Flexible bronchoscopes (FBs) used in intensive care units (ICUs) frequently harbour pathogenic micro-organisms, creating early reprocessing risks for environmental contamination and staff exposure.

In a six-month evaluation of 832 ICU FBs sampled immediately post-use with metagenomic next-generation sequencing, 55.4% carried one or more pathogens, including multi-drug-resistant bacteria, fungi and airborne agents. We instituted an enhanced reprocessing protocol centred on sealed transfer using double biohazard bags, a two-person dedicated handling method that separates contaminated-scope contact from support tasks, segregation of sinks and a dedicated automated endoscope reprocessor (AER) for ICU FBs, and rigorous terminal disinfection of equipment and work surfaces.

Quality checks showed unchanged cleaning efficacy of FBs, whereas the environmental microbial burden on work surfaces after reprocessing was significantly reduced under the new protocol.

These findings identify ICU FBs as a high-load reservoir at the point of receipt and demonstrate that targeted, standardized controls during the earliest reprocessing steps can mitigate environmental contamination and enhance sterile-processing worker protection without compromising device reprocessing outcomes.