Evaluating Endoscope Cleaning Methods: HSPA 2026 Poster Highlights Safety, Fatigue, and Real-World Feasibility

At the 2026 HSPA Annual Conference, a poster presented by Mary Ann Drosnock, DHSc, MS, CIC, CFER, RM (NRCM), FAPIC, AAMIF, head of clinical affairs for Healthmark Industries, a Getinge company, examined a critical but often underexplored question in endoscope reprocessing: when multiple cleaning methods achieve similar technical outcomes, what factors should guide best practice?

Titled “Evaluation of the Outcome of Three Cleaning Methods on Flexible Endoscope Residual Soil Levels,” the study compared traditional manual cleaning (MC), pump-assisted manual cleaning (PAM), and an enhanced manual (EM) method that incorporated additional inspection and verification steps. The goal was to determine which approach not only reduces residual soil effectively but is also sustainable and safe for health care workers.

Flexible endoscopes remain a known infection risk if not properly cleaned and disinfected. According to the poster, infection following routine endoscopy has been reported in approximately 1 in 1,000 procedures, with more than 22 million procedures performed annually in the US. Residual soil can interfere with high-level disinfection or sterilization, making effective cleaning a critical first step in preventing transmission.

In this prospective laboratory comparison, Drosnock analyzed 264 extracted samples from both colonoscopes and bronchoscopes using artificial test soil. Protein and hemoglobin assays were used to evaluate residual contamination. Across all 3 methods, the results were strikingly similar.

“All 3 methods produced nondetectable protein and hemoglobin for both scopes,” the poster author reported, with no statistically significant differences between methods in residual soil levels. All results fell below ISO alert and action thresholds.

However, the findings did not stop at quantitative outcomes. A key strength of the study was its inclusion of qualitative data, particularly technician feedback and workflow observations. These insights revealed meaningful differences that could influence real-world practice.

Technicians described traditional manual cleaning as “most physically taxing and exhausting,” noting the risk of repetitive strain injuries associated with manual syringe flushing. Fatigue was also identified as a factor that could lead to abbreviated or skipped steps, introducing potential safety risks despite acceptable lab outcomes.

In contrast, both pump-assisted and enhanced methods were reported as “less physically exhausting,” though not without tradeoffs. These approaches required more counter space, additional equipment, and longer processing times, which may present operational challenges in busy sterile processing departments.

Importantly, all methods resulted in significant splashing during cleaning, reinforcing the need for proper personal protective equipment (PPE) to protect staff from exposure.

Based on qualitative findings, the poster recommended pump-assisted and enhanced methods over traditional manual cleaning. These approaches were associated with reduced fatigue, lower risk of repetitive injury, and a decreased likelihood of skipped steps.

“Implementation considerations mattered most,” Drosnock noted in the discussion section, highlighting fatigue, injury risk, time, cost, and workspace constraints as critical factors in method selection.

The study also emphasized that quantitative data alone may be insufficient when evaluating cleaning methods. While all 3 approaches met laboratory thresholds, the human and environmental factors ultimately shaped the recommendation.

“Automated flushing reduced fatigue and may reduce step skipping and repetitive injuries,” Drosnock concluded, pointing to the importance of designing processes that support both effectiveness and consistency.

The findings have important implications for infection prevention and sterile processing leaders. As health care systems continue to focus on patient safety, attention must also be given to the conditions under which staff perform critical tasks.

Future research, the poster author suggested, should include larger sample sizes, multiple technicians, and clinical samples to further validate findings. Additional evaluation of automated technologies and staff exposure risks may also help refine best practices.

Infection Control Today asked Drosnock why she chose this topic. “I chose this topic because I have spent so much of my career focused on infection prevention, endoscope reprocessing, and the people who perform this work every day,” Drosnock said. "I wanted my doctoral dissertation to address a practical problem: how we can improve cleaning effectiveness while also considering technician fatigue, workflow, safety, and consistency. For me, this research was about protecting patients while supporting the frontline professionals responsible for these complex devices.”

Ultimately, the study underscores a broader truth in infection prevention: Achieving optimal outcomes requires more than meeting technical benchmarks. It requires aligning processes with human factors, ensuring that the methods used are not only effective in theory, but sustainable in practice.