Why the Latest Endoscope Cabinets Are Must-Haves

Upgrade where you store reprocessed scopes between cases to increase patient safety.

The guidance for storing flexible endoscopes starts with a simple enough premise: Make sure the cabinets you choose are expressly designed for that purpose.

Translation: Gone are the days when scopes could be stored horizontally, or when staff could simply hang scopes on the wall of a procedure room. No more filing cabinets or home storage cabinets from your local home-improvement megastore. No more placing towels at the bottom to catch the runoff from the tubes of the scope.

Today, the most important purpose of any endoscope cabinet is to keep scopes not only protected from damage, but also free from contamination.

My biggest and most obvious recommendation, then, is that facilities use cabinets that are specifically designed for storing endoscopes, manufactured by companies that specialize in producing storage units for medical devices.

Additionally, guidance from the Association for the Advancement of Medical Instrumentation (AAMI), the Society of Gastroenterology Nurses and Associates (SGNA) and others says that facilities should have protocols in place that detail how to clean endoscope storage cabinets based on manufacturer instructions for use (IFUs). When evaluating cabinets for purchase, look for models that tell you how to keep them clean along with how to keep your scopes safe for the next patients they’ll be used on.

In addition to the cabinet protecting the scopes from damage as they hang between cases, the scopes must also be kept free from contamination. A big part of that is keeping the scopes dry on the outside and on the inside. Many endoscope storage cabinets offer features that keep the scopes inside of them dry, or even technologically enhance the drying process in some way.

Follow the guidance

The updated standard from AAMI released in 2021 includes revised storage guidelines that recommend two types of cabinets in which to store flexible endoscopes after they have undergone high-level disinfection or liquid chemical sterilization.

One type is referred to as a “conventional storage cabinet” because it doesn’t include a method of circulating forced air through the long, narrow channels of the scopes. The other type is called a “drying storage cabinet,” which includes a feature that enables staff to attach a forced-air drying system onto each endoscopic channel. Each circulates HEPA-filtered or instrument air through the cabinet at continuous positive pressure.

“Cabinets must enhance the drying process in some way.”

The standards and guidelines do not offer universal agreement on whether conventional or drying cabinets are best. I would suggest that any HOPD or ASC perform a risk assessment to decide which type of storage cabinet is best for their facility. This assessment should be performed by an interdisciplinary team that consists of scope processing leadership, providers, infection control professionals and the technicians who process the scopes.

Why is drying so important? Many studies have concluded that droplets can remain in scopes even after they have been actively dried. These droplets can make the scopes breeding grounds for microorganisms. As such, it is preferred to use an active drying method for the internal channels after processing.

This issue is often addressed in the scope’s IFU, which tells you how to dry the scope after processing, what to use, how long to use active drying for each channel and so on. There are times, however, when a scope’s instructions might not include specifics on how to dry after processing. In these instances, refer to ANSI/AAMI ST91:2021 and the Association of periOperative Registered Nurses (AORN) guidelines regarding flexible endoscopes, which provide guidance on how to dry a particular scope if its IFU does not include that information. (This is also a good thing to discuss with the interdisciplinary team convened for the risk assessment.)

Studies suggest that a cabinet can reduce moisture left in the channels after active drying. It follows that this will reduce the risk of microbial growth inside the scope, ultimately making the scope safer.

Although there is no specific rule right now about using active drying cabinets or standard drying cabinets, there is evidence in studies that conclude that active drying cabinets, where you hook up air to each channel of the scope as it hangs in storage, enhance the safety of the scope for patients after your staff has completed all of the reprocessing work that the IFU tells them to do.

The evidence mounts

Ofstead & Associates, a research and consulting firm based in Bloomington, Minn., that assists providers, device manufacturers and others in the healthcare industry, sought to determine how dry scopes were after an automated endoscope reprocessor (AER) cycle and an alcohol flush. The firm’s 2024 study essentially found that copious amounts of water remained in the devices after this phase of reprocessing.

As awareness grows about this reality, manufacturers have responded to the guidance and recommendations from professional organizations by offering a wide array of both conventional and drying cabinets that circulate air in the units while the reprocessed scopes are stored. These changes in product offerings could also have been spurred by the warning letters sent to endoscope manufacturers in recent years from the U.S. Food & Drug Administration urging a strict adherence to sound reprocessing techniques.

These offerings allow facilities to adhere to the more stringent guidance that tells facilities to avoid storing endoscopes in cabinets that do not have vents — that is, ones that weren’t designed to house medical devices — and suggests that active drying cabinets are preferred. If drying cabinets cannot be used, endoscope storage cabinets should at least be ventilated with HEPA-filtered air circulating through them.

Beyond circulation

EVEN FLOW Storage cabinets, at a minimum, should circulate HEPA-filtered air throughout the units.

Some of the latest cabinets even offer tracking technology that traces who cared for the scope at each phase of the reprocessing cycle.

Hopefully, an increased awareness of the risks posed by residual moisture inside scopes results in a more aggressive stance toward using drying cabinets, and toward adherence in following other areas of the AAMI standard as well. These include the recommendation that the cabinets be located in a secure, clean workroom as opposed to being placed in procedure rooms, which is suboptimal from an infection prevention standpoint, and that they should also always be closed and housed at least three feet away from sinks.

I suggest facilities author a procedure for how often the HEPA filters are changed and to assign one person to that task. Document the change times so you have a record if an accreditation surveyor ever asks about it.

If the IFUs aren’t specific or detailed enough, ask the manufacturers’ reps for help with staff education on how to clean the cabinets. The AAMI standard recommends that reprocessed scopes be cleaned at least weekly, as well as whenever they are visibly dirty.

The four- or low-five-figure expense of a specialized conventional or drying endoscope storage cabinet is worth it, as it is far superior to a cabinet that doesn’t circulate air to keep scopes dry. These cabinets are a strong insurance policy against having a scope linked to a potentially deadly infection, which is expensive to treat and even more costly to potentially litigate. The latest cabinets also reduce the effort needed from reprocessing staff and save time by doing some of the drying work for you. OSM