Community Oral Health Facility Guide

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CommunityOral Health ServiceFacility Guideline


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Citation: Ministry of Health. 2006. Community Oral Health Service: FacilityGuideline. Wellington: Ministry of Health.

Published in August 2006 by theMinistry of Health

P !o" #0$%& Wellington& 'e( )ealand

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4his docu5ent is aailable on the Ministry of Health7s (ebsite:htt8:99(((.5oh.got.n


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Acknowledgements

4his docu5ent reflects adice 5ade to the Ministry fro5 a ariety of indiiduals andorganisations. 4he Ministry (ould li1e to ac1no(ledge in 8articular the in8ut fro5 thefollo(ing indiiduals and businesses in the deelo85ent of this docu5ent.

Margaret !innie& ;esearch Fello(& 4he Center for Health Assets& Australasia

!ob !us1in&


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Contents

$ *ntroduction

2


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/ *nfection Control/.$ niron5ental

/.2 Personal hygiene and 8rotection

/.% *nstru5ent re8rocessing area

3 Health and +afety3.$ erie(

3.2 +ole o8erator

$0 !uilding +erices and niron5ental


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;eferences and Further ;eading$. 'e( )ealand

2 Australia

A88endicesA88endi" $: Policy Fra5e(or1 for this Guideline

A88endi" 2: ;ole uantity +ureyor Costs

@ist of 4ables4able $: ssential ite5s of dental eui85ent (here installation 5ust be considered at the

design and layout stage4able 2: Clinical eui85ent for consideration and installation reuire5ents

4able %: *te5s to consider (hen 8lanning an oral health facility

4able -: +erice characteristics essential for @eel $ serice

4able #: +8ecific @eel 2 characteristics

4able 6: +8ecific @eel % characteristics

4able : ;elationshi8 bet(een 5odels of care and facility ty8es

Community Oral Health Service: Facility Guideline vii


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1 Introduction

stablishing a ne( 8ublic oral health facility (hether it be a unit in a hos8ital& aco55unity dental clinic or a 5obile unit reuires careful 8lanning. A range of factors(ill influence ho( (ell the facility functions& in ter5s of 8roiding a high,uality serice

in a safe eniron5ent. 4his ral Health Facility Guideline has been deelo8ed to8roide best 8ractice guidance on ho( to ensure this ha88ens.

4he Guideline (ill be of 5ost use to:

health serice 8ersonnel inoled in the 8lanning and design of oral health facilities

architects& 8lanners& engineers and others (ho are engaged to 8lan and design oralhealth facilities

8ersonnel (hose role it is to oersee and 5onitor such 8roDects.

Although the leels of serice 8roided (ill ary across


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Descri!tion o" Facilities

#1 Services !rovided

Most 8ublicly funded oral health facilities (ill 8roide 8redo5inantly co55unity,based

out8atient serices& but there 5ay need to be so5e in8atient access in hos8ital,basedunits. ueensland arere8licated in the 'e( )ealand oral health sector. We therefore thin1 that the

>ueensland guideline is releant and 5a1e reference to their suggested design criteriabelo(.

ral health facilities should su88ort the effectie and efficient 8roision of oralhealth serices to eligible clients. *n order to do this& the follo(ing outco5esshould be achieed by facility designs:

ca8acity to co58ly (ith releant la(s& by,la(s and standards

safe& hygienic buildings

ca8acity to achiee accreditation to an a88ro8riate leel

innoatie& sti5ulating and res8onsie eniron5ent for 8atients and staff

fle"ibility to allo( for future change

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5a"i5u5 energy efficiency

accessibility for disabled 8ersons

ca8acity to su88ort the deelo85ent and retention of high uality staff to 5eetthe needs of 8atients.

#$ %arget !o!ulation

4he target 8o8ulation for 8ublicly funded oral health facilities includes:

8re,school and school,aged children and adolescents

8eo8le (ith s8ecial needs (ho are unable to access dental care fro5 8riate dental8ractices

adults on lo( inco5es (ho are entitled to a Co55unity +erices Card

co55unities (ith high needs

clients in re5ote and rural areas.

#& Care o""ered

4he care 5ost co55only offered in co55unity,based facilities includes:

oral e"a5ination and diagnosis including radiogra8hic diagnosis

8reentie care& including fissure sealing and fluoride a88lications

general dental care& including restoratie dental care at a non,s8ecialist leel

e"traction of teeth and oral surgery

treat5ent of 8eriodontal disease

referral of 8atients as reuired.

Co55unity,based dental facilities 5ay also be used to 8roide dental serices beyondthose traditionally offered in school,based facilities& such as:

fitting and adDusting dentures and re5oable 8rosthetic care

s8ecialist care eg& orthodontic& out8atient oral surgery or 8aediatric dentisttreat5ent.

Facilities should be 8lanned bearing in 5ind the e"tended sco8es of 8ractice that 5aybe offered by a dental tea5 including dentists& dental thera8ists& dental hygienists orclinical dental technicians in the conte"t of each


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$ 'lanning Assum!tions

$#1 (ole delineation and level o" service

;ole delineation is a 8rocess that deter5ines the facilities& staff 8rofile and other

reuire5ents that ensure oral health serices are 8roided at an a88ro8riate leel andin a facility that is a88ro8riately su88orted. 4he leel of serice describes theco58le"ity of the clinical actiity underta1en by that serice& and is chiefly deter5inedby the 8resence of dental and other health care 8ersonnel (ho hold ualificationsco58atible (ith the defined leel of care.

4his Guideline reco55ends a role delineation and organisation syste5 (ith ahierarchy of leels of care& fro5 less co58le" to 5ore co58le"& (ith a88ro8riateconsideration gien to local needs& resources& cultural diersity and geogra8hicalconstraints. *t is based on the A5erican +ociety of Anaesthesiologists A+A Physical+tatus Classification +yste5& and considers the 8hysical states of the 8atients to be

5anaged and the serices to be deliered fro5 the facility to define four leels offacility& as follo(s.

@eel $: access is li5ited to e"a5ination and 8reentie oral health care for nor5alhealthy 8atients (ith 5ild syste5ic disease& deliered fro5 a fi"ed 8ur8ose, andnon,8ur8ose built or 5obile dental facility in a co55unity setting.

@eel 2: e"a5ination and treat5ent oral health serices for nor5al healthy 8atients(ith 5ild syste5ic disease are deliered fro5 fi"ed or 5obile co55unity facilities.

@eel %: e"a5ination and treat5ent oral health serices& (ith the ability to offersedation serices for nor5al healthy 8atients or 8atients (ith 5ild syste5ic disease&are deliered fro5 co55unity, or hos8ital,based facilities.

@eel -: e"a5ination and treat5ent serices& (ith the ability to offer sedationserices for nor5al healthy 8atients and e"a5ination and treat5ent serices for8atients (ith 5ild or seere syste5ic disease& are deliered fro5 a hos8ital,basedfacility.

For 5ore detail on role delineation and leel of serice& see A88endi" 2.

$# Hours o" o!eration

ral health facilities (ill usually o8erate during business hours& Monday to Friday.

Ho(eer& so5e 5ay o8erate outside these hours and this 5ay hae 8articulari58lications for access& security and safety of 8ractice that need to be consideredduring the 8lanning and design stages.

$#$ %y!e o" "acility

ffering a co55unity,based and 8o8ulation,focused oral health serice reuires a5i"ture of oral health facilities a88ro8riate to the needs of each co55unity and theneeds of the 8o8ulation. *t is antici8ated that co55unity oral health facilities (ill beeither:

stand,alone and co55unity,based in a 5etro8olitan or rural area

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co55unity,based and 8art of a school& co55unity health centre or other 5ulti,8ur8ose co55unity,based centre

a 5obile unit in an outreach location 5ade aailable for dental care

a hos8ital,based unit.

4he


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$#& Alternative contract arrangements


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3. 4herefore& $2&000 a88oint5ents 8er year reuire -.6 chairs.


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& O!erational 'olicies

4here are a (ide range of national& regional and local regulations and 8olicies releantto the 8lanning and deliery of oral health serices and facilities. For details on these&refer to the ;eferences and Further ;eading7 at the bac1 of this Guideline.

Accessing services

Child and adolescent 8atients generally access dental serices through an enrol5ent8rocedure& (hich 5ay include referral fro5 other health care 8roiders. ngoing careis 8roided& including a recall syste5 that 5ust be 5anaged by the 8roider.

Access by adults 5ay inole self,referral or referral fro5 other health care 8roiders&including 8riate 8ractice dentists& general 5edical 8ractitioners& 5edical s8ecialists&dental thera8ists and hos8ital,based clinicians. Adults often receie e8isodic 8eriodsof dental care& (ith relatiely fe( receiing regular dental care through recall arranged

by 8ublic dental 8roiders.

'atient management and "low

Patients attending the dental unit (ill re8ort to rece8tion& (here a88oint5ents (ill be5ade or confir5ed& and 8ersonal details ta1en or 8reious records retrieed. After this&8atients (ill be directed to the (aiting area.

Patients 5ay be acco58anied by su88ort 8eo8le& (ho 5ay include 8arents andcaregiers& (hInau and other children. Consideration 5ust be gien to 8roidingfacilities (ith sufficient roo5 to acco55odate all su88ort 8eo8le. When the dentist is

ready for the5& 8atients 5oe fro5 the (aiting area to the treat5ent areas.

4he design of the facility 5ust allo( easy access to clinics for 8atients& including those(ith disabilities. 4he unit 5ust also be designed to 8reent unauthorised access fro5the rece8tion 9 (aiting area into the treat5ent and sterilisation area& and fro5 thetreat5ent area to the sterilisation area. 4his 5eans creating a barrier by (ay of a door.

$ Anaesthesia

4his Guideline does not a88ly to the 8roision of day surgery under generalanaesthesia fro5 a day 8rocedure unit or o8erating suite.


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& ,edical emergencies and !atient recovery

Facilities for 5anaging 5edical e5ergencies 5ust be a88ro8riate to the agreed leel ofcare to be 8roided by the facility and (ithin the sco8e of 8ractice releant to theo8erators.- Facilities& staffing and s8ace 5ust co58ly (ith the codes confir5ed foreach dental clinician.

- Instrument re!rocessing

We antici8ate that the 5aDority of re8rocessing of re,usable surgical instru5ents (ill be8roided on,site in the dental facility.

On*site instrument re!rocessing and sterilisation

*t is 5andatory for facilities 8roiding on,site instru5ent re8rocessing to hae adedicated area to su88ort this 8rocess. 4he follo(ing standards are s8ecific toinstru5ent re8rocessing:

A+9') -/$#:2006 A+9') -$/:200%


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rtho8anto5ogra5#PG and other e"tra,oral radiogra8hy facilities (ill only beestablished in large& hos8ital,based units. 4he o8tion to outsource dental radiogra8hyfro5 radiology de8art5ents should be considered.

All eui85ent 5ust be tested for electrical and radiological safety before beinginstalled. *n the design stage it is essential to address (all shielding and to createcontrolled areas that ensure o8erator e"8osure is 5anaged (ithin the 'ational;adiation @aboratory guidelines.6 +ee also section $0./: ;adiation screening.

Dental records

Current dental records should be stored adDacent to rece8tion& using fi"ed 5etalsheling or a co58actus syste5 to allo( ad5inistratie staff easy access. Archies8ace for non,current records 5ay be off,site& but health records 5ust be accessible(ithin a reasonable ti5efra5e.

Health records 5ust be retained for the 5ini5u5 8eriod reuired in the Health;etention of Health *nfor5ation ;egulations $336. ;egulation # states:

*n these regulations the 5ini5u5 retention 8eriod in relation to health infor5ation(hich relates to an identifiable indiidual& 5eans a 8eriod of $0 years beginningafter the date on (hich the 8roider 8roided health serices or disabilityserices& or both& to that indiidual.

*ndiidual


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Mercury discharge is a significant concern& and dental clinics are recognised as8otential contributors to 5ercury conta5ination of the eniron5ent. ProDect staff shouldrefer to their releant local authority for guidelines on dis8osing of both liuid and solid(astes& bac1,flo( 8reention and (aste,(ater dis8osal./

6a+oratory4he need to include a dental laboratory in an oral health facility (ill de8end on the ageof the 5ain 8atient grou8 and the serices to be 8roided. 8tions include outsourcingdental technology serices or 8roiding an in,house7 serice. Consider 8roiding a5inor 8rosthetic adDust5ent area een if an in,house laboratory is not reuired.

4he 5anage5ent of noise and dust& and infection control& 5ust be considered at thefacility design stage.

In"ormation and communication technology 7IC%8

Planning *C4 syste5s to su88ort clinical and o8erational actiities is an essential 8artof the design and configuration of any facility. 4he nu5ber& sie and 8osition of(or1stations& including des1 s8ace and co58uters& (ill be deter5ined by the facility7sfunctions and should be su88orted by an ergono5ic assess5ent in relation to thefacility7s staff.

/ ;efer to: +tandards ') Waste Manage5ent +tandard ')+ -%0-: 2002. 'ote that this standard isdue for reie(. niron5ental issues eg& 5anage5ent of conta5inated (aste and deelo8ing

solutions 5ay result in additional reuire5ents to the e"isting standard 'e( )ealand


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- Facility 6ocation

4he ideal is a ground,floor location for ease of access by high olu5es of out8atients.*f the facility is in an u88er,leel floor& access by escalator is reuired as (ell as stairaccess.

*f 8ositioned in school grounds& the facility should be easily accessed& (ith 5ini5al orno disru8tion caused to the school& by children& adolescents and 5e5bers of the 8ublic(ho 5ay attend the facility but not hae a relationshi8 (ith the school. @ocating fi"edclinics and 8ads for 5obile units& on the school boundary is therefore desirable.

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/ Functional Areas and Design

/#1 Functional areas

4he functional areas of an oral health facility (ill co58rise:

entry 9 rece8tion 9 (aiting clinical treat5ent areas surgeries

8lant roo5

store roo5

",ray deelo85ent

sterilising roo5

staff offices

staff a5enities

cleaner7s roo5.

/# Shared or common areas

4he reuire5ents for co55on areas (ill de8end on the leel of serice and the ty8e offacility 8roided. 4he co55on areas (ill 8ri5arily be entry& rece8tion& (aiting and toiletfacilities for 8atients& 8lus su88ort areas for staff staff roo5& tea and coffee 5a1ingfacilities and bathroo5 facilities.

Access to these areas 5ust be aailable at all ti5es the serice is o8erating. Whenfacilities are located in a school& (ider health facility or other 5ulti,8ur8ose locationeg& a co55unity centre& agree5ents (ill need to be reached bet(een health serices

and school boards or other facility o8erators to ensure access to co55on areas (hendental serices are in o8eration. Ho(eer& a88ro8riately negotiating thesearrange5ents 5ay substantially decrease the costs associated (ith designing& buildingor refurbishing facilities and utilising shared area agree5ents should be considered(here 8ossible.

9ntry 4 waiting

4his area is ideally situated (here it has easy access fro5 the 8ar1ing areas forout8atients. 4he design of the entrance (ill de8end on (hether the unit is accessedfro5 inside a building or directly fro5 outside. *n the latter instance& an airloc1 (ill be

reuired. ntry to the clinic 5ust allo( easy barrier,free access for 8eo8le (ithdisabilities& including 8eo8le in (heelchairs& and 5ust co58ly (ith the 'e( )ealand!uilding +tandards.


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(ece!tion

;ece8tion (ill acco55odate one or t(o staff de8ending on the sie of the unit. 4hecounter 5ust hae one (heelchair,accessible section. *t is reco55ended that therece8tion area enable the collection and 5anage5ent of account 8ay5ents. A duressalar5 5ay be 8roided.

'atient and visitor amenities

Patients and their su88orters should hae access to either in the facility or in close8ro"i5ity a toilet& including hand,(ashing& (ith disabled access.

/#$ Dental surgery design

Single*room: e)amination 76evel 1 "acility8

+ingle,roo5 design for e"a5ination incor8orates all serices and eui85ent reuired

for the assess5ent and 8reentie care of one 8atient& and is a88ro8riate (hen: dental eui85ent is li5ited to a single dental chair& along (ith light and co58ressed

air

an e"isting s8ace lends itself to this for5 of design

8riacy for 8atients is reuired.

Single*room: treatment 76evel and a+ove "acility8

+ingle,roo5 design for @eel 2 treat5ent incor8orates all serices and eui85entreuired for the assess5ent and treat5ent of one 8atient. *t is reco55ended that at

least t(o single roo5 surgeries be 8roided in a facility. Priacy for 8atients and(heelchair access is reuired.

L

O!en*!lan design 76evel and a+ove "acility8

*n an o8en,8lan surgery design& surgeries& each acco55odating one dental unit arearranged in 8airs (ith shared hand,(ashing& ",ray and storage facilities locatedbet(een the5 and se8arated fro5 each other (ith 8artial height 8artitions. 4he design5ust ensure 8riacy fro5 the circulation corridor. Manage5ent of ",rays and 8atient8riacy (ill need careful consideration.

4he adantages of an o8en,8lan design include: s8ace efficiency

cost efficiencies through shared resources eg& dental assistants& ",ray units

an eniron5ent for teaching and su8erising clinicians.

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,ulti!le room surgeries

A 5ulti8le roo5 surgery is reco55ended for 8ro8osed co55unity clinics in urbanareas or centres of sufficient 8o8ulation. 4hese facilities 5ay include a co5bination ofsingle,roo5 dental surgeries acco55odating one dental unit and9or surgeries (ith ano8en,8lan design acco55odating t(o dental units. 4he final configuration and nu5ber

of surgeries and dental units (ill de8end on the 8o8ulation sered and the facility7sfunctions eg& clinical training. Multi,roo5 facilities could acco55odate fro5 four u8 toeight dental chairs.

@arger co55unity,based facilities (ith 5ulti,roo5 surgeries hae the adantage ofoffering the o88ortunity to:

engage a dental tea5 consisting of a dentist& dental thera8ists& dental assistants andad5inistration9rece8tion staff

i58roe access to serices through increased o8en hours

offer training 8rogra55es for health 8rofessionals and su88ort 8ersonnel.

/#& Dental surgery layout

A ty8ical dental surgery has the dental unit 8ositioned close to the centre of the roo5 orcubicle& (ith the foot of the chair facing a(ay fro5 the entry. 4his is the 8referredorientation of the unit because it addresses both 8riacy and 5odesty concerns for8atients& and ensures easy staff 5oe5ent in and out of the roo5 and a ready 5eansof e"it if a 8atient beco5es aggressie.

4he dentist or dental thera8ist and dental assistant o8erate around the head of thechair& (ith the o8erator nor5ally 8ositioned on the right side of the 8atient. A dental

assistant7s (or1station is located behind the head of the chair (ith adeuate o8eratings8ace& and incor8orates the storage of dental 5aterials and eui85ent& dis8osableite5s& and a (or1 surface for retrieing and 5i"ing dental 5aterials.

*n both single,roo5 and o8en,8lan surgery designs& the dental assistant7s (or1stationand adeuate shared storage units for eui85ent and dis8osable ite5s should bes8ecifically designed for user accessibility& s8ace efficiency& infection control and theeasy 5aintenance of a clean& clutter,free (or1 eniron5ent. 4he dental surgery isessentially designated a dirty area& (ith all sterilising serices carried a(ay fro5 thesurgery to a se8arate sterilising area.

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0 Su!!ort Areas

4he e"tent to (hich the follo(ing su88ort areas are included in an oral health facility(ill de8end on the sie and location of the unit:

8lant roo5

instru5ent re8rocessing 9 sterilising

resuscitation trolley bay

stores su88lies and eui85ent

linen store

",ray 8rocessing

laboratory

cleaner7s roo5

dis8osal roo5.

*n s5all& single,surgery units sericed by a isiting dentist or dental thera8ist& fore"a58le& the full range of facilities (ill 8robably not be a88ro8riate. Arrange5ents (illneed to be 5ade for serices not aailable on site& (hich (ill co55only includesterilising and laboratory needs.

0#1 6a+oratory

@aboratory (or1 is li1ely to be outsourced. Ho(eer& if included in the clinician7s sco8eof 8ractice there 5ay be a 5ini5u5 reuire5ent for a s5all area in larger co55unity,based clinics (here staff are able to tri5& adDust or 8olish dentures or a88liances.4here 5ay also be a need to 8our i58ressions before they are sent out to a laboratory.

0# *ray !rocessing room

4he reuire5ents (ill de8end on the ty8e of 8rocessor. 4he o8tions for fil5 8rocessingare dar1,roo5 or daylight 8rocessing. A dar1 roo5 (ill be reuired if a 8rocessor(ithout a daylight loader is used& (hile a 8rocessor (ith a daylight loader can be8ositioned in an assigned bench area of the facility.

4he 5ini5u5 s8ace reuire5ent is 6 52. Water and (aste facilities and storage forche5icals are reuired. ;adiogra8hic fil5 8rocessing (ill not be reuired if digitalradiogra8hy is utilised& but additional *4 soft(are and hard(are (ill need to be

considered and acco55odated.

0#$ Sta"" o""ices and amenities

*f no dedicated staff roo5 is 8roided& 8roision 5ust be 5ade for staff a5enities in asecure eniron5ent.


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ffices and (or1stations 5ust co58ly (ith ergono5ic reco55endations as to their sieand allocation.

A tutorial roo5 (ill be reuired in larger facilities that su88ort student teaching and staffin,serice training. +5aller units 5ay share a si5ilar ty8e of roo5& or access this fro5facilities located else(here.

0#& In"ormation technology

Planning *4 syste5s to su88ort clinical and o8erational actiities is an essential 8art ofany facility configuration. *te5s to consider are:

the 8atient 5anage5ent syste5

teleco55unications

other technology eg& digital radiogra8hy& tele5edicine.

0#- Car !arking;eady access to 8ar1ing (ill be necessary for 8atients and their su88orters& includingdisabled dro8,off and 8ar1ing. Facility 8lanners should refer to the local council by,la(s for the reuired nu5ber of car 8ar1s (hich (ill be facility s8ecific& and deter5inedby its function& sie and location.

Community Oral Health Service: Facility Guideline 10


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In"ection Control

#1 9nvironmental

4he 8lanning and construction of any ne( facility 5ust incor8orate the 8rinci8les of

eniron5ental control to 5ini5ise conta5ination fro5 8articulates and 5icro,organis5s. Consideration should also be gien to (or1 flo( and surface finishes.

4he general layout of the dental surgery is based on a strea5lined design a88lyinginfection control 8rinci8les. 4he surgery design 5ust focus on 5ini5ising the nu5berof surfaces li1ely to be e"8osed to aerosols&3by concealing eui85ent other than thatassociated (ith the dental chair or re5oing certain ite5s eg& the ",ray ie(er andad5inistration area a(ay fro5 the one of aerosol conta5ination.

Aerosol conta5ination can be reduced by ensuring that a 5ini5u5 area of $ 5 radiusaround the reclining 8atient7s head is clear of (or1 surfaces and unnecessary

eui85ent. 4he 5ini5u5 reco55ended surgery sie to achiee this and to allo( foraccess and eui85ent is -.# 5 " - 5. 4he use of high,olu5e eacuation eui85entand 8roiding barriers oer surfaces is also i58ortant to 5ini5ise aerosol effects. *naddition& regular cleaning of the facility 5ust be underta1en to 5ini5ise the nu5ber of5icro,organis5s in the eniron5ent and to 1ee8 all surfaces clean and tidy.

Procedures 5ust be i58le5ented for the safe handling and a88ro8riate dis8osal ofconta5inated 5aterials and (aste. Hands,free access to bins for 8a8er and clinical(aste is reco55ended.

# 'ersonal hygiene and !rotection

Hand,(ashing facilities in eery dental surgery are essential& and 5ust not beco5bined (ith sin1s used for other 8ur8oses& such as deconta5ination and instru5entcleaning. 58hasis should be gien to the use of hands,free facilities& (here 8ossibleeg& elbo( or 1nee o8erated ta8s or infra,red,actiated o8erating lights and hand,basinta8s. 'ote& ho(eer& that infra,red ta8s can be a 5aintenance 8roble5 because theyreuire t(o technicians 8lu5ber and electrician to serice the5& and the flo( ratecannot be adDusted by the user.

A88ro8riate 8ersonal 8rotectie eui85ent such as gloes& 8rotectie eye(ear& go(nsand face 5as1s 5ust be used to reduce the ris1 of e"8osure to blood and body fluids.

Access to dis8ensers and storage for 8ersonal 8rotectie eui85ent 5ust beconsidered in each surgery to ensure their ease of use.

+torage and s8ace for the dis8osal of conta5inated goods and access to trans8ort byan a88roed carrier for used9conta5inated ite5s 5ust be aailable.

#$ Instrument re!rocessing area

4he 5ain function of the instru5ent re8rocessing area is to 5a1e conta5inatedeui85ent used in oral health care fit for re,use. 4he area 5ust acco55odate a (astecollection 8oint& and eui85ent cleaning and sterilisation area& and a storage area for

3 Aerosols are generated by the dental hand8iece and air9(ater syringes.

1 Community Oral Health Service: Facility Guideline


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sterile goods. 4he design should 8er5it a flo( of actiities fro5 dirty to clean to sterile.*t has been esti5ated that # 5 of bench s8ace is reuired for these actiities.

4he 8roision of a hand,(ashing facility in the deconta5ination area is a standard8recaution for controlling infection.

+torage 5ust be arranged so that the ite5s are 8rotected fro5 eniron5entalconta5ination.

4he sie of the s8ace and the eui85ent selection (ill de8end on the nu5ber ofsurgeries being sericed& (or18lace 8rocesses& and staffing ie& the nu5ber of staffreuiring access to the sterilising area at any one ti5e. Consultation (ith localinfection control 8ersonnel and sterilisation staff is adisable.

Adice for the design and layout of these areas is contained in A+9')+ -/$#:2006 andA+9')+-$/:200%& and


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2 Health and Sa"ety

2#1 Overview

We endorse the >ueensland Health 200- Oral Health Facility Design Guidelines

follo(ing reco55endations regarding health and safety:4he facility 5ust 8roide a safe (or1ing eniron5ent (hich (ill not cause anyris1s to the health of the occu8ants. *n addition to those ris1s and haardsco55on8lace in health care eniron5ents& there is s8ecific occu8ational healthand safety issues associated (ith oral health facilities.

"a58les of health and safety issues of 8articular releance to oral health facilitiesinclude:

leaning oer reclined 8atients to 8roide treat5ent

(or1ing (ith infectious 5aterials

heat and noise associated (ith sterilising 8rocedures (or1ing (ith 8otentially har5ful che5icals.

2# Sole o!erator

;eco55endation $ of the 200$ 'e( )ealand


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15 ;uilding Services and 9nvironmental Design

All serices 5ust satisfy the serice leel and 8rocedure reuire5ents for the s8ecificfacility. +erices should be designed and installed in a 5anner that (ill allo( easyaccess for 5aintenance and cause only 5ini5al disru8tion (hen 5aintenance is

reuired.

15#1 9lectrical systems

4he reuire5ents for electrical installations in health care facilities are those set out in')+ %00%.$:200% lectrical *nstallations. At the ti5e of (riting& a draft 'e( )ealandstandard


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15#& Acoustics

'oise leels should not e"ceed those established in the


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Proision 5ust be 5ade to ensure an adeuate air su88ly& (ith filters a88ro8riate to thefacility& and for e"haust fro5 the steriliser in the re8rocessing roo5 and suction unite"haust in the 8lant roo5. Air inta1e to the co58ressor should also be considered.+e8aration of air inta1e and e"haust discharges 5ust be 5a"i5ised& and as a 5ini5u5co58ly (ith reuire5ents of the 'e( )ealand !uilding Code.

All occu8ied areas should be heated (ith ther5ostatically controlled heaters& (hich5ay be 8art of an air,conditioning syste5. Portable heaters and unflued gas heatersshould not be installed in 8atient areas.

Fil5,8rocessing areas and sin1 units used in connection (ith the regular cleaning of",ray 8rocessors 5ust be 8roided (ith adeuate e"haust entilation to ensure theyare ca8able of containing& diluting and re5oing any a8our released fro5 the 8rocess&and 8reenting the s8read of fu5es fro5 che5icals into occu8ied s8aces.

15#15 3ater


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15#1 'lant room and su!!ly lines

A 8lant roo5 of sufficient sie to acco55odate all the 5echanical and electrical 8lant isreuired. +erice su88ly lines co58ressed air& acuu5& e"traction syste5s& etc and8lu5bing lines 5ay be run under a sus8ended floor slab& oerhead& or throughchannelled concrete. +u88ly lines can also be in e"ternal ducting& (ith short& straight

under,floor ducts to serice the connection 8oint for the dental unit. +erices shouldnot be incor8orated into a concrete slab because this 5a1es future 5aintenance and5odifications difficult and e"8ensie.


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the (rite u8 des1 and the other 8ositioned for easy access by the assistant. 4hebalance of the bench s8ace is filled (ith storage cu8boards and rubbish collection bins.

An o8en section under the bench to8 to house an assistant cabinet is reco55ended.4he 5obile cabinet (ill hae s8ecific dra(er sies for storage of dental instru5ents and5aterials.

15#1- Signage

*t is reco55ended that e"ternal signs (ill clearly indicate the Co55unity ral HealthFacility& its address& 8hone nu5ber and o8erating hours. *nternal signs (ill direct8atients and identify roo5s as a88ro8riate.


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11 ,o+ile Dental >nits

11#1 Overview

Mobile dental units (ill usually be co55issioned for use in re5ote& rural locations

(here the cost,effectie and accessible deliery of dental serices fro5 fi"ed facilitiesis not 8ossible. Mobile serices 5ay also be used in so5e urban settings for8o8ulations that do not hae easy access to a fi"ed facility& or (here outreach sericesto high,need 8o8ulations are reuired.

Enits 5ay be to(ed or self,8ro8elled& ranging fro5 s5aller& one,chair& high,olu5ee"a5ination and 8reentie care units& to t(o,chair units that can be used fore"a5ination& 8reentie and treat5ent serices. *t is i58ortant to consider the sie and8racticality of the unit needed in relation to the locations it (ill be reuired to serice.A88ro8riate access to a suitable site and serices concrete 8ad& electricity& clean and(aste (ater& data and 8hone 5ust be aailable at each location.

Mobile units a88ear to be si5ilar in cost to fi"ed facilities to deelo8 but can haesignificantly higher 5aintenance and de8reciation 8rofiles& increasing their oerall costto o8erate. Par1ing& security& relocation of units and staff trans8ort costs need to befactored into the oerall cost of 8roiding serices fro5 a 5obile facility.

11# 'lanning considerations

4he general 8rinci8les that a88ly to deelo8ing fi"ed facilities a88ly to 5obile facilities.4he follo(ing list includes issues that are reco55ended for 8articular consideration(hen deelo8ing and designing a 5obile facility. 'ote that this list is not all,inclusie.

@ayout and cabinetry design: these 5ust su88ort the 8ur8ose& ergono5ic needs&instru5ent re8rocessing& staff nu5bers and staff 5i"& and 8atient through8ut and(aiting areas.

Chassis: a durable& (atertight& reinforced floor is reco55ended. *nsulation should8roide the best 8ossible 8rotection fro5 outside te58eratures.

@eelling Dac1s: there should be one on each corner to 8roide stability (hen the unitis stationary.

Access: there should be t(o doors nearside front and rear.

+te8s: these should be fold,a(ay& loc1able (hen in 8osition& and incor8orate a

handrail. A(nings: there should be a(nings oer both doors.

Windo(s: tinted security (indo(s are best& (ith insect screens and blinds.

+erices: these (ill include a co58ressor& eacuator 5otor& (ater inlet& and 8u58 forthe base of the dental chairs.

Mounting brac1ets: these are reuired for lights& the ",ray unit and dental unit.

lectrical serices: these 5ust co58ly (ith A+9')+ %00$ lectrical *nstallations ;elocatable Pre5ises including caraans and tents and 4heir +ite *nstallations&and A+9')+ %000& 1no(n as the Australia9'e( )ealand Wiring ;ules.

/ Community Oral Health Service: Facility Guideline


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Water su88ly: use a dual syste5 so that to(n (ater can be used (hen aailable&8lus storage tan1s beneath the ehicle floor but 8rotected fro5 road da5age.

Filtered (ater su88ly: this is reuired for the dental unit and sin1s.

Water filter: use a filter suitable for use in dental units& and locate this (ith the (ater8u58.

Hot (ater syste5: use a tan1 (ith a 5ini5u5 2# litres ca8acity.

Waste dis8osal: solid and (ater (aste 5ust co58ly (ith territorial local authority andregional council reuire5ents (here the unit (ill be o8erated.

Co58ressed air: a reticulation syste5 is reuired to serice the dental units.

Air conditioning: use one unit 8er chair roof,5ounted. Condensate 5ust drainoutside the ehicle.

*nternal finishes: cabinetry and bench to8s 5ust be easily cleaned.

+in1s9basins: there should be a 5ini5u5 of t(o clean and one dirty.

*C4 connections: these include 8hone and data lines.

ui85ent: 5ust be 8ro8erly secured to be 8rotected fro5 road shoc1 and ibration&and (all,5ounted ",rays and lights 5ust be secure in,transit. Water and air lines 5ustnot lea1& on,board 8o(er generators cannot 5a1e too 5uch noise and9or ibration& andeui85ent 5ust be 8ro8erly 8laced to ensure there is adeuate s8ace for dentists andtechnicians to o8erate.

4he 5a"i5u5 (idth for a standard ehicle is 2.# 5& (hich is considered too narro( toacco55odate the functional areas reuired in an oral health facility. A (ider facility5ay be constructed& although


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source of su88ly of consu5ables

(aste dis8osal solid and (ater

a clean (ater su88ly

",ray fil5 8rocessing and radiation 8rotection

staffing clinical and ad5inistration su88ort

access to shared and co55on areas.

Community Oral Health Service: Facility Guideline


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1 Dental Facility >!grades and (e"ur+ishments

4he guidelines for ne( fi"ed facilities a88ly to inest5ent in fi"ed facility u8grades eg&re5odelling and refurbish5ent of e"isting school,based dental clinics. *n 8lanningfacility u8grades& a decision 5ust first be 5ade about the leel of care to be 8roided

fro5 the facility& including the nu5ber of dental units& staffing and su88ort sericesreuired.

*f the facility cannot acco55odate the reco55ended schedule of acco55odation&design and layout foot8rint& then serice 8lanners and 8roiders 5ust considerrelinuishing the facility& e"tending the facility& constructing a ne( facility& or e"8loringalternatie o8tions for deliering oral health serices to that co55unity.

Community Oral Health Service: Facility Guideline 2


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1$ Com!onents o" a >nit

4he oral health unit (ill consist of a co5bination of standard co58onents and non,standard co58onents& de8ending on the leel of serice to be 8roided and the ty8e offacility.

1$#1 Standard com!onents

"a58les of standard co58onents to be considered in facility design can be found inroo5 data sheets contained in this section of the guideline& the Public


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(alls these 5ay reuire reinforce5ent for (eight,bearing eui85ent.

Fi"tures and fittings (ill include:

dental chair

s8ecialist fittings eg& oerhead light& ",ray unit& dental unit

co58uter ter5inal ",ray ie(er

o8erator7s chair

assistant7s chair

hand,(ashing facilities elbo(,touch ta8s or infra,red

su88ort 8ersons7 chairs

dental cabinetry and oerhead cabinets

interco5 and9or duress call

bins for general (aste& clinical (aste and shar8s

(hiteboard cloc1

(all 5irror.

1$#& Instrument re!rocessing room

Descri!tion and "unction

4here needs to be a designated roo5 for cleaning and sterilising instru5ents andeui85ent. *ts sie (ill de8end on the nu5ber of surgeries and the aailability of staff.*t has been esti5ated that a bench area of # 5 (ill be reuired to su88ort the entire8rocess.


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hand basin

(asher9disinfector

8ac1ing bench (ith sheles for storing 8ac1aging 5aterials and a heat sealer

steriliser 8lu5bed or 8ortable9benchto8

cooling bench

storage.

Function and relationshi!s

4he instru5ent 8rocessing roo5 should be adDacent to the dental surgeries and dentallaboratory& centralised to reduce the distance bet(een these areas.

Considerations

4hese include:

non,sli8 flooring

eui85ent s8ecifications sterilisers& disinfectors& etc 5ust co58ly (ith releantAustralian9'e( )ealand standards.

1$#- 'lant room

4he 8lant roo5 (ill house eui85ent including (ater filtration eui85ent& dentalsuction 8lant and air co58ressors& and 5edical gas storage. 'ote: 5edical gas cut,offales should be easily accessed& and not in the 8lant roo5.

4he 8lant roo5 5ust be a 5ini5u5 of 6 52& but the actual sie (ill de8end on the

a5ount of eui85ent to be acco55odated& and the layout.

6ocation and relationshi!s

4he 8lant roo5 should be located to 5ini5ise the i58act of noise and heat generatedby eui85ent on adDacent areas. Access to the 8lant roo5 though an e"ternal door isreco55ended& because internal access 5ay 8resent noise issues.

Considerations

+erices reuired for eui85ent 5ay include co58ressed air& cold (ater& and bothsingle, and three,8hase 8o(er. Additional reuire5ents 5ay include floor (astes andreseroirs for (aste (ater& e"ternal e"hausting for suction syste5 air discharge& androo5 entilation.

;e5ote isolation s(itches for 8lant should be considered the sterilising roo5 orrece8tion are ideal locations so that 8lant can be easily shut do(n at the end of theday. 4he roo5 should be acoustically treated and& if 8ossible& 8ositioned a(ay fro5the surgery. Adeuate entilation for eui85ent o8eration and heat re5oal 5ust be8roided.

$ Community Oral Health Service: Facility Guideline


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1$#/ Dental la+oratory

Descri!tion and "unction

4his functions as an area for adDusting and 8olishing dentures& and for constructing8rosthetic a88liances and other ite5s relating to dental treat5ent unless outsourced.

6ocation and relationshi!s

4he dental laboratory should be located (ith ready access to the dental surgery roo5s.

Considerations

4hese include:

lighting a natural 9 fluorescent 5i" for colour 5atching

5oisture,resistant Doinery all surfaces including dra(ers 5ust be la5inated or

5ade fro5 5oulded 8lastic for ease of cleaning a storage area for 5odels

inclusion of a 8laster tra8 under the sin1 is adised if the use of 8laster for dental5odels is enisaged

non,sli8 inyl flooring

5echanical debris9dust e"traction e"ternal e"hausting through hoods in 8olishingbays and at des1,to8s

natural gas connections and air outlets

a 5aster tra8& if there is going to be 5odel 8runing.

ui85ent 5ay include:

8laster bins

s1i8 for (aste 8laster

ultrasonic cleaner

5odel tri55er

8laster ibrator

casting 5achine

8olishing 5achine

dental lathe ice

boil,out unit

!unsen burners

acuu5,for5er

8rocessing tan1.

1& Dental Surgery 9.ui!ment

4he follo(ing section (ill assist


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%a+le 1: ssential ite5s of dental eui85ent (here installation 5ust be considered at thedesign and layout stage

Item Features "or consideration

Dental o!erating unit


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4able 2: Clinical e.ui!ment "or consideration and installation re.uirements

Item Feature to consider

*ntra,oral ca5era

Air abrasion unit


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1- In"ormation and Communication %echnology 7IC%8

Planning *4 syste5s to su88ort clinical and o8erational actiities is an essentialco58onent of any facility design and serice reconfiguration. 4he follo(ing table listsite5s for consideration (hen 8lanning a dental facility.

4able %: Items to consider when !lanning an oral health "acility

Item Feature to consider

Patient 5anage5ent syste5 PM+ *ntegrated electronic clinical record

Partial data ca8ture

Manual syste5s

Hard(are la8to8 or 8ersonal co58uter

+erer

Connection:

dial u8 landline

broadband

+oft(are su88ort

*4 e"8ertise

+yste5s 5aintenance

@ocal area net(or1 or (ider area net(or1@A'9WA'

+torage and bac1,u8 of f iles

+cheduling

4eleco55unication internal net(or1 ande"ternal net(or1

Priate auto5atic branch e"change PA!B sindiidual lines

@andline or cell8hone based

@in1ages 4o the 8roider organisation syste5s eg& intranet

*nternet access

ther technology


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(e"erences and Further (eading

1# ?ew Bealand

Documents


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(elevant regulations and codes o" !ractice

Code of Health and


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Australia

ueenslandHealth. !risbane.

Community Oral Health Service: Facility Guideline $2


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A!!endi) 1: 'olicy Framework "or this Guideline

4he strategic ision for oral health is sha8ed by the 8rinci8les of the follo(ing 1eyhealth strategies:

"e% )ealand Health Strategy

He ,oro%ai Oranga: !2ori Health Strategy

Primary Health Care Strategy

Health of Older Persons Strategy

"e% )ealand Disa&ility Strategy.

Ney docu5ents that hae influenced these guidelines are:

'ational Health Co55ittee. 200%. +mproving Child Oral Health and Reducing ChildOral Health +ne3ualities. Wellington: Ministry of Health.


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A!!endi) : (ole Delineation and Organisation o"Dental Care

4his Guideline reco55ends a role delineation and organisation syste5 (ith ahierarchy of leels of care& fro5 less co58le" to 5ore co58le"& (ith considerationgien to local needs& resources& cultural diersity and geogra8hical constraints. 4hisa88endi" considers in 5ore detail the serice characteristics of the four leels ofserice based on the A5erican +ociety of Anaesthesiologists A+A Patient +tatusClassification +yste5& and ho( they relate to the different facility ty8es.

6evel 1

@eel $ 5eans access to e"a5ination and 8reentie oral health care for nor5alhealthy 8atients or 8atients (ith 5ild syste5ic disease deliered fro5 a fi"ed 8ur8oseand non,8ur8ose built or 5obile dental facility in a co55unity. 4he follo(ing sericecharacteristics are considered essential for a @eel $ serice.

4able -: Service characteristics essential "or 6evel 1 service

Feature Service characteristic

Client grou8 ;eferral9recall fro5 the co55unity 8o8ulation& 8ri5arily the eligiblechild and adolescent 8o8ulation but 5ay include e"a5ination for high,needs grou8s eg& s8ecial needs and the older 8ersons.

+erices 8roided "a5ination and 8reentie oral health serices.

+taffing


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4able #: S!eci"ic 6evel characteristics


Client grou8 ;eferral fro5 health 8roiders and co55unity agencies for child&adolescent& lo(,inco5e adult and s8ecial,needs 8o8ulations.

+erices 8roided "a5ination& assess5ent and general dental treat5ent serices.

Facilities A surgery to acco55odate t(o dental units for the 8roision of generaldental care. A 5ini5u5 of t(o chairs is reco55ended& (ith the o8tionto e"tend to a larger facility for this leel of facility. With the e"ce8tionof unusual circu5stances& 8lanners should aoid single,chair units.

Priacy for 8atients o8en 8lan surgery 5ust be se8arated by 8artialheight 8artitions.

Ad5inistration functions should be se8arated fro5 the o8eratie area.

A se8arate instru5ent re8rocessing area& or off,site instru5entre8rocessing at a C++< facility.

;elationshi8 and su88ort

areas

For s5all surgeries& su88ort and staff areas 5ay be shared (ith

adDoining facilities or located in adDacent on,site buildings eg& schoolfacilities.

@in1s (ith other 8roiders @in1s (ith schools& dentists& hos8ital dental serices.

6evel $

@eel % serice inoles e"a5ination and treat5ent oral health serices (ith the abilityto offer sedation serices for nor5al healthy 8atients or 8atients (ith 5ild syste5icdisease deliered fro5 co55unity or hos8ital,based facilities. @eel % sericesco58rise the characteristics of @eel 2 serices& (ith the addition of the follo(ing

serice characteristics.

4able 6: S!eci"ic 6evel $ characteristics


Client grou8 ;eferral9recall fro5 the co55unity 8o8ulation& including children&adolescents& lo(,inco5e adults& and those (ith s8ecial needs andadults.

+erices 8roided "a5ination and treat5ent oral health serices (ith the ability to offersedation serices for nor5al healthy 8atients or 8atients (ith 5ildsyste5ic disease& deliered fro5 a co55unity or hos8ital,based

facilities.

Facilities Multi,chair& co55unity,based the final nu5ber of surgeries and ty8eshared9single (ill de8end on the co55unity sered.

;ece8tion 5edical gases o"ygen su88ly recoery area.

+taffing


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6evel &

@eel - inoles e"a5ination and treat5ent serices (ith the ability to offer sedationserices for nor5al healthy 8atients& and e"a5ination and treat5ent serices for8atients (ith 5ild or seere syste5ic disease deliered fro5 a hos8ital,based facility.

Pri5ary& secondary and tertiary serices are 8roided fro5 these sites. *t is antici8atedthe facility reuire5ents (ill be si5ilar to those for a @eel % serice& but this serice(ill be su88orted by anaesthetists and anaesthetic technicians& nursing& laboratoriesand general hos8ital su88ort staff.

4he follo(ing table outlines the relationshi8 to the 5odel of care and facility ty8es.

%a+le 0: ;elationshi8 bet(een 5odels of care and facility ty8es

Facility ty!e 6evel o" service

1 $ &

ffsite

Mobile

Co55unity

Hos8ital

6evel o" service Facility ty!e

O""site ,o+ile Community Hos!ital

6evel 1:"a5 and8reentie& A+A $ and 2

6evel :"a5 andtreat5ent& A+A $ and 2

6evel $:"a5 andtreat5ent 9, sedation& A+A$ and 2

6evel &:"a5 andtreat5ent 9, sedation& A+A2& % and -

ey

Dar$ grey: good synergy& (hereby the facility su88orts and is a88ro8riate to the 8lanned leel of serice.

!edium grey:health serice 8lanners should 8roceed (ith caution the serice 5ay be better sered byan alternatie facility or the facility (ill be under,utilised.

'ight grey: 8oor synergy and9or utilisation these o8tions should not be considered (hen deelo8ing theserice and facility 8lan.

Community Oral Health Service: Facility Guideline &$


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A!!endi) $: Schedule o" Accommodation

4he acco55odation schedule indicates e"a58le roo5s and s8aces for co55unity oralhealth facilities and di5ensions for one,& t(o,& four, and si",chair facilities.

4he areas are indicatie and s8ace can be 8otentially reduced and9or co5bined (herean oral health facility is collocated (ith other serices.

(oom4s!ace 1 chair 6evel 1 1 chair 6evel chairs & chairs / chairs

Euantity Area %otal Euantity Area %otal Euantity Area %otal Euantity Area %otal Euantity Area %otal

9ntry4rece!tion

ntry airloc1 $ # # $ # # $ # # $ # # $ # # *f reuired inlocal situation;ece8tion $ $0 $0 $ $0 $0 $ $0 $0 $ $2 $2 $ $2 $2

+tore files 0 # 0 0 # 0 $ # # $ / / $ $0 $0

+tore 8hotoco8ier9stationery +hare 0 +hare 0 +hare 0 $ / / $ / /

Ad5inistration office 0 - 0 0 - 0 0 3 0 $ 3 3 $ $2 $2

Waiting $ $0 $0 $ $0 $0 $ $0 $0 $ $6 $6 $ 20 20

Child 8lay area *ncl. in(aiting

0 *ncl. in(aiting

0 *ncl. in(aiting

0 $ $0 $0 $ $0 $0

!ay (heelchair 8ar1 +hare 0 +hare 0 +hare 0 $ 2 2 $ 2 2

4oilet9baby change disabled $ # # $ # # $ # # 2 # $0 2 # $0

Su+total $5 $5 $- 5 2

%reatment areas


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A!!endi) &: 9)am!le Floor 'lans


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A!!endi) -: Euantity Surveyor Costs

A uantity sureyor can 8roide facility cost esti5ates based on the floor 8lans& thefacility guideline and a brief descri8tion fro5 the architect.

Particular note should be ta1en of the cost e"clusions listed in uantity sureyorre8orts. 4he i58act of 5any additional costs are site s8ecific and 5ust be ta1en intoconsideration to deter5ine the 8roDect budget& (hich (ill for5 8art of the business casesub5ission.

Where costs for rebuilding9re5odelling e"ceed those of ne( buildings&

Community Oral Health Facility Guide

Documents

Transcript of Community Oral Health Facility Guide