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Infectious Disease Control Through Design
Jen Rhode, Manager & Renee Susami, Lead Designer, Henry Schein Integrated Design Studio
When it comes to building a dental office, good design is at the heart of the entire practice. Henry Schein Integrated Design Studio focuses on design so the practitioner can focus on patient care. We understand that safety has always been a priority in the dental environment. Therefore, the following recommendations are intended to expand on current design processes to promote practice efficiency, boost patient and staff satisfaction and confidence, as well as design for the future.
Circulation
One of the most important elements a good designer will plan for is the flow of people in and out of the practice. Good circulation is essential for efficiency and for patient and staff safety. In the floor plan, there’s a nice connection between the two zones so staff can move from space to space. In the clinical space, the treatment rooms are aligned around the perimeter, and the sterilization is in a central location, making it easy for staff management and instrument management. The floor plan is designed for patients to have a one-way flow through the office, and to eliminate the need for patients to cross paths along the way.
Whether building a new practice or retrofitting an existing one for increased infection control, the fundamental design elements essentially remain the same, with some additional precautions.
Waiting Rooms
Many doctors are questioning whether or not to still incorporate a reception area or waiting room. Our recommendation is that it is always key to have a waiting area and a greeter for your patients.
Utilize virtual check-in and waiting when necessary, but make sure to also create a space within the office for patients to check in. Upon entry, offer a sanitation station. Manufacturers such as A-dec offer units with a small footprint that house hand sanitizer, tissues, masks, and a trash receptacle all in one. For patient check-in, consider adding an optional kiosk for isolated check-in and clear partitions at the reception desk to provide protection between visitor and greeter.
Regardless of your check-in method now, you still want that entry to make a great first impression. This is where patients are going to have the most anxiety when they walk into your space, so having an area that’s warm and welcoming is key. Incorporating high-end finishes such as quartz counters, decorative lighting fixtures, and an inviting color palette can enhance the ambiance.
Additional safety precautions include the furniture configuration in waiting areas. We recommend connecting with a commercial furniture dealership since they’re experienced at optimizing the use of space as well as choosing styles that fit your patient demographics. A good dealership will have access to a wide range of vendors so you have many choices to fit your style and budget.
Flexible seating that is arranged in smaller group configurations rather than long banks of side-by-side seating offer enhanced privacy and protection from others waiting. Free-standing panels can also help divide the space and add visual interest.
Business Office
There are many ways to make the reception and business office area safer and more efficient. For example, when designing an office, try to achieve in-and-out flow around the business desk with wider corridors in heavy traffic areas, especially at check-out. This helps avoid patients entering treatment and those leaving from crossing paths.
Consider providing consultation and appointment booking at the treatment chair. This can help reduce queueing at check-out. An enclosed consultation room can also be incorporated for longer conversations relating to financials, new patient consultation, and practice management.
Treatment Rooms
Closed treatment rooms offer the most protection, though shared areas are necessary sometimes when space is limited. Whether you’re planning for closed treatment rooms, semi-private, or open treatment areas, there are many steps you can take to support infection control.
One step we recommend is the addition of air purification systems. The number and type of units is based on the square footage and design of the space, so connect with your Henry Schein Representative to evaluate and make recommendations.
Another consideration, especially when building a new practice, is to evaluate the HVAC system. Optimized ventilation is key to infection control and should be discussed with an HVAC specialist.
Closed Treatment Rooms
As mentioned, closed treatment rooms are ideal for infection control but are not always the best option for the practice. However, including at least one closed room in a practice would allow for increased safety when treating sick patients with emergency needs. Incorporating an additional entrance or exit to the closed treatment room would further prevent contamination to the rest of the office. When not being utilized for sick patients, a closed treatment room can also offer additional privacy for patients with longer procedures that require additional time for post-treatment recovery.
Semi-Private Spaces
Treatment rooms that utilize center island cabinets or t-wall sinks are more enclosed than open bays; however, there are still some adjustments that can be made to further provide separation and infection control.
Adding a header above the center island cabinet can aid in preventing the spread of aerosols. This is a great option for offices that are retrofitting an existing office. Before doing so, check that the addition of the header does not impede existing sprinkler systems.
For both center island cabinets and t-sink configurations, consider adding sliding, barn-style doors across openings to enclose the two rooms. This may be a worthwhile solution for practices that often see families. The sliding doors must maintain ADA accessibility requirements.
Open Treatment Areas
Open treatment bays are an efficient solution for Orthodontic, Pediatric, and Hygiene treatments. For this reason, it is important to design the bay in a way that benefits the practice and keeps the patient safe.
The HVAC and air purification measures mentioned earlier are solutions that are most essential to incorporate in the bay. When possible, orient chairs parallel to the direction of airflow improved control of aerosols. Barriers like privacy panels can also enhance the effectiveness of aerosol containment and add interesting design elements to the space. As mentioned in semiprivate spaces, these panels must maintain ADA accessibility requirements and sprinkler clearances. If designing a new bay, space chairs at least six feet apart arm-to-arm for social distancing and improved circulation.
Sterilization Area
Sterilization, of course, has always been at the heart of the practice. Allowing patients to have a view into your sterilization area is a great opportunity to showcase your processes and also the special attention that you give to infection control. Utilizing red and blue lighting as recommended by dental manufacturers provides a clear process for patients to understand and soothe anxieties.
Staff Work Areas
It’s equally important that staff areas be set up in a way to minimize the spread of infection. For the staff lounge, this means avoiding large tables with close seating facing each other. Instead, opt for single-station areas. Consider investing in flexible pieces that can be reconfigured in the future should there be less rigorous isolation practices.
For shared staff workspaces, avoid having staff sitting side-by-side if possible and instead arrange for back-to-back configurations. If this isn’t possible, use separator panels at least 24" high to act as physical barriers and avoid sharing of personal items.
Other staff spaces to consider include sanitation stations, a designated delivery station, changing spaces, lockers, and laundry services. Laundry could either be on-site or off, just be conscious of the placement of the washer and dryer to avoid cross-contamination.
Within the clinical zone, it is critical to have a space off the treatment area for staff that’s large enough to allow for the storage and donning of PPE. As for donning, according to the CDC, all doffing of PPE other than the mask or respirator should be removed before leaving the treatment room.
Interior Design and Finishes
Configuring the space is the first step in office design. Whether using Integrated Design Studio or another design firm, it is important to have professional guidance in interior selections that are appropriate for the dental environment. Commercial-grade materials are essential in reducing the risk of infection. Commercial products are tested and proven for exceptional durability in withstanding rigorous cleaning processes.
A few products that IDS interior designers highly recommend are commercial carpet tiles and luxury vinyl tile for flooring. Many carpet tiles are bleach cleanable and easy to install and replace, if necessary, while providing sound absorption, comfort, and visual interest. Luxury vinyl tile (LVT) is extremely low maintenance with no additional finishing necessary. LVT is also highly durable and works great in high traffic areas such as halls, sterilization, and treatment rooms.
Surfaces are one of the most important finish considerations throughout the entire office. Whether specifying a work station in reception or a sterilization counter, a designer must select the proper finish to withstand the test of time and promote infection control.
When it comes to dental chair upholstery, seamless models are easy to clean. Check with the manufacturer to see what they can offer for each model.
In addition to material finishes, furniture selections also contribute to infection control and safety. Commercial seating options offer fabrics and finishing materials for enhanced moisture control and bleach cleanability.
Another element to consider is partitions. While inexpensive material such as acrylic from a hardware store was a good initial option, many are experiencing the deterioration of these products. It is important to select materials that can withstand stringent and frequent cleaning procedures. Well-incorporated, quality partitions can boost staff and patient confidence in the practice’s commitment to safety. Consider investing in solutions that are flexible and fitting to the overall look of the space.