Endoscopy
and a substantial part of the energy use and greenhouse gas emissions associated with reusable scopes.12-13 Manual cleaning is a critical step in
the reprocessing of flexible endoscopes. Inadequate manual cleaning can compromise the effectiveness of subsequent disinfection, increasing the risk of contamination and patient harm.14-16
As a result, national and international
guidance places strong emphasis on thorough cleaning, appropriate detergent use and adherence to validated procedures. However, manual cleaning is also time- consuming and physically demanding. It requires skilled staff, consistent technique and significant water usage. Technicians must manage comprehensive cleaning requirements with short turnaround times in high-volume clinical settings.17
Survey studies
have shown that endoscopy staff, including nurses and technicians, frequently report musculoskeletal symptoms associated with repetitive, high-volume endoscopy work, raising concerns about fatigue and the ability to sustain performance over long shifts in busy services.18-19 At the same time, decontamination services
face increasing operational pressures. Recruitment and retention challenges are common, and staff often work at or near capacity. Estates teams are also under pressure to reduce water consumption, improve environmental performance and manage rising utility costs. Within this context, even modest improvements
in process efficiency can deliver benefits. Reducing manual cleaning time, minimising water use or improving workflow efficiency can help services accommodate rising demand while supporting sustainability objectives. Given that environmental impacts can be expressed on a per-procedure basis, even small reductions in resource use per reprocessing cycle could accumulate into substantial annual savings when multiplied across thousands of procedures in a typical endoscopy unit.
The Service Challenge The EDU at Blackpool Teaching Hospitals NHS Foundation Trust faced a combination of
pressures familiar to many NHS organisations: l Increasing endoscopy activity year on year l High utilisation of staff time during peak periods
l Growing emphasis on sustainability and environmental reporting
l Anticipated service expansion, with plans for increased endoscope throughput and the potential requirement for additional staffing to support future demand
Manual cleaning was identified as a key stage within the reprocessing pathway due to its reliance on staff time, water use and consistent technique. At the time of the evaluation, the Trust was preparing to transition from its existing detergent to a new detergent. This presented an opportunity to examine the impact of the change under typical working conditions. The Trust was therefore selected as the study
site to enable a direct, like-for-like comparison of the manual cleaning process before and after the introduction of the new detergent. The existing process required two sinks per endoscope — one for detergent cleaning and a second for a final rinse prior to automated disinfection. The revised process allowed the final rinse to be omitted when used in conjunction with validated washer-disinfectors, in line with manufacturer instructions.20-21 An observational study was undertaken
to assess how this change affected manual cleaning time, water usage and overall operational efficiency. The study aimed to answer several key questions: l Could manual cleaning time be reduced? l Would water consumption decrease in a meaningful way?
l What impact would the change have on staff workload and workflow?
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l Could any efficiency gains support future service demand?
Implementation and process change The study was conducted as a real-world observational study within the Trust’s EDU. Two distinct phases were observed: 1. Phase 1 – manual cleaning using the existing detergent and standard workflow
2. Phase 2 – manual cleaning using the new detergent that allows for the omission of the final rinse after manual cleaning, when the reusable flexible endoscope is subsequently reprocessed in a validated Endoscope Washer Disinfector (EWD).
Prior to implementation, technicians undertook a short familiarisation period with the new detergent and received manufacturer-led training on the revised process, including correct detergent dilution, handling procedures and workflow changes.20-21 Observations were conducted using
structured time-and-motion techniques to capture: l Duration of manual cleaning tasks l Workflow steps and sequence l Staff movement and handling time l Water usage per cycle l Impact on overall throughput
Technician feedback was also collected to understand perceptions of workload, efficiency and usability. Structured questionnaires were used to capture views on productivity, physical workload, ease of use and awareness of water conservation, providing qualitative context to the quantitative findings. No other aspects of the decontamination
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