Endoscope Reprocessing

Flexible endoscope reprocessing is one of the most complex and highest-risk processes in Central Service. The intricate design of flexible endoscopes — with multiple narrow channels, delicate components, and materials that cannot tolerate heat — makes them especially challenging to reprocess. Failures in endoscope reprocessing have been directly linked to patient infection outbreaks.

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The Complete Reprocessing Sequence

Step 1: Point-of-Use Treatment (at Procedure Site)

• Immediately after removal from the patient, wipe the insertion tube
• Flush all channels with manufacturer-recommended enzymatic solution
• Suction enzymatic solution through the suction channel
• Transport to reprocessing area in a covered, leak-proof container

Step 2: Leak Testing

• Perform before every cleaning cycle — do not skip
• Pressurize the scope per manufacturer IFU and submerge in water
• Look for air bubbles indicating a breach in the outer sheath or channels
• If leak detected: Remove from service → tag as damaged → send for repair
• A scope with a leak must NEVER be processed further or used on a patient

Step 3: Manual Cleaning

This is the most critical step — automated cleaning alone is NOT sufficient:

• Brush all accessible channels with appropriately sized brushes
• Flush all channels with enzymatic detergent solution
• Clean the exterior with a soft cloth and enzymatic solution
• Clean all valves, buttons, and biopsy port caps
• Brush tips should exit the distal end of the channel — this confirms the brush traversed the entire length
• Rinse all channels and exterior thoroughly

Step 4: Visual Inspection

• Inspect the insertion tube for damage, kinks, or discoloration
• Check the distal tip for scratches or lens damage
• Verify all valves and buttons are intact
• Confirm channels are patent (not blocked)

Step 5: High-Level Disinfection or Sterilization

Manual HLD:

• Completely immerse the scope in HLD solution
• Fill ALL channels with solution (no air bubbles)
• Maintain immersion for the required contact time
• Verify MEC before each use

Automated (AER):

• Connect ALL channel adapters per manufacturer instructions
• Run the complete AER cycle
• Verify cycle completion on the AER printout

Step 6: Rinse

• Rinse thoroughly with appropriate water (critical water for final rinse)
• Flush ALL channels to remove all HLD chemical residue
• Inadequate rinsing can cause chemical injury to patients

Step 7: Drying

• Alcohol flush: Flush all channels with 70% isopropyl alcohol to facilitate drying
• Forced air: Blow compressed air through all channels to remove moisture
• Critical importance: Moisture left in channels promotes bacterial growth (especially Pseudomonas)
• Drying is NOT optional — it is a mandatory step

Step 8: Storage

• Store hanging vertically in a well-ventilated endoscope drying/storage cabinet
• Remove all valves and caps to allow air circulation through channels
• Do not coil the scope tightly — this can damage internal channels
• Storage cabinets should have HEPA-filtered air circulation

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AAMI ST91: The Endoscope Reprocessing Standard

Key requirements from AAMI ST91 (Flexible and Semi-Rigid Endoscope Processing):

• Written reprocessing procedures must be available at the point of processing
• Staff must be trained and competency validated before processing endoscopes
• All steps of the IFU must be followed — no shortcuts
• Documentation of each reprocessing cycle
• Quality monitoring including periodic culture surveillance

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Common Endoscope Reprocessing Errors