Gearing Up for GI

We’ve helped plan and build numerous GI centers and know from experience the amount of time and resources top-performing facilities have invested in smart procedure room designs, the latest flexible endoscope technology and reprocessing areas outfitted with patient safety in mind.

Endoscopes are difficult to properly disinfect and preventing infections during endoscopies and colonoscopies is paramount, so the design of the reprocessing department might be the most important place to start when planning a new space. With that in mind, best practice is to frame out 3 different rooms: one for decontamination; one for scope washing and one for drying. At a minimum, there should be 2 rooms with a pass-through automated endoscope reprocessor (AER) between them. A pass-through AER costs about $120,000 — 4 times the price of a traditional unit — but it eliminates the need for a third room. The amount of space you have in the new facility and your budget will guide your choice, but either is preferable to washing and drying instruments in a single open space.

Some AERs include barcode-scanning technology that provides the ability to trace the entire life cycle of the scope. It logs which patient the scope was used on, when it was used, when it enters each phase of the high-level decontamination process, which staff member cleaned and disinfected the scope, when it’s placed into a storage cabinet and when it gets used on the next patient. We suggest investing in one of these reprocessors, at about $60,000 each, for every 2 procedure rooms.

Standard endoscope storage cabinets cost $4,000 or $5,000, but we always advocate that new suites be outfitted with cabinets that have automated air circulating technology, even though they’re twice the cost. When you wash and decontaminate scopes, even though the water is filtered and you’re using a highly disinfecting scope washer, it’s possible to turn the scopes around before they’re dry. When that happens, there’s a risk that chemical and water residue will remain in the internal lumens to increase cross-contamination risks. Storage cabinets with air circulating inside ensures scopes return to the procedure room bone dry.

If the budget permits, more advanced drying cabinets let you attach the lumens of each scope to a drying unit that blows air straight into the scope. They’re as expensive as they are advanced, however, costing $16,000 to $20,000 — 4 to 5 times the cost of a traditional cabinet.

Does air circulating through a storage cabinet keep scopes sufficiently dry? Current evidence suggests it does. But if you’re a very busy, high-volume GI center, the more advanced and most expensive cabinets would let you turn over scopes faster and have them dried in the most effective way for your patients.

A final note about proper endoscope care: These devices are fragile and should be transported back and forth from the procedure room to the reprocessing area in plastic bins. The bins aren’t sealed, but they are closed so there’s no chance of staff or patients being exposed to infectious organisms while the scopes are en route.

Investing in high-end reprocessing technology is certainly more costly, but better overall operations will reduce cross contamination risks for your patients. The success of your entire new venture will in large part be based on the success of your sterile processing department. Don’t make it the least looked-after room in the design phase, or operationally.

Most GI facilities are designed to move patients through procedure rooms as quickly as possible. The best centers are built with as much of an emphasis placed on where and how endoscopes are reprocessed, because speed should never trump safe patient care. OSM