Manual cleaning is the most challenging, but most critical, part of endoscope reprocessing.1,2 Even when performed with adherence to guidelines and IFUs, studies show that manual cleaning can fail to systematically remove soil from endoscopes.3,4
It is essential that biofilm is removed during the manual cleaning phase, as it can survive high-level disinfection.8,9
However, current cleaning and reprocessing methods are not always sufficient to remove biofilm. A clinical study found that the majority of gastroscopes had biofilm detected in multiple channels after only 60 patient use/reprocessing cycles.6
Manual cleaning is a complex process that requires high levels of technical skill and concentration. Reprocessing staff rate manual cleaning as the most challenging part of reprocessing.1
This complexity leads to missed or incorrectly executed steps. An observational study showed that less than half of endoscopes had all components brushed correctly.10
A literature review found insufficient manual cleaning in 50% of studies, and complete neglect of channel brushing in 17% of studies.11
Some small channels of endoscopes, such as air/water and auxiliary channels, have very narrow diameters. The design of endoscopes means that these channels are inaccessible to brushes and can only be cleaned by manual flushing.2
Biofilm forms quickly in these narrow channels, and is not removed by routine manual cleaning.5,6
Endoscopy reprocessing staff experience discomfort and pain from leaning over sinks, scrubbing endoscopes and standing for long hours.1
Over 75% of reprocessing staff report fatigue or discomfort as a result of manual endoscope cleaning1
Automation of other aspects of endoscope reprocessing has had positive effects for staff, who reported increased compliance with guidelines and less physical discomfort.10