by Rose Seavey MBA, BS, RN, CNOR, CRCST, CSPDT President/CEO Seavey Healthcare Consulting, LLC
Contaminated endoscopes have been a huge topic with the media and the public due to the reports of infection transmission as a result of inadequately processed scopes. Flexible endoscope are arguably the most difficult pieces of equipment to effectively reprocess. There are over 120 steps involved in reprocessing each scope. No wonder “Inadequate Cleaning of Flexible Endoscopes before Disinfection Can Spread Deadly Pathogens” is listed as the number one hazard on the Top 10 Health Technology Hazards for 2016 from the Emergency Care Research Institute (ECRI).1

There are several published standards and guidelines available for processing flexible endoscopes. Many of these recommendations have been recently updated or newly created.

AORN Guidelines
The Association of periOperative Nurses’ (AORN) Guideline for processing flexible endoscopes provides evidence-based detailed guidelines. AORN used 418 researched documents with strong evidence for their recommendations.2 Each piece of evidence used was given an appraisal score that describes the level of strength and quality of the published findings. 3
For each appropriate reference used the appraisal scores are then noted in brackets at the end of the recommendation(s). This evidence taken from science and other literature can help health care facilities in enforcing best practices necessary to meticulously reprocess including flexible endocsopes.2
The rationale behind this evidence-based document is to provide guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories.4

AAMI Standards
The Association for Advancement of Medical Instrumentation (AAMI) published ST91 Flexible and semi-rigid endoscope processing in health care facilities in 2015. This standard provides guidelines for precleaning, leak testing, cleaning, packaging (where indicated), storage, high-level disinfection, and/or sterilizing of flexible gastrointestinal (GI) endoscopes, flexible bronchoscopes, surgical flexible endoscopes (e.g., flexible ureteroscopes0, and semi-rigid operative endoscopes (e.g., choledochoscopes) in health care facilities.

This document specifically covers:

  • Functional and physical design criteria for endoscope processing areas,
  • Education, training, competency verification, and other personnel considerations,
  • Processing recommendations,
  • Installation, care and maintenance of automated processing equipment,
  • Quality control, and
  • Quality process improvement.

SGNA Standards
The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes was updated in 2016. This document contains recommendations for personnel, management, quality assurance, reprocessing environment, spill containment, reprocessing accessories, and GI endoscope reprocessing protocol.

SGNA also has a guideline for Use of High Level Disinfectants and Sterilants for Reprocessing Flexible Gastrointestional Endoscopes published in 2013. This guideline provides information about the properties of solutions, their safe and effective use, and their compatibility with flexible endoscopes.

Multisociety Reprocessing Flexible Gastrointestinal Endoscopes
In 2003 the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Healthcare Epidemiology of America (SHEA) collaborated with multiple physician and nursing organizations, infection prevention and control organizations, federal and state agencies, and industry leaders to develop evidence-based guidelines for reprocessing gastrointestinal endoscopes.

This document was updated in 2011 and incorporated recent guidance that is specific to those endoscope models with movable elevators at the distal tip, such as duodenoscopes and linear ultrasound endoscopes. A 2016 version of the document is expected to be published soon.

Flexible endoscopes are very complicated devices that are difficult to process and require specific attention to detail in every processing step. Following current updated evidence-based guidelines can help facilities ensure the effectiveness of processing procedures and help eliminate the possibility of infection transmission from one patient to another. Having competent processing staff and following the endoscope IFU can help to decrease damage to the very expensive endoscopes. A multidisciplinary team should be established to help create a strong policy and procedure for endoscope processing. The endoscope processing policy and procedure should be standardized throughout the organization and note which standard/guideline the facility is following.


  1. 2016 Top 10 Health Technology Hazards. What technology hazards are lurking in your hospital? Accessed 1/25/2016.
  2. 6 New Evidence-Based Practices For Implementing More Effective Processing Of Flexible Endoscopes in; AORN Periop Insider, 1/13/2016.
  3. AORN’s Revised Model for Evidence Appraisal and Rating. In: AORN Journal, January 2016 vol. 103, No.1 p60-72.

Rose Seavey is President/CEO of Seavey Healthcare Consulting and formerly the Director of the Sterile Processing Department at The Children’s Hospital of Denver. Rose served on the AORN Board in 2008-2010. Rose is a past President ASHCSP. She received numerous awards such as AORN’s award for Mentorship in 2012 and Outstanding Achievement in Nurse Education in 2001. In addition, she received the national 2013 IAHCSMM award of Honor, the Industry Leadership Award from the Massachusetts chapter and the educator of the year award from the Golden West chapter. She was one of the Who’s Who in Infection Prevention in 2006 by Infection Control Today. Ms. Seavey is the author of the book tilted Sterile Processing In Healthcare Facilities: Preparing for Accreditations Surveys, published by AAMI and she serves on several AAMI committees writing standards.