3: Surgery Design and Surgery Equipment

Chapter 3

Surgery Design and Surgery Equipment

Aim

The aim of this chapter is to delineate the principles for surgery design, which incorporate the principles of infection control. The selection of equipment is also discussed.

Outcome

After reading this chapter, surgery design and how it affects infection control, and the purchase of sterilisable instruments, should be understood.

First Principles

Very few dentists have the luxury of starting with a blank piece of paper and designing and building a dental practice. Most start with a building and convert it into a practice, which often means compromise. All too often infection control is an afterthought in the design and development of a dental practice.

The first major decision that has to be made is whether central decontamination facilities are to be used. The advantages of central facilities are the following:

  • Instrument decontamination and processing is not done in the surgery.

  • Steam and other emissions are confined to one area, with appropriate provision being made for ventilation.

  • The noise from operating autoclaves, thermal disinfectors, ultrasonic baths and related equipment can be confined to one room.

  • Machines for decontamination with high throughput can be used in centralised units.

  • Only one decontamination facility has to be commissioned, tested routinely and validated.

  • Testing, repair and maintenance of decontamination equipment does not interfere with clinical activities.

  • It is possible to have suitably trained staff dedicated to delivering decontamination of appropriate quality.

There are, however, disadvantages to central decontamination facilities.

  • The number of instruments required is high, as allowances have to be made for processing time.

  • The capital cost of machines can be high.

  • The cost of ventilation in the decontamination area can be high.

  • Some surgery staff do not enjoy working full-time in instrument processing.

  • Systems have to be designed for the safe transport of instruments to and from the surgery to the central facility.

  • Central facilities can occupy a lot of space.

Central facilities are most efficient when a number of surgeries are being serviced from it. The best arrangement for central facilities is a “hub and spoke” design, with surgeries being provided with instruments from a directly contiguous central facility (Fig 3-1). This is seldom possible, so the safe transport of dirty instruments, in particular, has to be arranged in leak-proof containers or trolleys.

QE39_Martin_fig021a.jpg

Fig 3-1 Possible design for “hub and spoke” layout for surgeries and central decontamination facility. HW = handwash sink; PPE = personal protection equipment; WD = washer disinfector or ultrasonic bath; AC = autoclave.

The position of the cleaning and sterilising equipment within the decontamination facility is also important (Fig 3-2). There should be a progress from dirty to clean areas with a sink in the dirty area to be used for decontamination. This sink must never be used for other purposes such as handwashing, let alone beverage preparation. Just before the sink there should be an illuminated magnifying glass to inspect the instruments. If instruments are still dirty after initial cleaning, then adherent material should be removed with a long-handled brush, with the operator wearing thick gloves, apron and eye protection. Beyond the autoclave should be a clean storage area.

QE39_Martin_fig021b.jpg

Fig 3-2/>

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Jan 5, 2015 | Posted by in General Dentistry | Comments Off on 3: Surgery Design and Surgery Equipment
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