Endoscopy Workroom

Figure 3-79. Layout of endoscopy workroom. (Design: Jain Malkin Inc.)

Nurse Station Design

Figure 3-80. Countertop model endoscopy automatic Figure 3-81. Floor model endoscope automatic reproces-

reprocessorunit. (Photo courtesy:Medivators Inc., sor unit. (Photo courtesy: Mediators Inc., Eagan, MN)

Figure 3-80. Countertop model endoscopy automatic Figure 3-81. Floor model endoscope automatic reproces-

reprocessorunit. (Photo courtesy:Medivators Inc., sor unit. (Photo courtesy: Mediators Inc., Eagan, MN)

floor drain facilitates the process). AERs include detergent, disinfectant, filtered water, air, and alcohol treatment cycles. They are designed to minimize chemical vapors and exposure and ensure a uniformly reprocessed instrument. Each AER usually requires a 14-inch water line with an accessible shutoff valve capable of providing 2 to 4 gallons of flow per minute, potable cold or hot water, a floor drain, and typically 120 volts ac (alternating current) with a 20-ampere line (fused and dedicated circuit). Suction and air connections are not required. The machines have internal air compressors that inject air through the endoscope channels. The countertop model in Figure 3-80 is designed for facilities that process more than 100 procedures per month, whereas the dual-basin floor model in Figure 3-81 is intended for higher volume.

Biopsy forceps and endotherapy devices introduced down the scope channels are of the one-time disposable or reusable type. The reprocessing protocol involves immersion in detergent, ultrasonic cleaning, rinsing, lubrication, followed by steam sterilization in an autoclave.

Glutaraldehyde Ventilation Strategies. Glutaraldehyde is used for cold sterilization and high-level disinfection of medical instruments. Although not proven to be a carcinogenic agent, it is an irritant that can be absorbed by inhalation, by ingestion, and through the skin. It has a strong odor and requires specific ventilation measures, including*:

• 10 air exchanges per hour

• A room large enough to ensure adequate dilution of vapors

• Exhaust vents located at the source of the vapor discharge (Figure 3-71—note exhaust grille at rear of sink)

• Additional exhaust vents at floor level (glutaraldehyde vapors are heavier than air and this pulls the vapors down away from the breathing zone)

• Fresh air supply at ceiling across (opposite) from exhaust vents

• Consideration of outside air intakes, windows, or other openings to prevent re-entry of discharged vapor or exposure to other occupancies—this air must not be recirculated

• Employing scope cleaning procedures and taking air samples to monitor vapor levels at completion of construction

Layout of Workroom. The room should have a dirty side and a clean side, with the dirty side being larger.

*The above recommendations are from The Safe and Effective Handling of Glutaraldehyde Solutions, SGNA Monograph Series, ©1996 Society of Gastroenterology Nurses and Associates, Inc., Chicago.

Dirty Side. The deep, large sink at 30-inch height would have a countertop space on the right and left. The dirty scope would be laid down on the left, held in the sink to be manually washed with brushes, then placed in the automatic disinfector reprocessor or soaked in trays to the right of the sink. Suction should be placed on the right side of the sink. The autoclave can be placed on the clean or dirty side. After the scopes are disinfected, they are rinsed off, then carried to the clean side to blow out with air and hung to dry. Even with the automatic reprocessor, scopes need to be hung in a drying cabinet. Locate a rack for gloves near the sink.

Clean Side. The sink should be on the right side with most of the countertop on the left. The sink here should also be lowered. Alcohol is used in the final stage of reprocessing. It is induced into the channels of the scope by syringe to dry any remaining water. Then the channels must be purged by air. Compressed air is needed on the right side of the sink. (The air compressor fits under the sink.) Bacteria grow quickly in damp, dark places. Therefore, air is used to blow dry all of the channels, and scopes must be hung in a tall cabinet so that they can be fully extended whether manual or automatic reprocessing (Figure 3-77). Locate a rack for gloves near the sink. A 6-inch-deep shelf over the sink is very useful on both the dirty and clean sides.

Miscellaneous Considerations. City water needs to be filtered; it's too contaminated. With the automatic reprocessor machines, leave space for an external pre-filtration system. Foot-pedal control for water at both sinks is ideal, but it must be a high-quality unit that has good temperature control and provides adequate flow.

Storage. Provide adequate storage in the workroom for boxes of gloves, masks, and disposable gowns, which provide a better barrier than linen. Storage for many gallon bottles of solutions must be accommodated.

Regulatory Agencies. Endoscopy facilities are state licensed, they require Medicare certification, and it is anticipated that they will soon have to be accredited by JCAHO or AAAHC (see Chapter 15) in order to get managed care contracts.

Recovery Room

The recovery room is standard in all respects, with oxygen and suction at each bed and privacy curtains separating each patient. Recovery time is normally half an hour, and recovering patients should be in view of nursing staff (Figures 3-73 and 3-75).

Interior Design

The interior design of an internal medicine suite should be tailored to the functional needs of the patient population. If the internist is a cardiologist or a pulmonologist, for example, those patients may, for the most part, be elderly. Therefore, a conservative color palette and furnishings might be appropriate. An oncologist, on the other hand, would have a broad age range of patients and a more upbeat design might be in order. A more important consideration is the socioeconomic level of the patients served to tune the design to their expectations and comfort. Color Plate 4, Figure 3-82, is a cardiac surgeon's waiting room. Patients visit the office preoperatively and postoperatively, on two or three afternoons a week. The remainder of the time, the office is a home away from home for the surgeon —a place to relax, sleep, prepare slides for lectures, and meet with colleagues to discuss cases.

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