From upgrades & enhancements to existing equipment, to new hospital department builds, Pure Processing helps medical facilities achieve three key objectives for their equipment investments:
1. Optimal patient safety outcomes
2. Enhanced operational efficiencies
3. Reduced costs associated with worker injuries & ergonomics, instrument damage, and infection risks
By leveraging our expertise and collaborative, partnership-first approach, we can help facilities protect their most important assets: their staff and instrumentation.
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The True Price to Pay For Endoscope Damage
Flexible endoscopes are among the most valuable and most vulnerable instruments in any healthcare facility. A single colonoscope costs $30,000 – $60,000 to acquire and they accumulate risk for damage the second they are handled. Accidental bumps during transport, improper handling at the decontamination sink, damage within the channels accumulated through regular use and over-coiling in undersized basins all go towards increasing endoscope damage. For GI departments already operating under budgetary and volume pressures, the financial and operational toll of endoscope damage can be substantial. The thing is, 85% of damage is preventable3. Understanding where that damage originates and what it truly costs is the first step toward preventing it. The Price to Pay At the individual scope level, repair costs vary significantly by damage type. Even relatively minor surface damage starts at $500 per incident; major fluid invasion events can exceed $4,300 (Ofstead et al., 2024)1. The table below illustrates a range of costs: Damage Type Est. Repair Cost Operational Impact Bending section leak / tear $500 – $1,500 Scope out of service; backlog risk Instrument channel perforation $800 – $2,000 Reprocessing failure; patient safety risk Fluid invasion $1,500 – $3,000+ Internal component damage; extended downtime Imaging / optics failure $1,500 – $3,500+ Extended downtime; possible full replacement Distal tip impact damage (45% of cases) $1,000 – $3,000+ High-frequency, often entirely preventable Major OEM-level repair $5,000 – $8,000+ Multi-week downtime; loaner costs accumulate Where Damage Happens Most Distal tip damage is a major contributing factor. According to a report in Gastroenterology & Endoscopy News, nearly 45% of all endoscope damage occurs at the distal tip3 the most fragile and most expensive part of the scope to repair. A primary driver of distal tip damage is impact: scopes dropped, set down carelessly, or transported without adequate protection from strikes against surfaces and countertops. In many cases, the damage is entirely preventable and the consequences are immediate. Fluid invasion is another leading contributor to high-cost repairs. It most commonly occurs when a scope’s outer sheath has a pinhole or micro-tear that goes undetected before immersion in enzymatic solution or disinfectant. Once fluid enters the internal components, the damage often requires significant repair or replacement. Preventative Measures Making proactive investments to avoid or reduce the instances of issues, is key to mitigating more costly, reactive fixes. One study by Cori Ofstead and Associates (2024) found that implementing borescopes into their departments saw a $476,000 reduction in repair costs1. While specific to borescope adoption, this study highlights that implementing solutions to ensure quality processes makes a significant impact in mitigating risks. The Departmental Ripple Effect The true cost of endoscope damage extends far beyond the repair invoice. When a scope goes out of service, the consequences cascade through the entire department. The Additional (Complete) Costs for One Damaged Endoscope4 Repair invoice: $1,000–$8,000+ depending on damage type Loaner / rental fees: up to $600/day — as much as $18,000/month Expedited repair premium: +50% added to standard repair rates Staff administrative burden: consuming nearly 9 hours of staff time2 Procedure delays and cancellations: revenue loss, rescheduling overhead, patient experience impact Take these costs across five endoscopes, and repairs quickly burden GI budgets: Scopes Damaged Estimated Cost Per Scope 2 Week Rental Per Scope Total Repair Price 5 $5,000 $8,400 $67,000 This example highlights the need to prevent avoidable damage where possible. Not only is there a high cost associated, but that is now 5 scopes out of rotation and that impacts procedure schedules. The majority of repair costs are caused by handling errors, rushed reprocessing steps, inadequate sink ergonomics, and missed inspection opportunities. Investing in the right equipment to mitigate these errors is not an optional quality improvement, it is a financial and operational imperative. The human element in manual reprocessing is another risk factor. Each manual touchpoint (every carry, every brush pass, every basin transfer, every act of staging and coiling) introduces variance. And variance introduces risk. The manual reprocessing environment introduces multiple high-damage moments that structured equipment and workflows can address: Insufficient staging space forces scopes onto countertops or improvised surfaces, increasing contact and impact risk Lifting scopes between wash and rinse basins, the highest-risk single moment in manual cleaning, exposes instruments to contact with sink edges, faucets, and hard surfaces Over-coiling in undersized basins creates bending stress Low-visibility working conditions create contact risks and cause technicians to miss damage during required visual inspection Reducing Damage Starts with the Right Environment GI staff cannot eliminate all risks, but they can reduce them by optimizing the tools and workflow conditions around them. These recommendations can include: “Sinks should be deep enough to allow complete immersion of the endoscope to minimize aerosolization. The size of the sink should be adequate (i.e., a minimum of 16 inches x 30 inches) to ensure that the endoscope can be positioned without tight coiling”- AAMI ST91 4.3.2 Consistent pre-immersion leak testing before any enzymatic or disinfectant immersion, as required by ST91 7.4.1 Smooth inter-basin transfer mechanisms, eliminating the highest-risk manual lift in the reprocessing workflow “Lighting of the recommended illuminance should be placed above the sink and counter area so that personnel can adequately perform inspection activities as the endoscope is processed…”- AAMI ST91 4.3.2 Ergonomic design “…enabling a person of average size to work comfortably without undue strain…” – AAMI ST91 4.3.2 Facilities that implement structured preventive maintenance programs, combining equipment investment with protocol discipline can see repair cost reductions. When departments can avoid repairs and their compounding costs, scopes are able to stay in rotation to address the growing procedure volumes, thus patient care is improved. Want to learn about solutions that can protect your flexible endoscopes? Come see our SuperDART® ONE PASS™ Brush with SmartSTOP™ and our PureSteel™ Immersion Sink and request a consult. Sources & References Ofstead, C.L. et al. (2024). “Impact of Borescope Inspections on Endoscope Repair Frequency and Costs.” Biomedical Instrumentation & Technology, 58(4), 88–98. https://array.aami.org/doi/10.2345/0899-8205-58.4.88 Mahawongkajit, P. et al. (2022). “Effects of
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
Fighting the Clock to Reprocess Flexible Endoscopes
Properly cleaning and reprocessing endoscopes is essential to the safety and proper treatment of patients. Endoscopes must function as intended to aid in diagnosis and must be free of microorganisms for each procedure to prevent adverse events such as infection. In busy endoscopy departments, time is everything. Endoscopy departments are tasked with turning over endoscopes (sometime more than once a day) efficiently in order to keep procedures moving. Procedure scheduling, staffing levels, and procedure volumes all place pressure on reprocessing teams to move quickly. When it comes to flexible endoscope reprocessing, speed is important, but compliance is non-negotiable. Proper cleaning and disinfection require a series of essential steps and skipping or cutting any part of the process can lead to infection risk. So how long does it actually take to properly reprocess one flexible endoscope? The answer depends on workflow, equipment, and scope type, but most facilities should expect a total cycle time of approximately 50 to 120 minutes per scope. Why Timing Matters in Endoscope Reprocessing Industry standards such as ANSI/AAMI ST91 and CDC guidance emphasize that successful reprocessing is not just about completing steps, but making sure each step is addressed for the required amount of time, in a timely manner. Pre-cleaning At Point-of-Use Point-of-use pre-cleaning should be done immediately after the scope is removed from the patient. Delays can allow soil and bioburden to dry inside channels, making manual cleaning more difficult and increasing the risk of residual contamination. Thorough Drying Before Storage Internal drying is also essential to prevent microbial growth. Endoscopes should be thoroughly dried using at least 10 minutes of forced air after reprocessing. Moisture left behind in channels can create an environment favorable for bacteria and microbes to grow; the longer they remain, the more difficult it is to clean. A Further Review of Reprocessing Time While no single guideline publishes an exact minute-by-minute total, the typical workflow includes various steps. Please note that these are process times and not indicative of time spent to attach connectors, fill basins, move the scope from basin to basin, etc. All of these factors add time. Overview Where Bottlenecks Can Exist While automation helps with the process, nothing can replace manual cleaning. Brushing and flushing channels are required and essential steps in virtually every IFU. That means throughput can be affected by: Available technicians and their competencies Manual cleaning consistency Scope complexity Drying workflow Delays between use and cleaning Where Facilities Often Lose Time Many facilities are impacted by disruptions and delays. Common occurrences include: Scopes sitting too long before pre-cleaning Bottlenecks waiting for sinks or AER availability Inadequate drying methods Rework caused by missed cleaning steps Manual brushing processes that vary by technician The Risk of Shortcuts When departments are under pressure or face disruptions and delays, shortcuts often appear in the form of shortened drying, rushed manual cleaning, or delayed bedside pretreatment. A recent article in The American Journal of Infection Control states that departments can reduce infection risk and enhance patient safety by performing risk assessments and implementing proactive strategies to improve quality in facilities 1. Reprocessing a flexible endoscope is not a simple wash, rinse and repeat task. It’s a complex, multi-step infection prevention process that typically requires 50–120 minutes per scope when performed correctly. Facilities looking to improve productivity should look for opportunities to: Reduce delays to pre-cleaning Standardize manual cleaning workflows Improve drying consistency Eliminate sink and equipment bottlenecks Support staff with tools that improve efficiency without compromising outcomes While a departments strive for efficient equipment turnover, speed and efficiency must work concurrently with safe, validated processes that protect patients and support outcomes for the healthcare facility. Do you have ideas or a need to improve your department’s turnover time on flexible endoscopes? Manual Cleaning | Pure Processing to see our solutions and see how you can save time while delivering optimal cleaning compliance. Works Cited Ofstead C, Smart A, Hurst L et al Endoscope processing effectiveness: A reality check and call to action for infection preventionists and clinicians American Journal of Infection Control, 2025; 53, 785-793 Madureira RADS, Oliveira AC. Cleaning of in-hospital flexible endoscopes: Limitations and challenges. Rev Lat Am Enfermagem. 2022 Oct 17;30:e3684. doi: 10.1590/1518-8345.5969.3684. PMID: 36287399; PMCID: PMC9580990.