The challenges and complexities of endoscope reprocessing

Endoscopes are sophisticated devices, with compact and intricate designs that allow for minimally invasive use. However, this sophisticated design makes endoscope reprocessing a complex task. Instructions for Use (IFUs) can contain more than 100 steps for endoscope reprocessing that must be followed.^1,2 Each endoscope model also has its own specific and complex instructions for cleaning, adding to the challenge for reprocessing staff.

This complexity can lead to parts of cleaning or disinfection being performed incorrectly, with issues such as skipped steps and neglect of channel brushing reported in multiple studies. An observational study evaluating endoscope reprocessing practices found that only one out of 69 endoscopes (1.4%) was reprocessed correctly by following all required steps for manual cleaning and high-level disinfection.³ The most commonly skipped step was the brushing of all channels, performed in only 43% of cases. Failing to perform the brushing step correctly can put patients at risk by allowing biofilm to accumulate, as biofilm requires mechanical action to be removed from endoscope channels.⁴

In 2021, a literature review identified 18 studies reporting gaps in clinical practice that can impact the effectiveness of endoscope reprocessing.⁵ Failure of the manual cleaning step of reprocessing was reported in 50% of these studies. Brushing was highlighted again as a missed step, with 17% of studies reporting a failure to brush all channels during manual cleaning. This highlights the need to monitor factors that may cause inadequate manual cleaning. Efforts should also be made to implement simplified alternatives to manual cleaning, that reduce the number of steps required when brushing and flushing the channels of endoscopes.