another area in the practice to store your instruments – either in your operatory or another space – is an option. Once the instruments are sterilized and they’re dry, they can be transported to another space that is appropriate. And that way, you’re not storing any sterile product in that sterilization area.”

Ultimately, having enough room anywhere in the practice for safe, efficient infection control is going to be a benefit to the practice and its patients.

“Ideally, whether you’re talking about the operatory or in the sterilization center, you really just want to think about using your space efficiently and having the appropriate cabinetry and such to do so,” Moore observes. “Because not working efficiently is going to slow you down and it’s a safety issue.”