Does ‘Linear Flow’ in Endoscope Reprocessing Require an Extra Sink?

Preventing Infection

Does ‘Linear Flow’ in Endoscope Reprocessing Require an Extra Sink?

"The standards around endoscope reprocessing are evolving to tolerate less risk than we've had in the past."

Many ambulatory surgery centers (ASCs) still use a single sink to reprocess endoscopes.

This practice could soon become obsolete as calls grow to implement a so-called linear flow in sterile processing departments at surgery centers. That’s according to a recent article in Outpatient Surgery Magazine, which is produced by AORN.

Reusable medical devices like endoscopes should follow this linear flow transitioning from "dirty to clean” — but that’s a challenge with a single sink, which is how many SPDs at surgery centers are designed, Frank Edward Myers III, the director of infection prevention and clinical epidemiology at UC San Diego Health, tells the magazine.

The single-sink method is coming under increasing scrutiny as more is learned about the opportunities for infection during the reprocessing cycle.

"The standards around endoscope reprocessing are evolving to tolerate less risk than we've had in the past," adds Myers.

The Challenges of a Single Sink

With a single sink, SPD techs first use the sink to perform a leak test, then clean the scope's internal lumen and flush out the enzymatic solution.

Once the second step has been completed, the sink is dirty, and the scope must be moved somewhere else to clean the sink before the third step to avoid recontamination. This disrupts the linear process and increases the risk of contamination.

Organizations such as the Association for the Advancement of Medical Instrumentation (AAMI) and the Society of Gastroenterology Nurses Associates (SGNA) say that healthcare facilities should use double sinks but it's not currently a requirement.

ANSI /AAMI ST91, which is a comprehensive set of guidelines to achieve best practice for each stage of processing flexible endoscopes, recommends using at least two sinks with two separate basins for processing flexible endoscopes, according to an article published in Biomedical Instrumental Technology.

One sink or basin should be designated for leak testing and manual cleaning, while the other should be used solely for rinsing a reusable endoscope.

Single-Use Benefits

While transitioning from single to dual sinks is a big step, another approach worth considering is using single-use endoscopes. The FDA has updated recommendations for reprocessing and among its recommendations is to consider using single-use endoscopes “where there is increased risk of spreading infection … or where there is no support for immediate reprocessing” of the device.

Single-use endoscopes not only eliminate the need for reprocessing but they can simplify patient care and enhance patient safety because they are sterile straight from the pack, never need repairs and are always available.

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