Endoscopy
process were intentionally altered during the evaluation period. Observations were conducted under standardised working conditions to maintain consistency between study phases, with the only procedural change being the omission of the final rinse step of manual cleaning in line with the new detergent’s instructions for use.
Outcomes and benefits Improved manual cleaning efficiency: One of the key outcomes of the study was a consistent reduction in manual cleaning time across all types of flexible endoscopes. Use of the new detergent reduced average manual cleaning time by approximately 15% per endoscope. While this equated to under two minutes per individual scope, the cumulative impact across daily and annual workloads was substantial. When extrapolated over a full year of activity, the reduction translated into 963 fewer technician hours required annually for manual cleaning. As the service was operating close to
capacity, the reduction in manual cleaning time created useful operational headroom. It allowed greater flexibility in staff deployment and day-to-day scheduling, with time released that could be redirected to other activities or used to support periods of increased demand. From a productivity perspective, the unit increased throughput from approximately 4.5 to 5.4 endoscopes per technician hour, representing a meaningful gain without additional staffing or capital investment. Reduced water consumption: The most immediate environmental benefit observed was a reduction in water usage. By removing the need for the final rinse after manual cleaning, each manually cleaned endoscope required 25 litres less water. Over the course of a year, this equated to an estimated saving of 725,000 litres of water within the Trust. Water reduction also has secondary benefits, including reduced energy consumption associated with heating and treating water, and lower utility costs for the organisation. These improvements align with NHS and wider sector guidance on water-efficient, climate-resilient healthcare facilities, which emphasise efficient water systems, leakage detection and active demand management to reduce potable water use in
hospitals.5
Given the scale of endoscopy activity
nationally, the potential cumulative impact of similar changes across multiple Trusts is substantial. Environmental life-cycle modelling of reusable endoscopes shows that reprocessing is one of the most environmentally impactful stages, so improving water and energy efficiency during reprocessing is an important lever for enhancing the environmental advantages of reusable technologies over single-use alternatives.10,22,23,24 Workforce and capacity benefits: Feedback
from technicians after the implementation of the new detergent, indicated that the manual cleaning process was easier to manage and more efficient to deliver. The majority of respondents agreed that
the new detergent reduced water use and saved time, with many also reporting that the physical workload of manual cleaning had become more manageable. The transition to the new detergent was described as smooth and straightforward.
This observational study demonstrated that targeted changes to manual endoscope cleaning processes can deliver measurable improvements in efficiency, sustainability and workforce utilisation.
Responses relating to motivation were
largely neutral, suggesting that while the change improved workflow and efficiency, it did not materially alter overall job satisfaction. Importantly, the implementation of the new detergent did not introduce additional complexity or disruption to routine practice. From a service planning perspective, the
reduction in manual cleaning time translated into improved utilisation rates. Under the previous process, the unit was operating close to capacity. Following the change, utilisation fell to a more sustainable level, allowing greater flexibility to absorb increases in activity. This is particularly relevant given national
projections for continued growth in endoscopy demand. By releasing approximately 17% additional capacity from the existing workforce, the service was better positioned to respond to peaks in demand. Such gains have the potential to support backlog reduction and wider elective recovery and screening commitments.24 Cost implications: Although the new
detergent had a slightly higher unit cost than the previous detergent, this was offset by improved operational efficiency rather than direct cost savings. While reduced water use contributed marginally, the primary benefit arose from shorter manual cleaning times, allowing technicians to process more endoscopes per hour (5.4 compared to 4.5 endoscopes per hour).24 As a result, the effective labour cost per
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