Double Sinks Could Become a Future Standard

Many ambulatory surgery centers are still using a single sink to reprocess endoscopes, but that could be a thing of the past in the next few years.

The reason? Surveyors are becoming increasingly observant as to whether sterile processing departments (SPDs) at surgery centers are implementing a linear flow in their operations. In other words, the devices being reprocessed should always be moving from “dirty to clean.”

That’s virtually impossible with a single sink, which is how a significant percentage of SPDs at ASCs are outfitted, according to Frank Edward Myers III, M.A., CIC, FAPIC, director of infection prevention and clinical epidemiology at UC San Diego Health.

“The standards around endoscope reprocessing are evolving to tolerate less risk than we've had in the past,” says Mr. Myers. “The single-sink method is becoming less acceptable as we come to better understand the opportunities of infection during the reprocessing cycle.”

SPD techs first use the sink to perform a leak test, then actually clean the scope’s internal lumen and then flush out the enzymatic solution. If you only have one sink, however, you’ve got a dirty sink after the second step. “The scope has to go somewhere in order to clean the sink before the third step in order to not recontaminate it,” explains Mr. Myers.

You can’t place it on the clean side of the room because it hasn’t gone through the process yet to be appropriately placed there. “By having just one sink, you essentially doom yourself to not having a linear process,” he says.

The current guidance on the issue from agencies such as the Association for the Advancement of Medical Instrumentation (AAMI) and the Society of Gastroenterology Nurses and Associates (SGNA) are essentially “should” statements, which means facilities aren’t in violation of the standard if they don’t follow it. Mr. Myers thinks the guidance will one day be at the “shall” stage, which means SPDs will have to install dual sinks to be standard-compliant.

If this happens, it will be following the direction the agencies took on strengthening their stances regarding the use of drying cabinets to store flexible endoscopes. The changes in the storage recommendations came about because studies have shown that the drying cycles of automated endoscope reprocessors don’t completely dry the insides of the scopes’ lumens. Also, published articles show that storage cabinets with air circulating in them reduced moisture in the deep channels of the devices.

In the meantime, surgery centers that can find ways to add double sinks before “should” becomes “shall” will set themselves for the future. OSM