Tools of the Trade

Did you know that your leak tester will need to be tested? Most automated leak testers have a specific pound per square inch (psi) requirement; so, how do you know if yours is meeting this requirement? Some newer leak testers have a self-testing function, but all of the older machines, such as a very common leak tester from a scope manufacturer that holds 90% of the market, do not. There are leak tester testers (Fig. 1) that can test your leak tester to ensure that the tester is testing as it should be.

There will be a test later. Don’t get testy about it.

Brushes

If cleaning is the most important step in the process, then brushing becomes the single most important component in the entire process. If it’s not clean, it can’t be sterile, and it’s essential that you have the right tools for this vital step. Classical Kovachian proverb says, “Keep it clean.”⁴

Previously mentioned, you shouldn’t just have one brush at the sink. Some flexible scopes have two lumen ports requiring two different size brushes. Some have a special brush required just for the larger entry port, and then a long lumen brush for the internal channel. Do you have a brush or sponge for the external surfaces of your scope? You should! Your manufacturer’s IFU will give you the sizes needed, so you’ll always need to have those brushes on hand.

Pro tip: Do not use enzymatic sponges at the sink with a different brand and dilution of enzymatic solution inside. The manufacturers have never tested the mixture on each product. We don't know if it will work, if the enzymes will react, or if they will inactivate one or both solutions. Instead, use a non-solution-soaked sponge, which is both effective and less costly. You’re welcome.

Automated Endoscope Reprocessor (AER)

When ANSI/AAMI ST91:2021⁵ for endoscope reprocessing came out in early 2022, it contained the strongest recommendation possible for moving away from manual disinfection soaking and strongly recommended the use of the automated endoscope reprocessor (AER). Manual soaking was such a highly variable process that a more automated, repeatable one in the AER became a preferred option. However, errors can still occur with the AER, so this process will need to be monitored. I would pay special attention to the water inlet line into your AER. Outbreaks have occurred from contaminated water lines, so review ANSI/AAMI ST108:2023⁶ on water quality for more information about testing here.

If your facility does not have an AER, and is still soaking scopes manually, I will align with ST91 and give my strongest recommendation possible for sunsetting this practice and acquiring an AER for your facility.

Drying

Another important takeaway from ST91 was the concept of 10 minutes of forced-air drying for scopes. Based on a 2018 water study performed by Ofstead and Associates⁷, residual water left in the channels of endoscopes was proven to foster microbial growth and provided a breeding ground for biofilm.

The rationale here is simple: microorganisms love dark, damp places, and endoscope channels provide a narrow, dark, damp chamber ideal for microbial growth.

In the past, we assumed that vertical hanging was sufficient. Gravity was supposed to do the drying job for us; however, because of the narrow channels and slight bends to flexible endoscopes, water droplets were shown to be present in vertically hung scopes for up to two weeks later.

Modern endoscopy departments may have continuous forced-air drying cabinets (Fig. 2) that utilize high-efficiency particulate air (HEPA) filtered air pushed through the scope(s). The turbulent airflow forces water from the channels and creates a hostile environment for microbes. I would certainly recommend these cabinets.

Labeling

In August 2025, I wrote an article here in HPN titled “Visual Communication”⁹ about the importance of communication using images, graphics, or signage to convey clear visual indications between users who may never have an opportunity to see each other or speak directly. Nowhere is the need for clear interpretation of messaging more important than in the endoscopy area!

Reprocessing technicians need to be able to clearly label scopes as having been processed. I can imagine few things more problematic in the endo suite than a contaminated scope being used on multiple patients due to improper labeling.

There are many options for labeling, and they will be dependent on the unique processes present at your facility. Blank tags can do the job, but you probably want to look at options that are less open to human error.

As far as clear visual indicators go, it’s tough to beat the convenience of a push-button tag (Fig. 3) that clearly indicates when your facility policy hangtime has expired, and the scope is due for reprocessing.

Conclusion

There are certainly more tools (e.g., chemistries, dosing machines, ergonomic sinks, etc.) that we can use in the endoscopy suite, but these are some of the major focus areas for surveyors that you may want to start with for compliance purposes. Flexible endoscopes aren’t getting less complex as technology advances, so it’s vital that we ensure our departments are reprocessing these devices safely and responsibly. To achieve this, we’ll need the proper tools and equipment to do the job.