We are all well aware that the best laid plans of mice and men often go awry, and the axiom is as relevant to the planning of cross infection control measures in the dental practice as it is anywhere else.
When planning to build a new dental practice, or refurbishing an existing one, practitioners are invariably keen to address the issue of cross infection control early on. They all want to ensure that they are ready to be assessed on their compliance with official obligations (chiefly to HTM01-05). They are also keen, of course, to ensure the best care for their patients.
It is widely accepted that although planning laws and building regulations are broadly the same across the UK, local authority building regulation officers will enforce them in different ways. There are a number of reasons for this situation, such as local economic conditions, knowledge and constant changes. It has become something we all cope with. However, it might be more surprising to many to hear that the conditions of HTM01-05 are enforced differently by different primary care trusts (PCTs).
At the heart of the issue is the way that HTM01-05 is written. Like many official and bureaucratic documents, it is at times ambiguous. Different PCTs have interpreted passages of the document in different ways and enforce it accordingly. Areas such as ventilation of the local decontamination units (LDUs) are particularly troublesome, because the guidelines do not actually give a tangible requirement for ventilation. Indeed, with some interpretations of the guidelines you might not need to have it at all.
The in and out locations of ventilation systems must create airflow in the right direction – that is, it must follow the passage of instruments from the clean zone of the LDU to the dirty area, rather than in the opposite direction. But there is no defined airflow rate or requirement provided, nor specification of the kind of vents, fans or other devices that should be used.
Local requirements can vary as a result. Primary care trust inspectors tend on the whole to be as helpful as they can in making sure that practices meet the relevant criteria, but they are reluctant, perhaps understandably, to commit to providing facts or opinions. This kind of situation seems to be increasingly common as employees fear being held to account for advice they give but it is frustrating for those hoping to create their own practice (and for those of us who are helping them).
As a designer, it makes it all the more essential to communicate with the PCT and with expert suppliers, such as those providing the ventilation equipment, about what will be acceptable within the jurisdiction of any given PCT. One thing is certain, efficient, informed design work at the initial space planning stage can mean significant savings in time and effort later on. The location of the LDU is critical. Ideally, it should be in the optimum location relevant to the surgery or surgeries, so that staff can go directly to it while maintaining as much distance as possible from public areas.
For larger practices it can be beneficial in both practical and financial terms to have two smaller LDUs rather than a single large one. A large LDU shared between several surgeries would demand a dedicated member of staff, while smaller LDUs directly adjacent to the surgeries could be operated by the surgery staff. Equipment costs will be higher, but often less than the staffing costs. Again, expert advice from equipment suppliers who know the local market can be invaluable.
The varied nature of the buildings used for dental practices means there is no ‘one size fits all’ design to make it meet HTM 01-05 demands. In some buildings, efficiency can be improved by using through units that allow nurses to pass items into the LDU through a hatch within a cupboard, though this needs to be planned very carefully. Those practices in converted historic buildings may need to take a more creative approach to meeting the demands of HTM 01-05. There are creative solutions from dumb waiters to air-powered systems with tubes and canisters for moving materials to and from the LDU.
Designers can advise on colour schemes and other aesthetic elements, but when it comes to the best choice for hygienic surfaces they should defer to the relevant experts. As with equipment, this results in the optimum outcome for the dental practice – and its patients.