Jeff Carter, DDS & Pat Carter, IIDA
Any successful dental practice remodel or new-build plan needs to follow sound design principles. These principles are even more important today due to the Coronavirus pandemic. Good practice design and a well-designed office can help you safeguard your team and patients, as well as manage infection control. Part of creating the optimal dental practice floor plan involves organizing spaces into “zones” that have a common function. Proper zoning drives efficiencies and helps to prevent cross-contamination hazards that can lead to transmission of contaminants.
Jeff Carter, DDS, and Pat Carter, IIDA, of Practice Design Group have a combined 60 years of experience with dental practice design. Their mission is to help dentists improve their practices through ergonomic and practice-driven design solutions. Dr. Jeff Carter practiced dentistry for 17 years and personally experienced the stress of working in poorly designed dental facilities. He transitioned to full-time dental office design over 20 years ago. Pat Carter has a degree in interior architecture, and for more than 40 years, she has focused exclusively on the unique design challenges of the practicing dentist.
“One of the challenges in planning a dental office is arranging the space for the most efficient flow,” says Dr. Jeff Carter. “We help doctors organize their spaces in ways that help them minimize stress and maximize the productive utilization of the space.”
Planning Your Space
The operatories are the starting point for laying out the office and will help determine the facility size needed. For general practitioners, the operatory sizing recommendation is 10 feet, 4 inches wide and 12 feet deep. If you plan to include five operatories, a great starting point for your total facility size would be 2,500 square feet. “The operatories are small spaces, so get the largest windows and as much ceiling height as you possibly can for patient comfort,” says Pat Carter.
Predicting the number of operatories needed now, as well as in the future, is crucial. “As you plan, keep in mind anticipated growth,” says Jeff. “We’ve tracked practices over 20 to 30 years, and, on average, after two years, the doctors’ production goes up 35%.” That productive increase can lead to “outgrowing” your facility in time.
“We recommend having at least one or two quiet ops since we’re seeing more and more general practitioners increase their expertise in more extensive and lengthier procedures,” says Pat. “This gives you the ability to bring in other specialists and expand your capabilities.”
The placement of the operatories in relation to the rest of the space is also crucial. For example, having an operatory across from the front desk does not work for many reasons. It violates HIPAA rules and causes stress for doctors and staff who get “caught” in unnecessary financial and scheduling conversations while attempting to stay on schedule clinically. This type of layout would also make it difficult to social distance and keep zones separate for infection control.
It is critical to create a well-designed sterilization area that meets CDC guidelines with a step-by-step process of dirty breakdown to clean buildup. “There's a tendency in some practices to skimp on the linear feet of sterilization,” says Pat. “I would definitely avoid that since you need plenty of separation between these steps. At a minimum, the sterilization area should be a 12-foot run for a four-operatory facility and then increase two linear feet for every additional two operatories added. For example, a ten-operatory facility will require a minimum of 18 linear feet of sterilization counter.”
The sterilization area should be central to all operatories for efficient workflow, so assistants don’t need to walk more than two or three operatories away. A lot of traffic goes in and out of the sterilization area, and the goal is to minimize cross-traffic flow between these spaces. Having an adequate number and type of cleaners and sterilizers for the volume of procedures and number of clinicians (dentists and hygienists) is important to maintain a productive practice. At least one large capacity sterilizer, like the Midmark M11® Steam Sterilizer, and one cleaner, like a Midmark QuickClean® Ultrasonic Cleaner, for every two to three clinicians is a good metric to follow. Fast sterilizer units, like the Midmark® M3 Steam Sterilizer, can also be added for higher patient turnover operations.
In a smaller office, auxiliaries or assistants go in and out of the sterilization area throughout the day. This approach proves the most inefficient as the practice grows. As facilities increase to eight operatories or larger, it is best to have a dedicated sterilization technician who receives contaminated instruments, sterilizes them, then distributes clean instruments back to the operatories. Some practices with ten or more operatories choose to take this one step further by creating satellite sterilization areas since it is difficult to centralize one sterilization area within efficient walking distance of ten or more operatories.
In a sterilization center, simple and durable is best. The more complicated the sterilizer, the more costly it is to run. Consider avoiding sterilizers that require special air or water filtration and extra monitoring tests. Because conditions in the sterilization center are harsh, steel cabinetry, such as Midmark Synthesis® cabinetry, and seamless non-porous countertops are vital. These classic, quality materials stand up to the daily onslaught of water, heat and cleaning agents. Adding self-sanitizing copper-infused hardware or covered door handles can also add durability.
Today, many clinicians are questioning how to configure waiting areas in the era of COVID-19, with some asking whether they still need the front desk. Yet the same design principles that were used to build up dental practices over recent decades continue to apply today. “Expanding production in a growing practice puts pressure on the front desk and accommodating growth in front-desk business functions is just as important as the rest of the practice,” notes Jeff.
“Keep in mind that in the most successful practices, patients are spending discretionary income on dental services that are often beyond basic dental care. Those types of patients will pick and choose where to spend discretionary dollars, often based on the perceived value they receive in services and what the experience is like. For example, a patient investing $20,000 in their dentition may react negatively to waiting in their car prior to a lengthy appointment. Having a warm, welcoming front desk and waiting area environment where your staff has a chance to interact with patients will always give you a competitive advantage.”
Practices need to be even more vigilant these days about keeping particulates out of the air. One of the most effective ways to reduce aerosol mist in operatories is through the dental vacuum pump. High-volume evacuation (HVE) equipment helps to reduce both the aerosols and splatter produced by ultrasonic and air-polishing treatments containing saliva, blood, bacteria and pathogens. Simultaneous HVE equates to approximately two users performing typical dentistry at the same time. It is important to have your Henry Schein technician visit the practice to evaluate your dental mechanical area and verify that the vacuum pump is the right size for your needs. For example, if an evacuator is rated for two or three users but five operators are on simultaneously, there could be a drop in suction if your system is not designed for that volume of output. If you need to upgrade, be sure to select equipment like the Midmark PowerVac series that can be upgraded to meet your new demands for simultaneous use.
Investing in quality dental chairs can also help with safety and sanitation. Lower and mid-tier chairs often have exposed seams and components that are difficult to clean and wipe down. Fluid and other matter can collect in these spots, making infection control more difficult. Midmark offers a limited-seams upholstery option designed to minimize these exposures.
Cabinetry and Furniture
Any material or surface used in a dental office needs to be very easy to clean. All operatories, transaction surfaces, such as the front desk, and insides and outsides of cabinetry need to be completely wiped down to remove biohazards. Quartz or solid surface are preferred choices for many surfaces due to their ease of cleaning and low maintenance characteristics. If price is a concern, plastic laminates are an option.
In terms of furniture, metal, plastic, and vinyl are common material choices for cleanability and durability. Upholstered Crypton fabrics are also available that can be sponged down and cleaned with bleach.
While certain aspects of dental office design have changed due to COVID-19, the fundamentals of form, function, aesthetics, and comfort remain the core of any successful plan. “Each new build and remodel project is so unique,” Pat concludes. “Every project is a distinct vision of your own that deserves to be explored, in depth and by multiple professionals, to give you the opportunity to see that vision come to reality.”