Episode #130 Dental Office Design from a Compliance Consultant's Perspective

Often when new offices are designed or older offices are remodeled, much of the emphasis is placed on the aesthetics of the building. This episode gleans the perspective of designing a compliant office from our Compliance Divas. 

• Sterilization Area  https://bit.ly/3rWdoMR
• Sterile Supplies https://bit.ly/3QvHDU3
• Storage of Medical Supplies https://bit.ly/3s6QJxb
• Reception Area Privacy Concerns https://bit.ly/3QsY5Ve
• Reasonable Safeguards for Privacy https://bit.ly/45JmKt0
• Active Shooter On-Campus Healthcare Facility https://bit.ly/3tJQRmX

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:05

Welcome!

SPEAKER_02 0:06

I'm Leslie Cannon. I'm Mary Gavoni.

SPEAKER_00 0:09

I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. My name is Olivia Juan, and I'm with the Compliance Divas. Today I will serve as your moderator on a topic that may be on your minds, especially if you're going to plan some remodeling of your office or you plan to build a new office. Together, the Compliance Divas have visited thousands and thousands of offices over the years, and we've had the opportunity to look at designs that we feel worked very well versus others that could have been improved. Today's discussion is basically a conversation. These are just ideas that you may find helpful to incorporate into your practice. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel, or you can visit our website at thecompliancedivas.com. Any resources that we mentioned during the episode can be found on the website. You may also submit your questions to support at thecompliancedivas.com. So to kick off our discussion, we wanted to approach the subject from different areas of a dental office and talk about different types of designs that we feel work very well, especially as it relates to compliance, versus designs that may not be the best fit. I'd like to start out speaking with Mary to get her discussion points on design concepts in the sterilization. Mary, can you help our audience to take into consideration some things that work well versus things that might present a challenge?

SPEAKER_02 2:14

Absolutely, Olivia. Thank you. The sterilization area is pretty much the heartbeat of the clinical area in a dental facility. And so it needs to be located centrally so it's accessible easily from all the treatment rooms, so that instruments are going in and coming out smoothly from their reprocessing. And there has to be, according to OSHA, a very specific flow in that sterilization area that goes from dirty to clean. So we bring in the contaminated instruments on one side or at one end of the room. And then we progress through the teardown of trays or cassettes and cleaning and rinsing and drying and packaging and then going into the sterilizer. And we don't cross over between the two areas. We also shouldn't have any other functions, if possible, going on in that sterilization area because there are contaminated instruments. But in some older office designs, the lab and the sterilization area were typically in the same room. So you'd have the sterilizer maybe on one side, and then you'd have the model trimmer and the lathe on the other side. And there's all kinds of cross-contamination that's that's possible. So most of the equipment and cabinet manufacturers have design templates and cabinets that make up what they would call a stereo center. And so doing some research with the equipment manufacturers could be really helpful to see what is available, what has a good feel. And it just really has to make sense to a particular team as to whether they want the flow to go maybe in a C shape in the room. So you come in on one side and then you just go around to the other side from dirty to clean, or if it's all one area, some practices decide that they want to keep the stairy center or the sterilization area in almost like in a hallway. So with a wall barrier that is glass or acrylic, you can see through it. So people can see these functions going on. But one of the most important things to remember, and it's not necessarily related to design, it's related to maintenance. This area needs to be uncluttered and spotlessly clean so that if patients do see or want to see where we sterilize their instruments, it doesn't make them head for the door because it's so cluttered and dirty.

SPEAKER_00 5:06

Those are great points, Mary. I I remember visiting a dental office some years ago. It was brand new, multi-million dollar building. And I couldn't believe that the sterilization area was teeny tiny. No room to accomplish the points that you made about defining clean versus dirty and being organized and allowing for the number of people that would be entering that room, handling those important functions. So I appreciate those points that you made. Our fellow diva, Linda Harvey, couldn't be with us today, but she wanted to make some points about the treatment room, making sure that it's adequate size and that consider aerosols, the type of equipment necessary for controlling aerosols. And as a thought that I wanted to add to that, recently I visited the mid-mark showroom with you, Mary, and you probably remember seeing that little operatory where it had the ruler and the wall moved. So when you move the wall over to show the different sizes of treatment rooms, that dentists really need to be mindful. Do you even have enough room to bring a wheelchair in to the treatment room? So many of our colleagues at work in metro areas, space is expensive. And so they're trying to get as many treatment rooms in as possible, but can we even comply with the Americans with Disability Act or serving patients that have special needs? So I think these are important aspects to think about as well. Now, our diva Leslie has experience and knowledge to share about storage. Leslie, what can you share with our audience?

SPEAKER_01 7:00

Well, Olivia, I think we all know that efficiency really counts in a dental practice because our time is better spent providing care for patients rather than trying to find things that we know we have, or maybe even ordering things because we can't find what we should have on hand. So making sure that we have areas that are set aside for inventory. And my recommendation that has something that's been a personal battle for me is keeping things in one place that are the same instead of having these items in multiple different places in the practice. If you have everything located in, let's say, an inventory closet, then you'll know how much you have at all times, and you won't constantly be running from treatment room to treatment room, opening drawers and closing them, trying to find things. So that would be the first step that I recommend is that we have our inventory and all of the items that are the same in one location for easy seeing. Unit dosing is great for making sure that we don't have cross-contamination when we are getting prepared for a patient. We can unit dose what we think we're going to need and hopefully we've estimated it properly. But if not, we can always go back and get more. Hopefully, we've not having to waste time doing that. And to avoid overordering, which I hear is a pain point for many dentists, because not only do they not need to be spending all of that money at that time for a specific product or material, but sometimes an overabundance can cause some of those materials to expire before we have a chance to use them. And I notice this a lot with the disinfectants. We may get a special deal from our dental supplier, and we'll, or we'll go to a trade show and they have something on the exhibit floor and they're buying a certain amount, you get a free football or something signed by an athlete. And we love that. But are we able to use it before the expiration date? So that would be something to avoid when it comes to uh to ordering too much. Expired products. I can't I can't state enough how important it is to look at the expiration date when you go to, first of all, to unpack your inventory that you've ordered from a dental dealer or for whatever company you order your supplies from. I wouldn't buy a carton of milk if it was expired or if it was close to expiring. I would look for something that has a later expiration date. So I like to remind my dental teams when they open up their containers of products or boxes that are delivered to look at the expiration date. And if it's uh expired, clearly get it back to the dealer. But if it's uh not expired, is it expiring soon? You know, would have a conversation with the dealer too about getting that back. And I know Mary wanted to say something about that too.

SPEAKER_02 9:51

Thanks, Leslie. I'm so glad that you were emphasizing expiration dates. I just had an email over the weekend from a client who said that their sterilization monitor test strips came already expired. And so the question was, now what do I do? Because they already came. So checking those expiration dates when you get the products is especially important. And another thing because I know we're going to sort of transition into the design of the business office. One of the things that we saw happen during COVID, and we see it now in the CDC recommendations for ventilation in buildings, is to continue to incorporate or to use HEPA air purification systems and making sure you have six feet of distance in between patients. And I think what we're going to see as a trend within the orthodontic community and the pediatric dentistry communities are kind of a change away from completely open bay settings to having even just partial walls in between because of the aerosol issue.

SPEAKER_00 11:06

Those are good points, Mary. And you know, with holiday season coming up, I think we should remind one another that, you know, the treatment room is really not the place for holiday decor and you know, personal decorations. You know, unlike you know, the dentists usually have a private office where they can put those things, but you know, your hygiene bay or the treatment room that you work out of as a dental assistant, it's assistant, it's not the place to put those items, especially I've seen where they've had stuffed animals hanging off the patient light and things like that. And it's subject to cross-contamination. You look at the if saliva were read video, and it's very sobering to think how many things can be contaminated during the patient's visit. So, really, we should see empty, nothing on those countertops. So it's really easy to disinfect it. And I agree with you, Mary. The design change of the future will be different than what we see right now because of aerosol. Leslie, you have some thoughts to add?

SPEAKER_01 12:11

Well, yes, uh what Mary was talking about in the sterilization room of keeping you know dirty and clean, having your designated sterile site, also uh can this also converts, I guess you could say converts, to the treatment room because we sometimes have sterile items. There are single-use items that are stored there that can become contaminated. And so we need to make sure we have a way of storing those products, whether it's uh cotton rolls or dry angles or pellets or uh gauze, what have you. If it's something that's going to be used in patient care, we need to be able to, number one, unit dose to the best of our ability and estimation. But if we have to access some of those products, it's reasonable to store them in the treatment room, but to store them in a manner as so to prevent contamination from the things we're talking about, just like the fallout or the aerosols or or from being uh access with dirty gloves, you know, to have a sterile set of uh cotton pliers where you can get your needed item without having to reach in with a dirty instrument or a dirty glove. And you know, I forgot to mention when we were talking about products and expiring products and inventory, that there are many companies that offer a tag system or a barcode system that you could use for keeping track of your inventory. It doesn't have to be just pencil and paper and and you know, just uh trying to remember what to order. There are some systems that dental practices can put in place to track their instruments and devices and uh not pardon me, not instruments and devices, but their products, their dental products and materials that they need to reorder on a regular basis, or even ones that are on an irregular basis.

SPEAKER_00 13:53

Yeah, those are great points, Leslie. And I wanted to mention about the front desk area. You know, years ago, there there used to be you'd see that sliding glass, and then they took down the glass because they wanted to be close to the patients and be more personable. And then here comes COVID, and we had those acrylic plastic sneeze guards that were put into place, and then with HIPAA, you know, privacy concerns. But you know, a recent concern would be that of an active shooter. So, what does that front desk look like? Have we taken into consideration those clinic doors, the doors that access the clinic area? You know, should they be locked to prevent someone from passing through those doors who is unauthorized? And also planning that front desk area around HIPAA compliance so that those conversations that are taking place are not overheard or what would you say, uh shoulder surfing to hear the conversations. So I think that's probably a place to see some changes in the future as well. And Leslie and Mary, what are some designs that you've seen over the years that you really liked? Can you share that with our audiences? Mary, we'll start with you. Thanks, Olivia.

SPEAKER_02 15:12

There is one office in particular that had the advantage of being in an area where building costs were not that great and space wasn't so expensive. And so they built out the support areas in their office to be really nice and large. And so they actually had an island, a big square island built into their sterilization area that was designated as a clean area. So the periphery was the dirty area. And then once the instruments came out of the sterilizer, they came to the island and then they had all kinds of storage for cassettes and pouches and other supplies. It was so efficient and it was just absolutely amazing. And then on the flip side, a number of years ago, I worked with a couple of doctors who were in the same practice that went with one of those really small treatment room design plans that someone recommended to them because it was going to be more efficient and more ergonomic. And as it turned out, the doctors just were having all kinds of pain and ergonomic issues. And they were given, I think, six operatories in the space that really could accommodate five. And the tragedy of that was they ended up having to just ditch their remodel and start over again because they were young enough to be in practice probably for 20 plus years after they did this remodel. And it was just really sad. And that's why I'm glad you mentioned that design center at Midmark because that is a very sobering thing. You can pull the curtains down on the side, you can move the cabinets in to really give somebody the feel of what does a very small treatment room look like. And it was scary.

SPEAKER_00 17:09

I enjoyed seeing that as well. Um, one of the designs that I thought was interesting was a dental office in East Tennessee I visited recently where, you know, the two doors that entered the clinic, they were locked. And then it was glassed in at the front desk so that you know they accomplished safety from someone going in that's not authorized, but they also accomplished satisfying the privacy rules. So those conversations were protected. And then from sterilization point, I had an office that, you know, they were very fortunate to have a dedicated sterilization tech who was stationed in that area all day long. And they had the pass-through where no one had to actually enter into the sterilization area. They had a pass-through for the dirty trays and containers, as well as one for those that were coming out. So it minimized the amount of traffic going into the sterilization area. And I thought that worked really well for a large staff. So we get a lot of ideas visiting different practices. And I encourage people, if you are remodeling or planning on a new design, not only meet with your dental supplier or design team, but visit some of the local practices and ask questions. You know, what do you like about your dental office design and what do you not like? And then consider some of the issues that we touched on, such as, you know, having come through COVID and the aerosol concerns and having enough room. Mary mentioned about ergonomic issues. So you can really put into place that ideal design that you love. So this has been an episode that's been enjoyable to discuss that of dental office design from a compliance consultant perspective. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliancedevas.com. Any resources that we mentioned during an episode will be available in the show notes. That's it for today, and we'll see you soon.