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Guide to Maximizing Sterilization Efficiency and Productivity
It is our attempt here to cover the most important considerations when trying to design, equip and organize your Sterilization area for maximum productivity. This is a work in progress and not a formal “How To” guide.
But through the implementation, feedback and revisions of the topics covered from doctors across the country, we will create an ever evolving method of how to eliminate one of the most common bottlenecks in dental practices, the sterilization area.
This is the first determination you need to make when considering how you will setup your sterilization area. First let’s describe the difference between these two practice types.
Room centric consists of having rooms that are fully stocked at all times with several weeks worth of the supplies you will use to do your dentistry. These rooms typically have large amounts of cabinetry both at the head and side walls to help store all of these items.
This method of stocking your treatment rooms can be quite effective in smaller offices (2-3 treatment rooms) for a few reasons: Inventory control across 3 rooms or less is fairly easy, especially if each room is stocked identically, space is less likely to exist in a 3 op office for a truly centralized sterilization and resupply area, likewise the need to mobilize technology is not as great.
Office centric on the other hand is the type of practice we will be covering in this guide. In an office centric practice the vast majority of supplies will be kept in a central sterilization & resupply area. Only small amounts of supplies are kept in the treatment rooms. (A typical ratio of supplies in sterilization to supplies in treatment is 5-1) If you are stocked for 1 weeks worth of typical dentistry within your rooms, your treatment area will have 5-6 weeks. This allows for you to order supplies once a month and still maintain your capacity during peak demand flow.
Another key principle is that your rooms are not stocked with everything you need. Your rooms will ideally be stocked with what you need to do 90% of your most common procedures.
The materials for less frequent procedures will be kept either in A) separate tubs in central sterilization for specific procedures (Implants, Dentures, etc.) or B) mobilized to readily deployable rapid carts so that they may be delivered chair side at a moments notice. (ie. Endo, Ortho, Sedation, Surgery, etc)
Office centric setup is best served for any practice with 4 or more ops. This will have a few immediate benefits at this size practice. First, it will reduce your cabinetry and space requirements within the rooms. Second, it will make you more flexible in determining where and when to schedule appointments. Third, it can greatly simplify inventory control and ordering, as everything is located in one central place.
Key Essentials for an Office Centric Practice
Next we’ll look at a way to make all of the items in your treatment rooms and your central sterilization area visible and easily accessible at all times. They cannot be hidden away in draws because the old cliché is true “out of sight, out of mind”.
Let’s take this a step further too, let’s not be satisfied with taking items out of drawers. Let’s take them right out of their boxes. They’re all individually sealed, remove the bulk of a box and you’ll be amazed at how little space the individual materials take up (anesthetics, adhesives, etc) Now you can organize them in a logical pattern, immediately accessible in half the space or less.
With your rooms stocked with a weeks worth of the materials you need to do 90% of your dentistry, some items will need to be deployed to the room per procedure. These items will need to come from somewhere. Ideally a location central amongst the treatment rooms. Items such as: instruments, handpieces, bur blocks, impression guns & material, case pans and anything else specific to the procedure you will be doing.
All of these items will have their own dedicated place within sterilization, labeled and accessible..
In the grand architectural scheme this room should literally be as close to the middle of the office as possible with the treatment rooms designed around it. This will ensure that no distance to and from sterilization is excessively long, it also allows any staff member available to run the sterilization sequence, deliveries can be made directly to this room and it’s a great place to break away and have semi-private conversations with staff.
If a truly central location is not feasible, locating this room off the main treatment room hallway is your next best option.
We could spend weeks debating the proper procedure and layout for a sterilization room, from the two ends of the spectrum: the minimalist perspective (our perspective – do what you need to and get back to treatment) to the school of thought where your sterilization should be a focal point and marketing tool for your practice (decidedly not our perspective).
If you want to debate the “proper philosophy” we suggest visiting Dental Town. Here we’ll cover the minimalist perspective.
These are the items you will need in your sterilization, in this specific order. Landing pad, trash drop and med waste, soak sink, rinse sink (a double bowl kitchen sink serves fine), a dishwasher (not a $5,000 dental disinfector), an autoclave/dry heat sterilizer with fume hood above, then a cabinet for storage of sterilized items.
That’s it. This will occupy less than 9 linear feet of base cabinetry on average and it need not be in a straight line, so long as it flows from one station to the next without interruption. Clockwise, counterclockwise, it doesn’t matter, so long as it’s in sequence.
What you do after that is up to you, we will typically then run bulk storage to the end along the bottom (no cabinets, just a toe kick & counter top), placing a refrigerator under this section is common.
Along the upper portion of this section we will commonly run our operative resupply storage. We recommend using hydraulic Resupply Pulldowns, made by Ergonomic-Products with built in tilt-bins for individual item storage. Although the most important aspect isn’t what cabinet you use but that your supplies are visible, accessible and organized.
Cassettes are extremely useful for an office centric practice. Most offices can consolidate their cassette setups into four cassette types: Operative/Crown & Bridge, Endo, Hygiene and Exam/Check cassettes.
The major benefit of cassettes is that they require only the initial time to setup. You set them up once and you’re done. For the next 6 months you will never even need to open a cassette unless you’re in treatment. Fill every slot, with different but perhaps redundant instruments (like burnishers). Question. Is the cassette complete and ready to go? Answer. Are all the slots full?
Cassettes are also a safer method of transporting soiled instruments throughout the office as well but this is a minor benefit compared to the time saved in setting up and breaking down trays. Also having the piece of mind that you’ll have the instruments you need come procedure time, can be well worth the initial expense.
Here is an example of what the 4 typical cassette setups commonly include.
This has less to do with sterilization efficiency but is a critical component in an office centric practice. When you only have small amounts of materials in the rooms to do your 90%, the remaining 10% will need to come from somewhere.
We opt to mobilize these procedural items. This allows us to set up every treatment room identically and transition to any procedure at a moments notice.
Endo is probably THE most common type of procedure mobilized although, Ortho, Air Abrasion, Sedation, Surgery, and Microscopy are all valid candidates for mobilization as well.
Gone are the days of the “room we do root canals in” or “room we do ortho in”. Again in a room centric practice, this might work, but once you start getting into mid to high range treatment room counts, this system simply breaks down and becomes unpredictable and unreliable.
Many doctors are already familiar with companies like Zirc and Akro who make a wide variery of tubs and bins for dental practices.
We strongly advocate the use of these bins & tubs to accomplish a few things.
The systems you use to organize, support and deliver procedurally are just as, if not more important than the procedures themselves. But they didn’t teach you that in dental school.
You rolled an Invisalign case into Lumineers? Well that’s good, but you had to reschedule that crown turned root canal halfway through column 2 for next week, tying up a room. You booked 4 sedations for next week? Well that’s good, but your staff is running around stressed and tired and your patients’ are feeling it.
Above average production should never come at the expense of your patient’s satisfaction, your staff’s sanity or your own personal health and well being. That’s a lose/lose situation for everyone.
But if you standardize your core work and systematize your plan of action so that every scenario runs the same way, every time, then you can spend more time adding value to your patients’ visits and less time micro-managing the day to day operations.
What will this afford you? Well several ancillary outcomes can be expected, smoother procedures, reduced costs, better on time performance, happier staff and ultimately more flexibility & control can be expected. However, the primary benefit is time.
Some doctors then choose to use the time they save by automating their systems (as opposed to micro-managing) to do more dentistry. Other doctors choose to spend less time in the practice and more time with family & friends. Some doctors enjoy just taking some time to think. But now you have a choice.