Rethinking Practice Design by HanH H. Tran
5 steps dentists should take to make their offices safer without sacrificing efficiency or elegance
خمس خطوات يجب أن يتخذها أطباء الأسنان لجعل عياداتهم أكثر أمانًا دون التضحية بالكفاءة أو الأناقة
by HanH Tran
COVID-19: A minuscule (Fig. 1), protein-coated molecule sure threw a mighty nine-punch combo. Within a few weeks, it managed to bring the world to its knees, virtually shut down nearly everything, and even caused the disappearance of millions of rolls of toilet paper.
We were encouraged to wash our hands more often, mind the 6-feet social distancing guidelines and self-isolate if we suspected we’d been infected. Then the full shutdown of all non-essential businesses and public gatherings, and lastly came the stay-in-place to slow the spread the newest of superbugs.
By now, many dentists have reopened their practices and are seeing patients while trying to figure out the rest of the infection program, either proactively or as potentially mandated.
The situation is still developing and morphing daily. There is certainly no shortage of ideas from all corners of the universe, both sound and questionable.
This article will highlight strategies of retrofitting, designing and building your dental office in response to COVID-19. What we have researched and analyzed and are planning to implement as part of our design strategies are outlined here for consideration.
Step 1: Assess
Have your facility assessed by an architect or engineers to confirm your assets and deficits. If you’re going to take up the battle against the superbugs, you’ll need to know what is there to work with in terms of building systems, wall assemblies and code requirements. With this knowledge, dentists can ascertain what they can do or what they need to do to achieve the infection control objective desired, along with learning the associated costs.
Step 2: Research
There are a lot of opinions and sources of information to digest. Be willing to invest your time in the process to separate fact from fiction to determine what can be accomplished both immediately and down the road. Every smart person must know his or her strengths and limitations. In the same way a general dentist will without hesitation refer out certain cases beyond their expertise (or desire), practice owners should consult with design professionals as needed.
Step 3: Accept
Be open to big changes to achieve maximum effectiveness for infection control. Few people welcome changes—even small ones—but large-scale alterations may be required to garner the optimal result needed to make you, your team and patients feel safe.
One example: It may become necessary to install doors in semi-open treatment rooms to control their air quality. Negative-air-pressure rooms can only be achieved in rooms that have doors.
Step 4: Strategize
To manage the potential effects of pathogens, a multilevel infection control strategy is needed. It would be a dream come true if a silver-bullet solution rids us of COVID-19 and the challenges it has created in dentistry, but until that day, here’s a list of steps that dental professionals can take, broken down into low- and high-budget strategies. While some of these options can be high in cost, consider the cost of losing the trust of your patients and staff when it comes to maintaining a safe, effective practice.
• Follow the CDC, ADA and OSHA’s current recommended guidelines for social distancing and installation of sneeze guards and follow proper PPE protocols.
• Install no-touch restroom accessories, including soap dispensers, paper towel dispensers, faucets (Fig.?2), toilet flush valves (Fig. 3) and occupancy light sensors. Costs associated with no-touch accessories vary widely; what’s important is that you invest in quality commercial-grade products that will perform, require little to no maintenance, and aren’t easily removed from the office.
• Install automatic door openers.
• Upgrade maintenance regimens, intervals and protocols.
• Using UVGI arrays in ductwork to sterilize the airstream of pathogens is an effective and safe system with no potential harm to building occupants. Surface-mounted or mobile units for sterilizations of vertical and horizontal surfaces are also effective systems. They are used when the space being treated is unoccupied.
• Install hospital-grade, stand-alone air filtration systems for treatment rooms and open spaces.
• Deploy the use of at-source aerosol and droplet collectors.
• Facility alterations may include reconfiguration of spaces, adding of doors and replacement of finish materials.
• Retrofit or replace HVAC equipment for higher air exchange and with HEPA filters for higher filtration performance.
• Negative-pressure spaces are not currently mandated for dental offices by building codes or agencies with jurisdictional authority. However, the American Society of Heating, Refrigerating and Air-Conditioning Engineers does recommend negative pressure for spaces with infectious aerosol concerns.
• Virtually every big-ticket item purchased for your practice comes with some type of a warranty; your office finishes are no exception. For the warranty to be honored, every detail and requirement must be adhered to, including handling, preparations, acceptable glues, tools used, maintenance cycles and recommended cleaning materials.
Step 5: Comply
This is not a home-building project. Many municipalities require individuals or companies working on commercial building projects to be licensed or certified to perform the work in their state or jurisdiction.
Designing and engineering work is often required by law to be performed by, and to be supervised by, licensed architect or engineering professionals.
Start the design process with firms that have licensed staff and experience with dental office design. Avoid equipment vendors that generate equipment installation plans, which cannot be used to build from and are in general void of pertinent acknowledgment, confirmation for zoning, building code and accessibility guidelines that have been properly analyzed or addressed.
What may influence the design of future dental offices has yet to be fully determined. Whether you’re designing a new building from the ground up or retrofitting an existing office (Fig. 5) or a new startup (Fig. 4), the rules of engagement will remain very much the same. So, before launching off the starting blocks, consider the advice here.
COVID-19 will remain with us into the unforetold future. The good news is there are various measures that can be put into practice to meet health organizations’ recommendations and regulatory mandates to minimize exposure and protect everyone in the practice.
As previously mentioned, there are three available main technologies—air filtration, irradiation and disinfection—with proven success. Each plays a role in fighting COVID-19, and when they’re integrated properly, they create a highly effective infection control strategy.