STANDARD 18: Physical Environment

18.1 Facilities 

1. The dental organization’s facilities shall ensure the safety of all persons. It shall be constructed, arranged, and maintained in accordance with national laws, regulations, and the scope of the services offered.

2. Pertinent information and data regarding the safe management of the physical environment shall be maintained for the dental organization management oversight.

3. The dental organization shall address the following processes in keeping with national law and standard of care: Life Safety, Security, Emergency Management, Hazardous Materials (HAZMAT), Medical Equipment, and Utility Systems.

NOTE 1 "Adequate facilities" means the dental organization has facilities that: 

a) allow safe access for all persons including those with disabilities and special needs; 

b) are designed and maintained in accordance with national law and regulatory requirements and dental organization policy. This may include designates patient care areas as indicated. Certain areas of the dental organization may be required to have external sources responsible for maintaining treatment areas. The dental organization must ensure that these services are providing a safe environment for all staff, patient, and visitors.

18.2 Life and Fire Safety Process 

18.2.1. Life Safety 

1. The dental organization shall develop, monitor, and maintain a life safety process that provides a safe, and hazard-free physical environment.

2. The dental organization shall conduct periodic surveillance of the facility to identify life safety risk to take corrective actions as needed.

3. The dental organization shall develop and enforce a vapor/tobacco-free policy in all facilities and other areas under the organization’s responsibility.

4. The dental organization shall address all safety recalls and alerts including equipment, pharmaceuticals, and other materials subject to removal from service. Related information shall be maintained as documented information.

5. The dental organization shall assess, document, and minimize the risk of construction, repairs, or improvement operations to patient care areas. This planning shall include consideration of 

a) infection prevention and control; 

b) utility requirements; 

c) noise and vibration; 

d) other life safety measures as required by national law.

18.2.2. Fire Safety 

1. The dental organization shall develop and follow a fire safety process to ensure that all fire safety requirements of national law or other regulatory agencies are met.

2. The dental organization shall have written fire management plans that contain provisions for: 

a) reduction of fire risks; 

b) prompt reporting of fires; 

c) protection of patients, personnel, and visitors; 

d) detection of fire and smoke by use of alarms including their transmission to fire department, as well as response to alarms; 

e) extinguishing fires; 

f) safe and unobstructed exit from the dental organization when fire emergencies occur.

3. The dental organization shall maintain written evidence of regular inspections and approval by all applicable fire control agencies and applicable national and local law and legislation. This evidence shall be maintained as documented information.

4. Fire drills and evacuations shall be conducted regularly according to national law. The dental organization shall evaluate the effectiveness of the fire drills. A performance report of effectiveness and efficiency of each fire drill shall be maintained as documented information for a period as determined by a national law.

18.3 Security Management Process 

1. The dental organization shall develop and maintain a security management process that provides a secure physical environment, including the identification of patients and staff as well as the monitoring other necessary security issues within the dental facility. 

NOTE 1 Unidentified persons may be assumed to be patients, family, or visitors.

18.4 Emergency Management Process 

1. The dental organization shall develop and utilize an emergency management process to address the safety and well-being of all persons and the facility.

2. This emergency management processes shall address means to support and maintain all essential facility functions including electricity, water, ventilation, fuel, medical gas, vacuum systems, and other identified utilities (see standard 18.7). This process shall include relevant required maintenance procedures and inspection logs.

3. The dental organization’s emergency management process shall be revised as necessary, in accordance with changing circumstances, and any identified opportunities for improvement

18.5 Hazardous Materials (HAZMAT) Process 

1. The dental organization shall develop, address, and maintain a HAZMAT process in keeping within national law. It shall assess the risk from materials and substances that include: 

a) selection and utilization; 

b) labeling and documentation; 

c) storing (including a hazardous materials and waste inventory); 

d) security; 

e) handling (including the provision and use of personal protective equipment); 

f) transportation; 

g) disposition of hazardous materials and waste; 

h) health monitoring, where appropriate subject to MSDS information and national law; 

i) an ongoing and updated inventory of hazardous waste and material; 

j) a policy for appropriate PPE use and HAZMAT exposure level monitoring.

2. The dental organization shall not introduce hazardous waste pharmaceuticals into the sewer systems or other channels leading to environmental waterways by flushing or similar action.

3. The dental organization shall meet the requirements for the installation and use of alcohol-based hand rub dispensers as allowed by national law or fire regulation.

4. The dental organization shall establish processes to ensure that contaminated and potentially contaminated biohazard waste is identified, handled, recorded, and stored effectively to prevent contamination of other areas.

5. When transporting and storing waste, the dental organization shall take appropriate measures to prevent and mitigate any hazard related to the following by: 

a) providing adequate facilities and procedures for the short and long-term storage of waste 

b) ensuring that appropriate containers and other materials are used during storage and transportation (e.g. carts, bags, sharps containers) 

c) adequately segregating waste to minimize risk of contamination 

d) addressing the potential of drug diversion.

NOTE 1 The organization should categorize HAZMAT sources of waste and their means of disposal including but not limited to: 

a) clinical waste including body fluids as circumstances indicate; 

b) medical equipment; 

c) needles, syringes, and sharps; 

d) clothing and PPE; 

e) paper and plastic waste; 

f) wastewater, including that from sinks and showers; 

g) air filters and air handling systems; 

h) discarded equipment used in the dental organization; 

i) pharmaceutical waste.

18.6 Medical Equipment Process 

1. The dental organization shall develop and maintain a medical equipment process that provides for selection, safe use, inspection, testing, recall, and maintenance of equipment to ensure an acceptable level of safety and quality in accordance with national law. A qualified individual shall be responsible for these duties as well maintaining an equipment inventory. These requirements shall be based on risk assessment in accordance with the manufacturer’s recommendations, and/ or dental organization experience. The equipment shall include but is not limited to: 

a) ionizing radiation equipment; 

b) sterilization and decontamination equipment; 

c) pharmaceutical equipment; 

d) patient monitoring equipment; 

e) CPR and other emergency related equipment including medical gases.

NOTE 1 As a part of this risk assessment process to determine maintenance intervals that consider safety, equipment, availability, and service life, the following should be considered: 

a) consulting manufacturer recommendations;

b) applicable codes and standards or accreditation requirements; 

c) health and safety information relevant to potential hazards; 

d) appropriate training and education of staff regarding the use of equipment; 

e) likelihood of an injury or illness occurring and the likely severity of any injury; 

f) illness resulting from the use of equipment.

18.7 Utility Systems Process 

1.The dental organization shall maintain a utility systems process that ensures the safe and reliable access to all required utilities necessary for the scope of services provided. Memorandums of agreement shall be developed and maintained accordingly. These shall be in keeping with the life safety requirements of standard 18.2.

2. The dental organization shall identify critical facility operating components for quality control and have methods for regular maintenance, inspections, and testing of all utility systems.