Introduction to the dental clinic
Sterilisation area layout and equipment
Tachae Douglas-Miller and Nicole Stormon
Learning Objectives
Appreciate the instrument reprocessing area design for facilitation of safe dental practices.
Explain the workflow of a reprocessing area.
Apply universal principles of infection control in dentistry to the dental surgery and sterilisation area layout.
Principles
Environmental controls in a dental practice design can reduce the risk of transmission of infection. Dental practices consist of a designated sterilisation area, where various instruments are processed via decontamination, disinfection and sterilisation. In this area there must be clearly segregated ‘clean’ and ‘dirty’ zones. To maintain these zones, it is imperative the layout or floor plan of a sterilisation room facilitates a one-way flow for the entry and exit of instruments. This flow provides operational efficiency as well as guaranteed infection control.
Instrument reprocessing area require:
- Aseptic techniques
- Instrument flow from contaminated to clean
- Adequate lighting and ventilation
- Hygienic and clean working spaces
- Suitable storage space
- Contaminated instrument sinks
- Separate clean handwashing sinks
- Cooling area for sterile items awaiting re-entrance into the operational rooms.
Workflow begins in the dirty zone of a sterilisation area and ends in the clean zone. It is a multi-step, universal process that includes cleaning, disinfection, inspection and assembly, and finally packaging and sterilisation, where applicable to the instrument.
The dirty zone is named as the contaminated instruments are brought from the surgery directly, to this zone in the sterilisation area. Upon entry, contaminated instruments will be placed in the ‘set down’ area to then begin the process of decontamination and cleaning before sterilisation.
The clean zone contains the instruments that have been decontaminated, sterilised and/or disinfected effectively. Instruments will re-enter the surgery or operatory room, from this area.
I have contaminated instruments but I don’t know where to place them in the sterilisation area. What do I do?
The dirty zone of the sterilisation area should be clearly labelled. If you are unable to locate the borders of where the clean or dirty zones begin, ask a colleague before placing your contaminated instruments in the sterilisation room.
Work flow steps:
- Wearing personal protective equipment, securely carry the contaminated instruments from the surgery to the instrument reprocessing area (sterilisation room)
- Place the items in the setting down area (dirty zone)
- After items have been adequality sterilised through several processes (discussed in later chapters) instruments enter the clean zone of the sterilisation area
- Clean hands are used to take instruments into the dental surgery or storage areas for placing sterilised instruments and instruments packs.
Who is responsible for maintaining the workflow in the sterilisation area?
It is the responsibility of all of the dental team to appropriately provide a safe environment for patients and colleagues minimising risk of transmission of infection from patients to clinical staff, within the clinical staff and from patient to patient.
Country context
Australia
The Dental Board of Australia develops and regulates infection control guidelines within Australia. This provides a basis for practice managers, dental practitioners and clinic owners, to develop protocols for infection control specific to practice settings.
It is the responsibility of dental practitioners to implement guidelines within the practice, ensuring staff are familiar with protocols. The infection control guideline refers to other reference documents such as the National Health and Medical Council Infection Control guidelines[1] and the Australian Dental Association Infection Control guidelines[2].
The Dental Board of Australia routinely audit clinic infection control practices. This is common if there has been a complaint from a patient, member of the public or a former/ current employee. It is important to ensure all guidelines are adhered to whether or not the practice is audited.
Practical application to the dental environment
Practices will vary slightly, with specific design and layout of sterilisation rooms. However, the work flow from dirty to clean zones will not change. The correct workflow for sterilisation should be followed closely, to minimise risk of cross contamination and disease transmission.
There are several different types of reprocessing machines and brands which may vary from practice to practice. This will be discussed in later chapters.
Key Takeaways
- A dental practice will generally have a separate room for the purpose of reprocessing and cleaning instruments.
- A ‘one way flow’ must be utilised to minimise infection control risks and exposure.
- Correct personal protective equipment must be worn at all times.
Clinical areas which are not contaminated by potentially infectious materials.
Clinical areas which potentially have infectious agents and are treated as if they do have contaminants.
The areas where contaminated instruments will be placed in the sterilisation room to then begin the process of decontamination and cleaning.
