Designing a Practical Sterilization Area
Jul 01th, 2012
Sterilization in the orthodontic office is a straightforward and simple procedure. If a sterilization area is designed properly, the daily infection control functions of the office will be smooth and productive. A poorly designed sterilization area will hinder an office’s ability to deliver efficient patient treatment, and in the worst case, cause all operations to cease. Orthodontic office sterilization differs from all other dental specialties as the volume of instruments used is far greater. Prefabricated sterilization centers usually cannot accommodate the volume and flow required by the busy orthodontist. Quality construction paired with a well-designed and intelligent area plan can communicate patient safety as well as provide an efficient means to sterilize your instruments.
Some thoughts to keep in mind when designing your sterilization area:
• How many people will be accessing the area at any one time?
• Who will be doing the sterilization and when?
• What amount of instruments would you like to keep in reserve while performing daily operations and sterilization procedures?
• What types of equipment will you be utilizing.
The CDC guidelines which were made binding as law by the Patient Protection Act of 1991 (and on which individual state guidelines are based) addresses specific aspects of a sterilization area which must be considered in any design:
“DHCP (Dental Health Care Personnel) should process all instruments in a designated central processing area to more easily control quality and ensure safety (248). The central processing area should be divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. Ideally, walls or partitions should separate the sections to control traffic flow and contain contaminants generated during processing. When physical separation of these sections cannot be achieved, adequate spatial separation might be satisfactory if the DHCP who process instruments are trained in work practices to prevent contamination of clean areas (248). Space should be adequate for the volume of work anticipated and the items to be stored.”
Determine the area that will be utilized for sterilization. Allow plenty of room for the workings of the area and the access both to and from the sterilization area. As the above CDC guideline stipulates, the sterilization area needs to address these separate functions of the process: Area One: Used instrument storage, breakdown, sharps disposal, and trash. Area Two: Ultrasonic cleaning and drying; rinsing (if required) and prep. Area Three: Sterilization. Area Four: Organizing, storage, and delivery.
In order to provide adequate separation of these distinct contaminated and clean areas, the minimum recommended length for sterilization center counter space is 10 feet. Each area can be broken down into a 30-inch wide section. If you have any less than 10 feet, some of the areas can be made smaller or stacked if needed. Flow is normally left to right. Storage for both clean and dirty instruments can and should be in the uppers to allow more countertop workspace.
Area One: Depending on how you transport your instruments from the chairs to the sterilization area will determine the design for the storage portion of the area. All will require some sort of shelving. Some designs incorporate stainless steel wire, some solid shelving, others clear glass or acrylic. Breakdown should have a counter space large enough to set the instruments, trays, and racks, to remove all waste products, disposables, and sharps. A trash chute or can and a sharps container are important design features.
Area Two: Allow enough room for your ultrasonic cleaner and adequate space for loading and instrument drying. If the ultrasonic allows for drip-drying then only the ultrasonic cleaner space is required. A large stainless steel or under counter sink should be accessible for filling and draining cleaning equipment and to allow for rinsing where necessary. Consider an arching faucet with wrist levers and possibly a foot control.
Area Three: Allow enough room for at least two sterilizers if possible - either by stacking or side by side. Dry heat works best for maintaining all orthodontic instruments. A small autoclave should be used for all remaining supplies and hand pieces that cannot handle the temperature of dry heat. Area Four: Storage of sterilized instruments can be similar to the dirty side of sterilization. An additional area in the storage section can be dedicated to non-standard instruments to help minimize the number of instruments having to go through sterilization constantly.
When we design sterilization areas as part of an overall office plan, instrument flow, staff efficiency, and patient safety are primary considerations. Always leave enough room for staff traffic flow as you don’t want to create a bottleneck in an area that wasn’t afforded adequate space. Remember, the simplest way is most often the smartest way.
Category: Dentronix Quarterly