Designing and redesigning

Nov. 1, 2002
What is the best way to achieve the goals and objectives of a dental office's health and safety compliance program?

Charles John Palenik, MS, PhD

What is the best way to achieve the goals and objectives of a dental office's health and safety compliance program?

One way is through task analysis, where all necessary resources (human, time, and materials) are identified. The interaction of people and people with equipment and processes is then examined. The result can be the generation of a step-by-step set of plans that helps with the choice of equipment, procedures, and even training.

Task analysis can take many forms. It can range from mere observations to sophisticated computer modeling. However, three basic activities are usually present — collection of information, organization of the information into a useful format, and, finally, application.

It is important to first determine what information is needed. Then, dentists must decide how can it be obtained. Sterilization of dental instruments could serve as a useful example of task analysis to satisfy a specific need. The actual task is to routinely provide sterile instruments chairside. Perhaps a series of six or seven progressing steps or stages can be identified and then placed into a sequence. What do workers need to know about each step? How will success be determined? Can the steps efficiently produce sterile instruments on a consistent basis?

The simplest way to collect information is to observe what is currently being done and then discuss individually what was seen. It may be necessary to conduct a staff meeting. A review of the practice's current operations manuals and other pertinent resources available from external sources is required. Generation of a structured checklist that identifies the desired steps or stages should be the result. It also is a good idea to determine how the process will be monitored.

Organizing information often involves the use of visual aids, such as flowcharts or timeline drawings. Do all the steps have to be completed without stopping? Or can they be grouped to make the process more efficient? Most organizational illustrations can be readily modified into a checklist or a step-by-step procedures document.

The final action is to apply the results when making design decisions. For example, do all the steps have to be performed in the same room? Can some be performed chairside? Good design will help identify which workers will be needed, which equipment is required, and how much time to allot for tasks. Some flexibility is required. What if the person recycling the instruments is needed elsewhere? What if there is an accident? What if a step has to be repeated?

Sterilization is just one component of a dental office's health and safety program. Yet, it is a very important function that could possibly be made safer and more efficient if the process is properly reviewed.

Task analysis is a natural process. We devise and perform multi-step duties every day. However, instrument sterilization requires a high level of organizational precision and planning. Steps cannot be readily combined or even occasionally omitted. Successful completion of the task requires a total review of the process and the elicitation of all the necessary steps.

For examples of sterilization sequencing or flow diagrams, readers can refer to the OSAP Web site (

Work associated with health and safety in dental environments is dynamic. Tasks, procedures, technologies, and skills evolve. A viable program must reflect the situation needed in a specific dental office. Regular review and updates of procedures are required.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection control issue may be directed to [email protected].

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