Sterilization Systems and Your Bottom Line

Opening your first practice can be both an exhilarating experience and exhausting process. Along with the excitement of starting your own business, comes the checklist of tasks to do before your opening day. Practice design, equipment and merchandise choices, software

Sterilization Area Design

options, business systems, marketing strategies… the list can seem endless. Because your practice is a healthcare facility where

invasive procedures will be performed, there are additional items that must be addressed before the first patient is seen. One of the themes that will be present throughout the life of your

Peggy Skirball, RDH, BS

practice is compliance. The Centers for Disease Control and Prevention (CDC), who set the standards of care for

Jessica Wilson

patient and staff safety, recommend all dental practices have written protocols in place for specific Infection Prevention tasks (1). Without a plan, some sleepless nights are in your future.

In this article, we will examine these systems and protocols from a business perspective. What does it mean to the health of your business when the right systems are in place and what is the cost to you when they are not?

INSTRUMENT MANAGEMENT

PEGGY SKIRBALL, RDH, BS

AND JESSICA WILSON

taminated instruments in private practice. It is important to understand this process can be laborious and time-consuming for your staff. Because staff salaries will always be your largest expense, streamlining instrument processing to maximize efficiency is in your best interest. Any amount of time lost due to inefficient systems is production time and potential revenue that will never be recuperated and adds to your business operating costs. Renee Pfefferle, Practice Management Consultant and owner of Dental Evolutions in Raleigh, N.C., targets efficiency as the key to cutting practice overhead. She states that the lack of efficiency is the number one reason overhead is high in a dental practice and points to the sterilization process as one of the main culprits.

The Sterilization Area is the heart of every dental practice. Almost everything used in direct patient care funnels through this area for reprocessing. It requires the highest infection control standards in the practice, as it has the highest potential for sharps injuries among staff and cross contamination to occur (2). This area should be a designated central processing area divided into four distinct sections for receiving; cleaning and decontamination; preparation and packaging; sterilization; and storage of these sterilized items (3). The CDC has outlined this sterilization

flow as a means of maintaining the chain of asepsis during instrument processing. The one-way flow of instrument processing from contaminated to sterilized also encourages staff to remain in compliance by making the process easy and systematic. If this area and your instrument processing systems is not well-planned, ultimately, it will slow down the entire clinical treatment area. Minutes wasted add up to hours lost over the course of a week… precious time no office can afford.

As the practice owner, having an established system for organizing instruments and their reprocessing will help you manage operating costs, reduce labor time and keep your eye on compliance. Staff safety has to be considered, as well with over 30 percent of all sharps injuries occurring in the transportation and processing of contaminated items. OSHA (Occupational Safety and Health Administration) directly addresses safely managing these items in their Bloodborne Pathogens Standard as a way to mitigate this high percentage (4,5). An instrument management system, like Hu-Friedy’s IMS system, is your answer to addressing all four of these concerns. Dr Louis Malcmacher states, “An Instrument Management System

Remember to consider your long-term practice goals and growth potential when purchasing sterilization equipment. For example, from a business perspective, it doesn’t make sense to purchase the smallest ultrasonic or autoclave available only to replace it with a larger one to accommodate your growing practice in a few years. Looking into the future and planning for practice growth is wise when making equipment choices.

eliminates many manual steps, including dangerous hand scrubbing and sorting of instruments, while increasing chair-side efficiencies. An Instrument Managament

Dentists receive little training on the complex steps involved in sterilizing con-

INSTRUMENT MANAGEMENT fficienc STERILIZATION

Hu-Friedy’s Instrument Management System (IMS®) is designed to keep your instruments organized and intact from cleaning to chairside, saving you 5 to 10 minutes per procedure so YOU CAN PRACTICE MORE:

Learn more at Hu-Friedy.com

Call 1-800-Hu-Friedy or contact your authorized Hu-Friedy representative for more information.

PRACTICE MORE

CHAIRSIDE

CLEANING

STORAGE

...Chairside Efficiency

...Cost-Savings

...Revenue Generating Activities

...Organization & Productivity

...Safety Protocols

Figure 1 is an example of a sterilization area that is set up in accordance with the CDC Guidelines.

System that stores procedural instrument set ups together through the use of stainless steel cassettes ensures that everything is where you need it when you need it.” This system standardizes the transportation, cleaning, sterilization and storage of instruments used during patient care while protecting instrument integrity throughout the day. It allows your staff to begin reprocessing with a safe, organized and efficient system that can quickly and easily adapt to future practice growth.

In addition to these benefits, practices that use IMS consistently show a savings of between five to 10 minutes per patient in instrument processing time. In one day, this can save over one hour of valuable staff time that can be spent on more revenue enhancing activities for the practice. Time is money, and if your staff is available for face-to-face conversations with patients, they are much more likely to help increase treatment plan acceptance rather than having their hands in the patient’s mouth or stressing over instruments piling up in the sterilization area.

PATIENT PERCEPTION

STANDARDIZED PROTOCOLS

Recent media coverage of infection

be alert to what your existing patients see and observe (6). “When patients notice a breach in a dental practice, they are unforgiving,” says Pfefferle. Patients are more curious than ever before as to what you are doing and happy patients are your best referral source and marketing strategy.

The internal marketing value of an organized practice cannot be overstated with over 40 percent of doctor production coming from new patients (7). You need to attract more patients like you already have. Using your IMS as an internal marketing tool is only one of the benefits it affords your office. The medical-grade cassette that was presented to your patient before treatment begins gives them something positive to talk about when they speak of their experience with your practice. It gives them confidence in you and the treatment you provided!

Conclusion

The investment you make now in your practice design, equipment and organizational systems will ultimately pay large dividends for your practice. Business owners must have a strategic plan to decrease risk and liability, comply with standards of care and best practices and be certain staff is working as efficiently as possible while making the best impression on your patients every time you see them! CDC and OSAP (Organization for Safety, Asepsis and Prevention) have websites

control breaches has highlighted the need for the practice owner to have a pulse on compliance. Too often, staff is left uninterrupted to perform outdated processes without any oversight from the practice owner. As the doctor, you are the person ultimately held responsible for any bad patient outcomes or allegations. Sean Kurdys, an investigator with the North Carolina State Board of Dental Examiners says, “If it isn’t written down, it didn’t happen.” Without written standardized protocols, documentation of the tasks performed and calibrated staff training, your exposure to liability and risk are dramatically increased.

that you can reference for translating these recommendations into protocols. However, confusion and misinterpretation abound with these recommendations and sometimes just getting started is overwhelming! Luckily, you have dedicated dealer representatives and support professionals available to help you through all of the decisions. Asking for advice from experts will allow you to focus on your patients and do what you do best while being sure you are making smart business decisions! A successful practice is definitely in your future. ■

Basic Infection Prevention protocols to consider include Instrument Processing, Biological Monitoring, Hand Hygiene, Dental Unit Waterline Management and Patient Room Turnover. Check with your state dental board to see if there are any additional state-approved plans with which to comply.

REFERENCES

With 25 percent of patients leaving a practice due to some witnessed occurrence that they perceive to be in breach of basic sterilization standards, you have to

1. Kohn, W.G., et al. Center for Disease Control and Prevention, Guide for Infection Control in Dental Health Settings, 2003.

Review of Science Related to Dental Infec-

Peggy Skirball is a dental hygienist with

tion Control/ Education and Training. 2. Molinari, J.A., Harte, J.A. (2010). Practical Infection Control in Dentistry, third edition. Chapter 14: Asepsis Considerations of Office Design & Equipment Selection, Lippincott Williams & Wilkins. 3. Kohn, W.G., et al. Center for Disease Control and Prevention , Guide for Infecover 23 year experience in private practice. Graduating with honors from the University

of North Carolina at Chapel Hill with a BS in Dental Hygiene., she has dedicated her professional sales career to raising awareness in the dental community about practice systems that affect office productivity and safety. Her passion is assisting Doctors in making good business decisions when setting up their new practice. Peggy is an expert in sterilization system

tion Control in Dental Health Settings, 2003. Instrument Processing Area. 4. Younai, F.S., Murphy, D.C., Kotelchuck, D., (2001). Occupational Exposures to Blood in A Dental Teaching Environment: Results of a Ten-Year Surveillance Study. Journal of Dental Education. 65:5. 5. Occupational Safety and Health Administration (OSHA). Bloodborne Pathogens Standard, 1910.1030(c)(1)(i), and 1910.1030(f)(3) 6. Kelsch, N.B. A Patient’s Perspective. RDH Magazine, Sept 2012. 7. Levin, R.P. Increase New Patient Production. Dental Economics, www. dentaleconomics.com/increase-new-patientprodcution.html. November 2003.

best practices and is intimately involved in planning dental practice clinical treatment area efficiencies and training staff on proper infection prevention protocols in the Mid Atlantic area. She is a frequent regional

speaker at local dental societies, dental hygiene components and study clubs. Peggy is a member of the ADHA and North Carolina Dental Hygiene Association.

Jessica Wilson is a National speaker, trainer

and educator focused on Infection Control. As the Instrument Management Specialist

for Hu-Friedy, Jessica is involved with

educating and training Dental professionals on current sterilization techniques in their day to day operations to ensure the safety of staff and patients. Jessica continues to stay on the cutting edge on Infection Control changes within the dental industry attending several continuing education courses throughout the year as well as continued professional development as an educator. Her passion for assisting dental professionals with time management practices, instrument maintenance, reduced staff stress and improved safety in the dental office comes through in her fun and interactive presentations.

Jessica is a graduate of the University of Rhode Island and certified in Dental Public Health from A.T. Still University in Mesa, AZ. She is a member of the ADHA, Atlanta Dental Hygiene Society,

Georgia Dental Hygiene Association, Organization for Safety, Asepsis and Prevention, and the National Speakers Association Georgia chapter.