Endoscopy
Endoscope cleaning: one sink or two?
Redesigning manual endoscope cleaning to use one sink instead of two can deliver improvements in sustainability and efficiency. A real-world evaluation at Blackpool Teaching Hospitals showed a 15% time saving, a 50% reduction in water use, with zero capital cost. Joshua Hicks and Mutsa Mutowo provide an insight.
Endoscopy services across the NHS are experiencing sustained and growing demand. Rising referral volumes, screening programmes and an ageing population have placed increasing pressure on endoscopy units to deliver high- quality, timely services while operating within constrained resources.1,2
Recent national
reports have highlighted that endoscopy activity continues to rise year on year, with many services working at or near capacity despite service improvement initiatives.1-3 Alongside these clinical demands, NHS
organisations are also expected to demonstrate progress against ambitious sustainability targets, particularly around water usage, carbon reduction and workforce efficiency.4
The NHS
Net Zero Building Standard and the Greener NHS programme now explicitly reference water conservation, resource efficiency and building performance as core components of the net-zero roadmap, creating an increasing expectation that clinical services demonstrate measurable environmental improvements.5 Decontamination units sit at the centre of
this challenge. The reprocessing of flexible endoscopes is an essential, safety-critical activity that must be performed to exacting standards. However, it is also a resource- intensive process, requiring staff time, water consumption, energy use and consumables. As throughput increases, so too does the operational and environmental burden associated with endoscope reprocessing.6-8 This article explores the findings of an
observational study conducted within the Endoscopy Decontamination Unit (EDU) at Blackpool Teaching Hospitals NHS Foundation Trust, evaluating the impact of replacing the Trust’s standard detergent with a new detergent (EndoPreZyme) during manual cleaning.9 The study assessed the impact of eliminating the final rinse after manual cleaning on water usage, staff experience, operational efficiency and resource cost. Importantly,
the study was undertaken in a real-world setting, providing insights directly relevant to NHS decontamination leads, infection prevention teams, estates professionals and clinical managers. The work also contributes to the emerging evidence base on sustainable endoscope reprocessing, complementing recent life-cycle and resource-use analyses in endoscopy.10
Background and context The NHS has committed to becoming the world’s first net-zero national health service, with interim targets focused on reducing carbon emissions, improving energy efficiency and conserving water.4
Water usage alone
accounts for a significant proportion of the NHS’s environmental footprint, with hospitals consuming billions of litres annually across clinical and non-clinical services.11
water use is explicitly recognised in NHS and UK guidance as an important aspect of net-zero-aligned building performance, with documents such as the NHS Net Zero Building Standard and HTM 07-04 emphasising efficient water systems, leakage detection and active demand management in healthcare facilities.5 Endoscopy is recognised as a resource-
Operational
intensive clinical activity, particularly in terms of water and energy use. Each reusable flexible endoscope must undergo a multi-stage reprocessing cycle, typically including pre- cleaning, manual cleaning, rinsing, automated disinfection, drying and storage. In high-volume service, this process can be repeated thousands of times each year. Life-cycle and ‘green endoscopy’ assessments have shown that the reprocessing of reusable endoscopes is one of the most environmentally impactful stages, accounting for a large share of water depletion
April 2026 I
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