In 2010, Claire Roberts’ dental practice suffered a complete rebuild following a gas explosion. She found herself having to close the practice, a situation that many are now in due to the outbreak of Covid-19. Here she shares her tips on how to effectively mothball your practice and keep your equipment in shape until normality resumes…
‘I have the unfortunate experience of having done this before in extreme circumstances. I’m not trying to teach you all to suck eggs, this is just what I will be doing over the following few months whilst equipment gathers dust.
The last thing anyone wants is to be told we can work and book patients in, only to switch everything on and it doesn’t work. Especially as I predict that engineers will be rapidly booked up when we can open.
Sadly, due to lack of financial support, some practices will shut permanently and well-maintained equipment will be worth more in the case of sale and disposal.
But for those who are able to re-open, below are my top things to consider when mothballing your surgery:
Can you keep your cleaner on?
Switch them to reduced hours if necessary but someone needs to come in and wipe down, dust, vacuum and mop. Alternatively, a staff member could do this or you could even do it yourself.
As a rule, if it has a moving part it is likely to break down if not used: switches, pumps both positive and negative, bearings, you name it, they are likely to fail.
If it has pipes or tubes, it is likely to block.
If it has valves, they will most likely stick.
Compressor – switch it on to do some of the other tasks I will list. This will let it come up to pressure, keeping the pumps happy, and bleed it as required. The pump on ours failed a few months after it went back into use. I don’t know if this was a coincidence.
Autoclave – this should be filled with enough suitable water (to keep the Reverse Osmosis (RO) filters fresh), run for a test cycle and put the parameters on your weekly test sheet. Keep the print out as usual. Drain down and switch off. Autoclaves are pretty flaky pieces of kit with pumps, micro-switches and a whole host of things that can go wrong. Ours died during its enforced break. Once again there will be a run on available engineers and emergency rentals when we start up again. I would do the same weekly run with washer disinfectors.
Chairs – switch them on. They should be wiped down weekly to get the dust off. Recline and return to keep it moving. Dental Unit Water Lines (DUWLs) do not like being dried out, but if you don’t run them you risk increased likelihood of biofilms forming. The delivery units are full of small valves for air and water and at risk of breakdown. I will have all our lines run for two minutes, three times a week using our regular water treatment. At the same time, you can do the next item….
Handpieces – they really don’t like being left unused. If you have an automated system, I suggest they are run through this weekly. If not then run them on the DUWLs weekly. They will not need re-autoclaving or bagging until going back into normal use. I would advise running aerosol-generating handpieces into a lab bag to catch the bulk of the aerosol, this can be simply poured away slowly afterwards. We will simply store them on a tray in each surgery for the duration. They should be oiled after running.
Suction – again whilst everything is on, put a good bucket load down two to three times a week. I would be careful with use of the normal fluids we put down. These are designed to keep biofilm at bay. The risk is to the larger pipes that run under the floor to the pump. If left for excessively long periods the cleaning agents can cause pipes to become brittle and cracked (we have experienced this). They are not normally left longer than a fortnight. For this reason, we will be running the suction with the cleaning agent at the start of the week and simply water the rest of the week. If the pipes dry out, then any biofilm left inside (again, think about the ones under the floor out of reach) can dislodge and block the pipe or even worse, travel to and damage the suction pump (another personal experience).
X-ray machines – switch these on once a month and put a test film through if you’re on digital phosphor plate. This is a good time to do your QA on your plates and find the duff plates for replacement later on. I don’t have a wet film developer, so I would recommend checking with the manufacturer if you have one to see how to maintain it.
We have unplugged anything that is rechargeable. Leaving it plugged in on charge is not good for the batteries. I may consider getting them put on charge once a month.
Materials – I have removed our materials from the surgeries and put them where I can maximise storage life. Disposables have been consolidated and put away so we have an accurate estimate of stock levels, there will be shortages if we all have to order stock at short notice. Note expiry dates, anything that will expire in the next three months should be put in one place so it’s easy to check at the time.
Emergency drugs and equipment – this will still need the regular checks on equipment. I am considering putting those drugs that store better if refrigerated into our stock fridge, they would need to be brought out if public are on the premises. Have a written list of expiry dates and where they are being stored if you choose to do this.
Taps and legionella – make sure the water is run weekly to keep this at bay. I would suggest testing should be done prior to reopening.
Lastly, don’t forget to turn it all off again before locking up!
That just leaves me to say, good luck and best wishes to all.’