Guideline for processing flexible endoscopes
The AORN Guideline for Processing Flexible Endoscopes provides guidance for perioperative, endoscopy, and sterile processing personnel on the safe processing of reusable flexible endoscopes and accessories. Its goal is to reduce the risk of patient-to-patient infection transmission through consistent, evidence-based processing practices.
The guideline treats endoscope processing as a multi-step cycle that includes point-of-use precleaning, transport, leak testing, manual cleaning, inspection, high-level disinfection or sterilization, storage, and reuse. It emphasizes following the manufacturer’s validated instructions for use throughout every stage.
A major focus is the design and control of the processing environment. Processing should occur in dedicated areas that support separation of contaminated and clean activities, unidirectional workflow, appropriate ventilation, hand hygiene, PPE use, and suitable sinks and utilities. These measures are intended to reduce cross-contamination and support safe, efficient processing.
The guideline places particular importance on immediate precleaning and thorough manual cleaning. Precleaning should begin as soon as possible after use to prevent organic material from drying and biofilm from forming. Manual cleaning is described as the most important processing step because residual soil or biofilm can interfere with subsequent disinfection or sterilization.
For endoscopes designed for it, leak testing should be performed after each use and before manual cleaning to identify damage that could allow fluids, chemicals, or organic material to enter internal areas of the device. Endoscopes that fail leak testing should be removed from service for repair or replacement.
The guideline also stresses proper drying, storage, and protection from recontamination after processing. Effective storage depends on correct processing, thorough drying, controlled storage conditions, and regular cleaning of storage cabinets.
Personnel responsible for processing flexible endoscopes should receive initial and ongoing education and competency verification. The document supports having trained personnel with specialized knowledge of endoscope construction, processing equipment, and infection-prevention practices to reduce variability and processing errors.
Finally, facilities should maintain traceable processing records, written policies, and quality-management programs. Documentation should connect patients, procedures, and specific endoscopes, while quality programs should routinely evaluate compliance, identify processing failures, and implement corrective actions.
In short: the guideline provides a comprehensive framework for ensuring flexible endoscopes are properly precleaned, transported, leak tested, cleaned, disinfected or sterilized, dried, stored, documented, and handled by competent personnel to minimize infection risk and maintain device integrity.