The future of dental clinic design fluctuates like a butterfly in the wind. Now, with a global pandemic and its associated new industry guidelines, changes are necessary in dental clinic design. Some of these changes will be in management and operations, and other changes will be to your dental tools and equipment; however this discussion will focus on certain architectural design implications of this pandemic, the physical environment, and the future design of dental clinics.
Dental Clinic Design must change… now. Architectural design focuses on the physical environment, specifically the enclosed physical environment. It’s important to note that the architectural design of a dental clinic significantly affects how a dental clinic works, as it significantly affects its processes. The layout of your spaces, configuration of your physical equipment and the ventilation systems in your clinic have a major impact on health and safety now and into the future.
One significant challenge for dental clinics during the COVID-19 pandemic is how to control the movement of aerosols within a clinic. Aerosols are suspended particles or droplets created by high speed dental equipment such as scalers, burs & air/water tips that potentially contain viruses, bacteria, and even blood. These aerosols are small enough to float in the air and can travel wherever the air flow takes them, possibly spreading up to 30 feet. The movement of aerosols within a clinic can be controlled in many different ways; solutions can be permanent, temporary, costly or cost-effective; there is not a magic formula for what works best, as each dental clinic and each business will need to weigh the benefits and drawbacks and decide on the best solution for your staff, patients, and business. In our pandemic environment, it is critical to reduce the flow of aerosols between treatment rooms while also reducing the flow into the hallway and circulation areas.
By separating treatment spaces, we can decrease the movement of aerosols from room to room. Many clinics already have full divider walls between treatment rooms, but for those that are using partial height cabinetry or partial height walls between treatment rooms there are solutions to close off those areas to reduce transmission of aerosols such as with new partitions, glazing with glass or plastics, or a temporary divider with inexpensive acrylic panels hung from the ceiling or supported on the partial wall or cabinets. Other options to minimize transmission of aerosols include screening devices, non-porous screening, or soffits to close off the openings. Whether a management effort or a marketing effort for your clinic, your staff has always cleaned the treatment rooms between patients; now, more than ever, you should visually alert your patients to your cleaning practices by putting small reusable and cleanable signage out that says “Sterilized Chair” or “Sanitized Exam Room.” As your patient enters the room they will clearly see your staff move the sign off the chair, reassuring them of the cleanliness of your office.
Improve your clinic’s air quality. Airflow significantly effects comfort and the movement of aerosols in a dental clinic. There are many ways to control airflow in a typical treatment room with the typical solution to blow heated or cooled air into the space over the window or exterior wall of the clinic and pulling the return air through the ceiling in the hallway outside of the treatment room. This creates a flow of air, that is considered “positive” pressure within the treatment room, like the air movement from a blowing fan, pushing the flow of air into the hallway, which is pulling the air out and considered “negative” pressure, like the suction of a vacuum. With current concerns about aerosols in the treatment rooms, this common and widespread design solution may be short-lived. A better approach would be to keep the treatment rooms under negative pressure, pulling the air into the rooms, and exhausting the return air directly outside or through a high level of filtration, like a HEPA filter, prior to recirculating that air. You can even enhance this filtration with systems such as ultraviolet (UV) light or ozone which can kill viruses and bacteria. While negative pressure within the treatment rooms is beneficial for containing the aerosols, it has its downsides; it may draw contaminated air from the hallway, possibly creating uncomfortable drafts on the patient, and it simply costs more. Retrofitting a clinic in this way may typically be infeasible; however, if planning a new clinic, this would be a potential design direction. Most existing systems can be updated with HEPA filters and UV or ozone systems, utilizing your current ductwork for modest costs.
Protection of your staff as well as patients from contamination is critically important, since they will have multiple interactions throughout a day. The ADA and state Dental Associations are recommending barriers between treatment areas, however, you may also want to consider providing temporary clear barriers at your reception desk protecting your reception staff and patients. These barriers would be similar to those being used for retail grocery clerk areas with multiple panels of clear acrylic or glass temporarily set or mounted to the front reception desk to shield the receptionists and related staff, like common cafeteria line sneeze guards. In the future, clinics may incorporate some form of separation at the reception desk, with more permanent glass or resin panels, while maintaining a satisfactory level of personal connection to the patients.
Toilet rooms may need physical considerations beyond simply sanitization. Hands-free faucets, soap dispensers, and paper towel dispensers/hand dryers should now be the standard for every public toilet in your clinic. You can easily retrofit hands-free faucets at every sink in your clinic, including the often overlooked breakroom sink.
Waiting room changes are being recommended by industry guidelines as a pandemic response, with most of these being procedural or management of patients and their families or attendants, including staggering of entrance timing. These are temporary measures meant to minimize cross-interactions of your patients. Some of the changes you may make will be temporary, while you may find others may actually increase your productivity and efficiency, so should be kept in place. The less touching of devices, paperwork, and shoulder-to-shoulder seating in a waiting room the better to reduce transmission of viruses and other illnesses. It is time to rethink the waiting room. Here are some ideas:
- Pre-appointment check in: patients can check in at home, on their own computer, prior to arriving at the clinic.
- No touch check in: check in on your phone at the clinic or prior to arriving. If you have patients that check in with paper and pens, provide the pens with your logo/phone on them and have patients take them home; do not use the pens for multiple patients unless you sanitize the pens between patients. Sanitize all check in materials such as clipboards between every patient.
- Text messaging: text patients that their treatment room will be ready for them at a particular time, maybe 30 minutes prior, so when a patient walks into the clinic they are immediately escorted to their exam room. Another option is texting or calling patients who are waiting in their cars outside of clinic.
- Check in kiosks reduce direct interaction with receptionists; since they are touchpoints, the kiosks will need to be sanitized between each patient use.
- Hands-free entry: Doors can be readily retrofitted with automatic openers with hands-free panel switches.
- Designated “IN” and “OUT” doors, when space allows, to keep patient-to-patient interaction to a minimum.
- Minimize touchpoints that can spread germs, such as coffee machines, and beverage coolers.
- Additional measures, permanent or temporary, might include: adjusting furniture to allow patients to maintain proper social distancing, hand sanitizer stations, and defining social distancing space in key areas.
- Best practices for cleanliness: keep the waiting room clean and clear of clutter and items that may hold and spread viruses. Remove items that multiple patients may come in contact with such as magazines – yes, even toys – and the ubiquitous information pamphlets.
When it comes to controlling contaminants in your clinic environment, many possible solutions are available for new clinic designs and for pandemic-related retrofits, but they will vary from clinic to clinic and location to location. As the pandemic situation is rapidly changing, keep a creative eye on all evolving solutions and recommendations. Some of these changes may become long-term best practices in your clinic, so plan for the future of what your clinic should be. Tap into resources from dental industry guidelines and connect with your dental architect for their professional advice, specific design ideas, and problem solving. Most important of all, be considerate of others by keeping your team and your patients safe.
We’re here to help! If you have questions about the future of dental clinic design or want to discuss a project, contact Bob at firstname.lastname@example.org or 612-340-5430