Areas of Concentration: Why Instrument Processing and Flexible Endoscope Reprocessing Each Demand Their Own Expertise
When our Voice of the Customer (VOC) council met to discuss how reprocessing work gets organized, one theme kept surfacing: the demands of the work itself. Following the call, we sat 
down with Gene Ricupito, System Director, Sterile Processing at UCSF Health, to talk through why both instrument processing and flexible endoscope reprocessing ask so much of the people who do them, and why the answer to how a facility should structure that work depends heavily on the facility.
Ricupito’s view is not that one discipline is harder than the other. It is that they are different disciplines, each exacting in its own way, and that the depth required by each is easy to underestimate from the outside. He frames the ideal as areas of concentration: people focused on instrument processing doing that, and people focused on flexible endoscope reprocessing doing that, so each gets the full attention it requires.
A Different Level of Competency
Ricupito opens with an analogy from the clinical side. You would not ask the technician who handles orthopedic cases to step into a transplant, because the work calls for a different level of competency. He sees reprocessing the same way. The skills that make someone excellent at instrument processing are not the same skills that make someone excellent at flexible endoscopes, and treating the two as interchangeable sells both short.
“The complexity of processing flexible endoscopes is such that you really need to focus. They’re really areas of concentration.”
That focus is the point. When a technician’s attention is concentrated on a defined body of work, the odds of a missed step drop, and the standard the facility can hold itself to rises. The argument is about doing each kind of work well, not about ranking them.
Where the Risk Lives in Endoscope Reprocessing
For flexible endoscopes, Ricupito locates the hardest part of the job precisely. The debate over whether a scope is high-level disinfected or sterilized matters far less than the step that comes first.
“Whether it’s disinfected or sterilized is almost irrelevant. It’s the cleaning process where the most attention to detail is required.”
Cleaning is where the risk lives, and it is highly technique-dependent. The instructions for use on a complex flexible endoscope can be long and unforgiving, and the device must be cleaned exactly the way the IFU describes or it cannot be reliably rendered safe for the next patient. Ricupito is blunt about how hard some of these devices are to clean by design, noting that a few are almost impossible to clean in some cases. The history backs him up. The duodenoscope-linked infection clusters of roughly a decade ago, at a number of institutions underscored how a device that is not cleaned to its IFU can carry risk forward even after disinfection. Manufacturers have responded since, including moving toward disposable components such as elevator caps on the most difficult-to-clean scopes, which removes part of that burden from the technician. The underlying lesson stands: this is meticulous, instruction-driven work where the details decide the outcome.
The Variety Problem
Part of what makes endoscope reprocessing so demanding is the sheer range of devices. Ricupito breaks the inventory into its three largest categories, colonoscopes, gastroscopes, and duodenoscopes, then notes how much variation hides underneath them. Scopes differ by vintage, by imaging capability, and by manufacturer, with EBUS bronchoscopes, urology scopes, and small rhinolaryngoscopes adding further wrinkles. The duodenoscope’s elevator channel is its own challenge, and the smallest scopes are difficult precisely because of their size.
At a large academic medical center, that variety multiplies. Ricupito describes inpatient and outpatient areas running a wide cross-section of makes and models from several manufacturers, occasionally including a specialty scope so unusual that even the users struggle to describe it. Reprocessing that range without easily confused protocols takes a team built around it.
The Rigor on the Instrument Side
None of this means instrument processing is the simpler discipline. SPD has its own deep demands, and the recognized standards spell them out. Under ANSI/AAMI ST79, decontamination is a sequence of exacting steps: technicians disassemble multi-part devices and open every jointed instrument, separate delicate items from general ones, pretreat according to the device IFU, and use cleaning solutions at the correct dilution, temperature, and contact time. Every item is inspected for flaws, damage, debris, detergent residue, and completeness before it moves on, and anything found soiled in the assembly area goes back to decontamination.
Water quality threads through all of it. ANSI/AAMI ST108 ties specific water standards to each stage of processing, from point-of-use treatment through cleaning, rinsing, and the final rinse, because the wrong water at the wrong step can hinder cleaning, leave residue, or stain and corrode instruments. Add the realities of modern surgical inventory, robotic instruments that require full immersion and lengthy enzymatic soaks, intricate lumens that need validated flushing, and high-volume tray assembly with accurate counts, and the instrument side is clearly its own specialized craft. Different from endoscope reprocessing, but no less reliant on training, attention, and IFU discipline.
Matching the Structure to the Facility
The right structure depends on volume and variety. UCSF has concentrated flexible endoscope reprocessing in dedicated, purpose-built space for two decades, routing scopes that require high-level disinfection to a team and an environment designed for them. At that scale, with that range of devices, keeping the disciplines distinct lets each be held to its own standard.
Smaller and medium-sized facilities live in a different reality. When a site runs only a handful of scope models and a more contained instrument load, the variety that drives specialization at an academic center simply is not there. Ricupito points to a children’s hospital in his own system where sterile processing handles a small set of pediatric scopes alongside its instrument work without the tangle of protocols a high-variety site would face, and to satellite locations that process just a few scope models and nothing else. The deciding factors are how much volume and how much variety sit on each side. Where both are high, concentrating each discipline pays off. Where they are modest, a more combined approach can be entirely appropriate.
Final Thoughts
The throughline in Ricupito’s thinking is respect for both kinds of work. Instrument processing and flexible endoscope reprocessing each demand deep, specialized competency, and they are not the same competency. For facilities where the volume and variety on each side are high enough, concentrating each discipline lets each one be done to its own standard, with technicians whose focus matches the complexity in front of them. For facilities where the work is more contained, the calculus looks different. The constant, regardless of structure, is that both disciplines reward the same things: training, attention to detail, and unbending adherence to the IFU.
About: Voice of the Customer Committee
The Voice of the Customer Committee is a panel of healthcare and instrument reprocessing professionals who have graciously donated their time to share their expertise and guidance on current challenges faced by the instrument reprocessing community. Through sharing their insights, experiences, and best practices, we have been given the opportunity to share these findings with our readership. We’d like to thank our VOC members for their outstanding input and insights, as well as their time! Thank you for your continued partnership, and all you do.
