5 keys to safer spaces for the orthodontic office
by HanH Tran
Who would have guessed that COVID-19, a minuscule protein coated molecule (Fig. 1), could manage to bring the world to its knees, shut down virtually nearly everything, and even cause a national shortage of toilet paper and hand sanitizers?
To slow the spread of the superbug, we were mandated to wear face masks, encouraged to wash our hands more often, mind the 6-foot social distancing guideline, and self-isolate (if suspected of being infected). Then the full shutdown of all non-essential businesses and public gatherings. Finally, many of us were told to stay in place.
By now, many orthodontists have reopened their practices and are seeing patients while trying to figure out the rest of the infection program. The situation is still developing and morphing daily. There is certainly no shortage of ideas, from all corners of the universe, both sound and questionable.
This article will highlight strategies of retrofitting, designing and building your orthodontic office in response to COVID-19.
If you’re going to battle the superbugs, you’ll need to know what is there to work with in terms of building systems, wall assemblies and code requirements. Have your facility assessed by an architect or engineers to confirm your assets and deficits.
With that information, ascertain what needs to be done to achieve the infection control objective desired, along with learning the associated costs.
There’s a lot of information and many opinions to digest. Be willing to invest your time in the process to separate facts from fiction. Determine what can be accomplished both immediately and down the road.
Every smart person must know his or her strengths and limitations, in the same way doctors will, without hesitation, refer out certain cases beyond their expertise (or desire). Practice owners should also consult with design professionals as needed for their expertise.
Be open to big changes that could help you achieve maximum effectiveness for infection control. Few people welcome changes—even small ones—but large-scale alterations may be required to garner the optimal result needed to make you, your team and patients feel safe.
Although orthodontic offices don’t typically perform restorative treatments, aerosol-generating activities still expose occupants to environmental contamination and infections similar to those in a general dentist’s office.
Chair spacing and utility hookup locations are two components that require thoughtful consideration to building systems such as HVAC, while electrical and plumbing may also need alteration.
You may consider retrofitting your open-bay-style treatment area into semiopen treatment rooms, or increasing the space between treatment chairs, perhaps adding wall partitions between them. The wall partitions between the chairs don’t have to be extended to the ceiling, which could preserve the mechanical layout or require minimal alterations.
Existing break rooms designed to accommodate team huddles may no longer be adequate. Again, these spatial constraints could be remedied through enlargements or careful retrofitting.
Likewise, the children’s area, on-deck areas and brushing areas may need to be reconsidered for appropriate use and size, as they relate to infection-control protocols. Consult with your design professionals for their recommendations.
To manage the potential effects of pathogens, a multilevel infection-control strategy is needed. It would be a dream come true if a single silver-bullet solution rids us of the COVID-19 virus and the challenges it has created in practicing, but until that day, here’s a list of steps that orthodontic professionals can take, broken down into low-budget and high-budget strategies.
Though some of these options can be high in cost, consider the cost of losing the trust of your patients and staff when it comes to not maintaining an effectively safe practice.
Follow current CDC, ADA and OSHA guidelines for social distancing, installation of sneeze guards and proper PPE protocols.
Install no-touch restroom accessories including soap dispensers, paper towel dispensers, faucets (Fig. 2), toilet flush valves (Fig. 3) and occupancy light sensors. Costs associated with no-touch accessories vary widely; what is important is that you invest in quality commercial-grade products that will perform, require little to no maintenance, and are not easily removed from the office.
Install automatic door openers.
Upgrade maintenance regimens, intervals and protocols.
Install UVGI arrays in the ductwork to sterilize the air stream of pathogens in an effective and safe system with no potential harm to the building’s occupants. Surface-mounted or mobile units for sterilization of vertical and horizontal surfaces are also effective. They are used only when the space is unoccupied.
Install hospital-grade stand-alone air filtration systems for treatment areas and/or open spaces.
Deploy the use of at-source aerosol and droplet collectors.
Facility alterations may include reconfiguration of spaces, adding of doors and replacement of finish materials.
Retrofit or replace the HVAC equipment for a higher air exchange with added HEPA filters for a higher filtration performance.
Note: Virtually every big-ticket item purchased for your practice comes with some type of a warranty; your office finishes are no exception. For the warranty to be honored, every detail and requirement must be adhered to—from handling to preparations, acceptable glue, tools used, and maintenance cycles and recommended cleaning materials.
This is not a home-building project! Many municipalities require individual or companies working on commercial building projects to be licensed or certified to perform the work in their state or jurisdiction.
Design and engineering work is often required by law to be performed by, and sometimes supervised by, licensed architects or engineering professionals.
Start the design process with firms that have licensed staff and experience with orthodontic office design. Avoid equipment vendors that generate equipment installation plans, which cannot be used to build from and are, in general, void of pertinent acknowledgment, confirmation for zoning ordinances, building code and accessibility guidelines that have not been analyzed and or addressed.
The future of orthodontic office design is yet to be fully determined. Whether you’re designing a new building from the ground up (Fig. 4) or redesigning an existing office to renovate (Fig. 5), the rules of engagement remain much the same, so before you launch off the starting blocks, consider the advice here.
COVID-19 will remain with us into the unforetold future. The good news is that there are various measures that can be put into practice to meet health organizations’ recommendations and regulatory mandates to minimize exposure and protect everyone in the practice.