How long do you hang your endoscopes after processing? In the latest episode of the Below the Hospital podcast, host Garland-Rhea Grisby Sr. sat down with Margaret Gilman, director of infection prevention in the department of quality and safety at Nemours Children’s Health to discuss her facility’s transition to a 14-day hang time and the research that backed it up.
In 2025, Gilman and her corresponding authors, Kwame Gyabaah, Katlyn Burr and Edna Gilliam, published Using a Risk Assessment to Transition to a 14-Day Endoscope Hang Time in AAMI’s journal BI&T. The paper explores how evidence-based risk assessment can safely support longer endoscope storage intervals and is a great blueprint for sterile processing departments interested in producing their own studies.
Gilman explained that the study was prompted by a real-world challenge; supply shortages affecting endoscope reprocessing chemicals. As end users and sterile processing leaders at Nemours were thinking through possible countermeasures, the question of hang time came up. Many stakeholders, she noted, had not been present when Nemours previously reduced hang time from 14 days to seven, making it essential to revisit the decision using current evidence and guidance.
At the heart of the project was a comprehensive risk assessment aligned with ANSI/AAMI ST91:2021. “This was really probably the most important step in all of this,” she explained. “Those guidelines actually provide you all of the pieces [literature reviews, IFUs, internal quality controls, etc.] that you need to take into account when you’re performing this risk assessment.”
Following approval from the Infection Prevention and Control Committee, Nemours transitioned endoscope hang time from seven to 14 days and monitored outcomes over a three-month period. Any scope that reached the full 14 days underwent quality testing upon return to sterile processing, with protein used as a marker for bioburden.
The results were clear.
“We had 72 scopes that hung for 14 days during that study period,” Gilman said. “And all of the 72 that came back, none of them returned as positive for protein on that initial quality testing.” Just as important, infection prevention surveillance showed no increase in endoscope-related infections during or after the study. “The change did not have any adverse patient safety outcomes,” she added.
Grisby, who has conducted similar hang time studies, underscored the importance of sharing this kind of data across the field.
“Folks need studies like yours so that they can look and perform their own risk assessment,” he said.
Beyond safety, the study also examined cost implications. By extrapolating the findings over a full year, Nemours estimated more than $150,000 in annual savings, from reduced consumable use and 600 hours of saved sterile processing technician time. Still, Gilman was clear that financial benefits should never drive clinical decisions.
“Patient safety should always be our North Star,” she said. “Cost savings is very, very, important, but it should be a secondary metric when we’re talking about patient care.”
What should you do if your facility is considering a change in its hang time procedures? Gilman indicated that the decision-making process should involve infection prevention, sterile processing, end users, perioperative leadership and nursing leadership. “Don’t skip the risk assessment … Gather all of that information ahead of your trial to make sure you that don’t have any unintended consequences.”
Per Grisby, “a lot of times in our industry, there’s this fear of infection prevention, right?” However, sterile processing is a team sport, and “I learned years ago that infection prevention, we need you.”
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