Decontamination: testing
Ultimately, there is a critical gap: the internal condition of a device is often assumed rather than verified.
What we cannot see, inside a device, we must be able to test. While contamination within lumens has understandably attracted significant attention, it isn’t the only area where hidden degradation presents risk. Rigid endoscopes, for instance, can gradually lose their optical performance over time. Light transmission may decline, fibres can fracture, and colour fidelity might shift – often without any obvious external signs. In many departments, this kind of degradation is only identified when surgeons suddenly report poor visibility, or worse, when procedures are disrupted mid-case. Electrosurgical instruments present another
invisible vulnerability. Insulation layers can develop microscopic cracks or pinholes that are not detectable through routine visual inspection. Studies examining minimally invasive surgery equipment have identified insulation defects at rates higher than many clinicians would expect.4 These defects may allow unintended current leakage, which unfortunately contributes to tissue injury outside the surgeon’s direct field of vision. Sterilisation containers introduce yet another dimension to the problem. Their gaskets and sealing interfaces undergo constant thermal cycling and mechanical handling, which eventually takes a toll. While obvious tears or distortion might be easy to spot, micro-leaks in the sterile barrier system are unlikely to be caught by observation alone. Yet the integrity of that seal is the only thing maintaining sterility between the processing department and the point of use. In each of these scenarios, the limitation
remains the same: visual inspection was never designed to assess internal, functional, or microscopic failures. While it is highly effective for identifying gross contamination or obvious damage, it is far less reliable when degradation occurs inside enclosed systems or beneath protective layers.
From observation to measurement Objective testing technologies have emerged in response to these limitations. They do not seek to replace established decontamination processes, nor do they undermine professional expertise. Rather, they introduce verification at points where traditional inspection is weakest. Internal visualisation tools, such as modern digital borescopes, allow technicians to see inside lumens and channels that were previously inaccessible. Unlike earlier fibreoptic devices, newer designs emphasise flexibility and
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Images of rusty and dirty lumens from latest boroscope technology
durability, recognising that fragile equipment can discourage routine use. The concept of the trained “borescopist” has developed alongside this technology – a practitioner equipped not only to visualise internal surfaces, but to interpret findings consistently and make informed decisions.5 Optical testing systems for rigid endoscopes
take a different approach. Instead of relying on subjective impressions of image quality, they measure light transmission, colour fidelity and field of view against defined parameters. Data can be recorded and trended, allowing gradual deterioration to be identified before it affects clinical performance.6 Electrical insulation testers similarly move
assurance from observation to measurement. By detecting micro-defects that cannot be seen, they provide an additional safeguard in environments where energy-based devices are routinely used. Container seal testing systems apply the same principle to sterile barrier integrity, introducing objective leak detection rather than reliance on appearance alone. What unites these technologies is not
marketing language or novelty, but philosophy: assurance becomes measurable, repeatable and documentable. The case for objective testing doesn’t rest on a single study, but on a growing body of evidence. Peer-reviewed research has already
demonstrated that internal debris can persist even when cleaning is fully compliant.1,7
At a
national level, investigations have shown that visually undetectable contamination can, and does, reach the patient.3
Alongside this, industry
evaluations continue to highlight rates of optical and insulation degradation that simply aren’t immediately apparent during routine checks. Departments that have moved toward objective testing often find they are catching issues that would otherwise have stayed hidden. Endoscopes with fading light output are pulled from service before a surgeon even experiences a problem. Lumened instruments are flagged for deeper evaluation the moment internal surfaces show signs of wear, and containers that fail integrity checks are withdrawn before they ever reach the theatre. These may seem like small wins, but together they represent a significant, incremental strengthening of safety margins.
Integrating assurance into the workflow Across the UK and Europe, adoption has generally been proportionate, rather than universal. Many sterile services departments have started by focusing on higher-risk categories: complex lumened instruments tied to previous incidents, high-value optical devices, or container systems used in critical specialties. In some centres, objective testing has been
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