Currently, the most common method of handling flexible gastrointestinal (GI) endoscopes is cleaning, followed by high-level disinfection, as terminal sterilization is often impractical.1

In this study, the research and development team from Advanced Sterilization Products examines endoscope processing challenges and the practicability of terminal sterilization.

Although endoscopes go through a cleaning and disinfection process after every patient use, infection related cases linked to endoscopes are reported and continue to increase at an alarming rate.2-5

N. Omidbakhsh et al. / Journal of Hospital Infection

Three important factors that compromise the cleaning and disinfection process of flexible endoscopes1:

  • Complexity of the GI endoscope design 
  • Formation of biofilms inside the lumens 
  • Inadequate margin of safety


According to the study, decontamination or sterilization of flexible endoscopes can be achieved by the endoscope manufacturers’ ability to design them to be easier to clean and/or simply using more robust materials that can withstand sterilization.1

Modified endoscope design


Effective staff training


Process control/ monitoring


Use of detergents with proven effectivity against biofilms


Overcome current risk of flexible endoscope related infection outbreaks

Helpful Resources

Here are some resources available on the ASP website you can use to help educate your teams on these important issues.


  1. Garcia-Houchins, S., Olmsted, R.N. (2023). The Joint Commission Guide to Reprocessing Reusable Medical Devices. Oakbrook Terrace: Joint Commission Resources.

  2. Wolters Kluwer. (2017, April 14). Benefits of Joint Commission accreditation. Retrieved from Expert Insights:

  3. Yang, L. X. (2022). Application of the defect management improvement mode under Joint Commission International standard to improve the instrument cleaning and disinfection effect and management quality in the central sterile supply department: a randomized trial. Annals of Translational Medicine, 1-11.