Manual cleaning is the most important step for endoscope reprocessing success,1 and effective cleaning relies on the process being followed stringently without skipping any steps. It is also the most time intensive step of reprocessing, with a United States survey reporting that manual cleaning took an average of 17 minutes to complete.2
Despite its crucial importance, staff face pressure to reduce the time spent on manual cleaning. Time pressure has been rated as the number one factor contributing to manual cleaning difficulty and reduced effectiveness.3 Among those performing endoscope reprocessing, 65% said that time pressure made manual cleaning unnecessarily difficult, and 67% reported that it made the process less effective.3 Given the complexities of manual cleaning, this time pressure can lead to rushed or skipped steps. In another survey, 17% of reprocessing staff said that they routinely skipped steps because of time pressure.4
Time pressure can compromise the overall effectiveness of reprocessing, and evidence has shown that shortening manual cleaning leads to unnecessary risks for patients. A study of duodenoscope reprocessing found that manual cleaning durations of 7 minutes or less were associated with significantly higher odds of contamination.5 Other factors, such as a delay in the initiation of manual cleaning, shortened drying times, and staff experience level, did not have a similar association with contamination levels. Given how critical manual cleaning is to the overall success of reprocessing, it is important that it is performed thoroughly and successfully. Simplifying or automating parts of the cleaning process may be a potential solution to the issues caused by time pressure and skipped steps.
1. Rutala, W. A., Weber, D. J. & Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf (2019).
2. Ofstead CL, Quick MR, Eiland JE, et al. A glimpse at the true cost of reprocessing endoscopes: Results of a pilot project. Communiqué. Published 2017. Accessed 16 May 2025. https://www.bostonscientific.com/content/dam/bostonscientific/uro-wh/portfolio-group/LithoVue/pdfs/Sterilization-Resource-Handout.pdf
3. Sivek AD, Davis J, Tremoulet P, et al. Am J Infect Control. 2022;50(9):1038-1048
4. Ofstead CL, Hopkins KM, Eliand JE, et al. Process 2019;July/August:61-71
5. van der Ploeg K, Vos M, Erler N, et al. Gastrointest Endosc. 2024;99(Suppl 6):AB397.
