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Legacy errors: Why do we normalize not-so-great behaviors in the dental industry?

Nov. 4, 2022
Michelle Strange talks about what you can do to stay abreast of the latest infection control guidelines to encourage a culture of safety and compliance among your team members and avoid human error.

As health-care providers, we are responsible for providing patients with safe, effective, high-quality care. Nevertheless, human error is unavoidable in the medical field—slips, lapses, and mishaps happen all too frequently due to latent systemic factors such as provider fatigue, inexperience, lack of organizational policies, poor work culture, and normalizing behaviors that lead to legacy errors.

As I was writing this article, the best example of a legacy error popped up in a place that fuels a content creator’s fire: Facebook. A question was asked regarding immediate-use steam sterilization (IUSS), also known as flash sterilization. The poster asked if they or the veteran hygienist were correct: should packed instruments be run on the rubber/plastic setting or the wrapped instruments setting?

You're probably transporting your instruments the wrong way

Single-use items: Let's follow the instructions for use, please

I was pleasantly surprised to see so many people recommend the poster look up the equipment manufacturer’s instructions for use. I will remember this post on the days when I am worried about infection prevention procedures in the dental industry. I want to be shocked by questions like this, but I also know how many times I used to operate off the “I’ve always done it like that” philosophy and didn’t question the task I had been performing for decades. Let this be a sign to question everything you do in your dental office. Ask, is it a legacy error or does it follow proper protocols defined by rules and regulations, manufacturer’s instructions for use, and evidence-based guidelines?

Understanding legacy errors

A legacy error is a mistake or issue that is passed down from one employee to another, from one generation to the next.1 It can be a serious problem that easily finds its way into any medical or dental office, sometimes supplanting procedures that are put in place when there is a lack of control.

You may wonder how legacy errors are allowed to happen in the first place. They predominantly occur due to the absence of accountability to science-based procedures, leading to their normalization over time.

Legacy errors often proliferate when long-term employees train new hires. The trainer, usually an experienced team member, may pass on the out-of-date infection control information and obsolete processes or ignore best practices learned in school. Asking new employees to blindly adhere to the way your practice operates without asking for their ideas is a missed opportunity to learn about the latest procedures, scientific research, and technologies. It can also block the chance to foster teamwork and create a culture around safety.

The problem with legacy errors

Generational errors that I often witness include employees simply eyeballing chemical measurements for things such as the ultrasonic bath solution or the enzymatic cleaner for suction lines. Staff members may fail to read protocols or instructions for use before undertaking new tasks, and instead just rely on what senior members (who might not have read the guidelines themselves) have been doing.

If there haven’t been any adverse events directly associated with these errors, we tend to assume that what we are doing is acceptable. We continue to pass the misinformation on to the next team member and the next, ultimately creating a virus that will eventually infect the entire practice for generations to come.

Eradicating legacy errors

So how do you erase the legacy errors that exist in your office? Here are some ideas you can consider implementing to create a culture of communication, trust, and accountability—one that will ultimately help you stop legacy errors once and for all.

Establish frameworks with regular inspections to avoid complacency

To uphold a high standard of care and eliminate errors in your dental health-care facility, you must avoid complacency at all costs. First and foremost, ensure comprehensive and up-to-date written frameworks are in place, such as your office infection control plan2 and current standard operating procedures (SOPs).

These must undergo routine inspection and thorough analysis to close gaps, stop suboptimal practices, and establish new strategies for addressing unsatisfactory procedures. Written protocols should serve as a reference for consultation or if any doubts or apprehension arise while carrying out daily activities. These documents should be living and revisable.

Build a cohesive team

The next step is to develop a team that focuses on cultivating communication and teamwork. Even from their first day of working with you, you must communicate your clinic’s vision and mission to each of your staff while letting them know there are structures in place to support them. Every office is different, so it is essential to let everyone you onboard know what to expect.

All new hires must be informed of your office’s SOPs and infection control plan, as well as undergo training to ensure they know how to conduct operations in your practice. All staff members, from juniors to seniors, must receive correct, relevant, and ongoing training to eliminate legacy errors or repetition of mistakes.

Appoint an infection control coordinator to oversee daily operations

An infection control coordinator (ICC) is someone with specialized training who knows the ins and outs of infection control. The role of the ICC is to lead by example, demonstrate a commitment to infection control, and exemplify a workplace culture of safety.3 It requires developing, writing, and implementing your office infection control plan while managing daily operations to guarantee the highest standards when it comes to safety and efficiency.

Even though everyone on the team is held accountable for maintaining hygiene and patient safety standards while performing their duties, an ICC should oversee procedures and provide leadership where necessary. Especially in the case of legacy errors, the ICC can ensure that all tasks are carried out according to established protocols—without any shortcuts—to achieve optimal outcomes. The ICC is also responsible for educating and retraining all team members to keep everyone updated on the latest health and safety procedures.

Working to eliminate legacy errors from your practice has a direct positive impact on the quality of treatment you provide. Your patients will feel safe when they visit your facility, and your employees will feel assured that they are fulfilling their duties according to the highest standards possible.

Moreover, it can help you build an effective team that understands your goals, takes accountability, and understands current protocols. With suitable support systems in place and an experienced ICC to manage day-to-day operations, you will have a well-oiled machine that prioritizes safety. 

Editor's note: This article appeared in the November 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.


  1. Auger A. How to become the practice top-notch candidates are searching for. DentistryIQ. November 10, 2020. Accessed June 17, 2022.
  2. Strange M. Promoting infection control practices in your dental office. Dental Economics. April 1, 2020. Accessed June 17, 2022.
  3. Hendrick JR, Hendrick LG. Beyond the operatory: dental hygienists serving as infection control coordinators. RDH magazine. September 1, 2019. Accessed June 17, 2022.