LAUSR

tious outbreaks of multidrug-resistant microorganisms in past decades, including those with carbapenem-resistant Enterobacteriaceae [1]. Outbreaks are caused by failure to properly reprocess reusable endoscopes, leading to persistent endoscope contamination and patient exposure to potentially pathogenic microorganisms. Such outbreaks occurred even though no reprocessing lapses or endoscope defects were identified [1]. Despite numerous attempts to control the issue, to date patientready reusable duodenoscopes remain contaminated with gastrointestinal microflora in approximately 15% of cases [2]. Moreover, endoscope contamination is not confined to the use of duodenoscopes. A recent review reported that 28% of gastroscope channels and 32% of colonoscope channels are contaminated after reprocessing [3]. Endoscopes have a complex design with multiple narrow channels that make it challenging to clean them adequately. The use of automated endoscope reprocessors, recommended by most guidelines over manual disinfection, standardizes highlevel disinfection [4]. However, manual cleaning of the endoscope before it is subjected to high-level disinfection remains a critical component of the overall cleaning process in order to decrease the bioburden; if not performed correctly, it can result in the build up of microorganisms and biofilm in endoscope channels [5]. Conventionally, manual cleaning is done by means of manually rinsing and brushing the endoscope channels. However, time pressure, dislike of the cleaning tasks and physical discomfort may result in omitted or faulty manual cleaning procedures [6].