Design & Layout

The prevention of infection must be addressed at all stages of the design of any practice to ensure that the ability to keep the environment clean is not compromised.

Design and Layout

The design and layout of a dental practice can actively support the maintenance of a clean environment.

Practice layout may be severely limited by the premises, with many dental practices being located in converted domestic buildings. However, even here much may be done to ensure a clean environment.

It is useful to use zoning extensively both in terms of the layout of rooms and the layout within rooms. HTM 01-05 recommends decontamination facilities separate from the treatment area. This is required for the purposes of ‘Best Practice’ and within the surgery and decontamination room(s) there should be provision of:

  • Separation between ‘clean’ and ‘dirty’ activities.

  • Systematic work flow from ’dirty’ to ‘clean’.

  • ‘Clean area’ to ‘dirty area’ air flow to minimise airborne recontamination of clean instruments.

  • Where physical separation is not possible, a temporal separation should be employed so that ‘dirty’ and ‘clean’ activities do not take place at the same time.

With ease of cleaning in mind, the design should provide a tidy environment without clutter and minimise areas that may accumulate dirt and dust.

Carpets and fabric covered furniture must not be used in clinical and decontamination areas because it is impossible to clean and disinfect adequately.

All surfaces should be impervious and easily cleanable. Work surfaces and floor coverings should be continuous and non-slip. Where possible, surfaces should be joint less, with coving between the floor and the wall to prevent accumulation of dust and dirt in corners to facilitate cleaning.

DoH Health Building Note 00-99: Infection Control in the Built Environment

The Department of Health 'Health Building Note 00-09: Infection Control in the Built Environment' provides examples of design principles which provide a good source of information however it is important to remember that some of these guidelines will not be applicable to the dental practice.

Design to Facilitate Cleanliness and Cleaning

  • Use finishes that are impervious, smooth and seamless, as far as practicable.

  • Run hard flooring up the walls for a short distance to provide an easy to clean coving.

  • Eliminate or minimise dead-legs and blind ends in water systems, both in the original design and as the systems are modified.

  • Consider hands-free operation of utilities, for example sensor taps, automatic lights and movement sensors for toilet flushes.

  • Consider hands-free operation of other facilities, for example automatic doors and proximity-sensors.

  • Consider integral blinds as an alternative to curtains at internal windows.

Encourage Desired Behaviour, Tidiness and Hand Hygiene

  • Provide sufficient space for activities to take place and to avoid cross-contamination between adjacent bed spaces.

  • Provide sufficient storage for patients’ possessions and for all supplies to discourage clutter.

  • Ensure proper segregation and management of waste, including clinical waste and linen.

  • Provide sufficient domestic waste receptacles.

  • Provide bedside waste disposal facilities for patient use.

  • Design-out unnecessary horizontal surfaces (for example window sills) in order to discourage clutter.

  • Provide enough wash-hand basins and antimicrobial hand-rub dispensers.

  • Plan for and deliver good separation of clean and dirty activities.

  • Provide sufficient space for storage and preparation of cleaning equipment and materials.

  • Provide suitable facilities for cleaning of equipment.

Design for Easy Cleaning

It is always best practice to maintain a visibly clean environment that is free from dust and soilage and acceptable to patients, their visitors and staff.

Good design can make cleaning immeasurably easier, for example:

  • Use finishes that are easy to clean.

  • In clinical areas, flooring should be seamless and smooth, slip-resistant, easily cleaned and appropriately wear-resistant.

  • Use threshold matting on all external entrances. The type should allow for expected through traffic and easy cleaning.

  • Supply pipework should always be concealed.

There may be pressure to choose the cheapest products or design however attention to whole-life costs, including the costs of cleaning and maintenance, is important.