How Sterilization and Infection Control Workflows Are Enhancing Dentistry

The dental profession, historically guided by strict infection control protocols, embraced new changes to old processes as a result of the COVID-19 pandemic. According to the Health Policy Institute of the American Dental Association, approximately 80% of practices in the United States shut down for a period of time last spring, except for emergency services. Not surprisingly, when dental offices reopened, they embraced new and reinforced regulatory mandates, with a host of new tools and resources available to them to protect patients and their practices from the coronavirus.

“Dental teams are paying closer attention to the OSHA rules and CDC¹ guidelines², as well as new, specific guidance on COVID-19,” says Dr. Karson Carpenter, President, Compliance Training Partners. “If there is a bright spot to COVID-19, it is that we are all working safer.”

Categorized by OSHA as a very high-risk profession, dentistry has been at the forefront of infection control practices since the outbreak of AIDS in the 1980s. However, COVID-19 raised the bar, requiring new and fortified infection control practices in addition to dentistry’s universal infection control precautions. Because COVID-19 is transmitted through aerosol droplets, a common biproduct of most dental procedures, there is heightened awareness and fear. Patients now scrutinize and want to know in detail what controls their dentists have in place to ensure their safety, since social distancing is not an option. As a result, workflow, processes, tools, and equipment need to be reconsidered, revised³, or replaced.

It’s All About the Flow

Infection control in dentistry starts with workflow. The CDC requires that dental offices ensure a clear separation of contaminated and clean workspaces, and recommends creating an instrument processing workflow pattern so that devices and instruments clearly move from high contamination areas to clean/sterile areas.

As a result, the COVID-19 pandemic puts practices’ sterilization areas front and center. Sterilization centers are now practice showpieces. How they are designed, their location, and their surroundings are critical to instilling patient confidence.

According to Dr. Carpenter, “A well-designed sterilization area can not only enhance workflow but also make the office safer for patients and staff.”

Sulens Dental Studio

Sulens Dental Studio in Zanesville, Ohio, has a walk-through Midmark sterilization center configuration that offers a generously sized space to accommodate the workflow and turnover of seven treatment rooms.

Dr. Michael Sulens of Sulens Dental Studio in Zanesville, Ohio, created an efficient state-of-the-art sterilization center, which was a major focus for his practice. The sterilization center was so critical that Dr. Sulens enlisted his wife, a specialist in efficiency modeling for the health care industry, to help research best practices.

Their Henry Schein representative arranged site tours of several dental practices, and they met with architects and engineers at Midmark to see the latest technology solutions. His office now showcases a Midmark sterilization center and specifically designed cabinetry line, with a walk-through configuration that offers a generously sized space to accommodate the workflow and turnover of seven treatment rooms.

“One of my focuses during our remodel was to create an efficient, state-of-the-art sterilization center that my whole team would take pride in,” notes Dr. Sulens. “Now, one of my favorite areas is our sterilization center, because it gives me confidence knowing that we are offering the most sterile environment for our patients.”

Mint Springs Dentistry

Mint Springs Dentistry in Mason City, Iowa, placed the sterilization center in the center of the practice, centrally located and outfitted with state-of-the-art equipment from SciCan and Midmark, and features QUATTROcare Plus and the VistaPure water system.

At Mint Springs Dentistry in Mason City, Iowa, Dr. Noemi Cruz-Orcutt rebuilt her practice after a devastating fire, with a more centralized, galley-style sterilization center.

 The center is outfitted with a SciCan Hydrim G4, Midmark M11 autoclave, QUATTROcare Plus, and VistaPure water system.

“The workflow within the operatories and the sterilization center have dramatically improved,” explains Dr. Cruz-Orcutt. “On the right side, as we enter, we have the dirty instruments storage, the cleaning handpieces station, ultrasonic, and dishwasher; then the Statim and autoclave. On the other side is where we store the clean cassettes and instruments.”

"Dental teams are paying closer attention to the OSHA rules and CDC Guidelines, as well as new specific guidance on COVID-19."

Karson L. Carpenter, BS, DDS, President, Compliance Training Partners

Medema Endodontics

Medema Endodontics in Grand Rapids, Michigan, showcases its A-dec sterilization suite, which is set behind a glass wall. It was purposely set out in the open for patients to observe the instrument sanitizing process. The staff utilizes Hu-Friedy Instrument Management System cassettes with an innovative hole pattern and rail design to significantly increase exposure to instruments during reprocessing, creating an optimal environment for cleaning and sterilization.

The first thing patients see when they walk toward the operatories at Medema Endodontics in Grand Rapids, Michigan, is the A-dec sterilization room, displayed behind a full-glass wall. “A-dec did a fantastic job with placement of everything necessary to make sterilization safe and efficient,” says Dr. Brent Medema. “Our infection control process and state-of-the-art setup allow for the highest standards in instrument sterilization.”

Containing Aerosols

There are at least three potential sources of airborne contamination during dental treatment:

  • dental instrumentation
  • saliva and respiratory sources
  • the operative site

Because dental staff must work inches from patients, with mouths open wide as they expirate, they strive to keep aerosol-generating procedures to a minimum. As a result, some of the more traditional teeth-cleaning and operatory workflows have changed.

Tooth isolation, using a rubber dental dam in conjunction with a saliva ejector, is a long-time standard of care for nonsurgical endodontic treatment. However, with the advent of COVID-19, dentists are turning to newer high-volume evacuation (HVE) intraoral suction devices.

Isolite® is a high-powered suction system attached to a plastic mouthpiece. During a routine cleaning, the Isolite is placed first on one side of the mouth and then moved to the other, each time wedged against the back teeth. This brightly lit device simultaneously holds the tongue in the back of the mouth and the mouth open while whisking all manner of dental detritus out of the way and down a suction tube.

DryShield performs all of the tasks of a high-powered suction evacuator, bite block, tongue shield, and oral pathway protector in one easy-to-use device, to help eliminate aerosol and overspray, while keeping the dental work area completely dry.

Mr. Thirsty is a hands-free, high-volume suction device with built-in bite block, tongue retraction, cheek and airway protection, to block droplets of patients’ saliva from spreading in the operatory.

Ivory® ReLeaf™ is a hands-free HVE suction device that conveniently connects to existing dental vacuum systems. ReLeaf assists with evacuation, retraction and maintaining a dry field during various dental and hygiene procedures. Dentists can work in all four quadrants with ergonomic comfort and full view of oral cavity — without need to move around.

Fresh Air

With the onset of COVID-19, many dental practices took additional steps to effectively reduce airborne particles, employing a broad array of new technologies, combined with proven standard procedures, including air filtration systems.

“Our office is proud to offer Surgically Clean Air. We have two large units that filter the entire office, as well as a smaller unit in each operatory,” adds Dr. Medema. “I am a strong believer in air-filtration systems—they not only help combat respiratory illness but also help clean other aerosols that are generated during dental procedures.”

Dental practices such as Mint Springs Dentistry have installed a new HVAC ventilation system containing HEPA filters, MERV 16 filters, and UV lights, in addition to procedural deep-disinfecting after each patient. Overall, efficient sterilization workflows, aerosol containment, air management, and following OSHA rules and CDC guidelines are here to stay, even after the pandemic comes to an end.

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¹Guidelines for Infection Control in Dental Health-Care Settings.
²Summary of Infection Prevention Practices in Dental Settings–Basic Expectations for Safe Care.
³Best Practices for Infection Control in Dental Clinics During the COVID-19 Pandemic