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Transmission of pathogens by inadequately reprocessed flexible endoscopes is well documented in scientific literature and is recognized as a significant patient risk. This paper outlines a comprehensive approach to improving the quality and consistency of flexible endoscope reprocessing including more detailed training and support for reprocessing staff, use of rapid cleanliness indicators for each endoscope, use of terminal sterilization by ethylene oxide as a replacement for High Level Disinfection (HLD), and use of microbial monitoring audits.