Flexible endoscopes are complex medical devices and difficult to clean and to disinfect. Following case reports on infection transmission in endoscopy the potential risk of infection transmission was critically discussed in the past questioning the appropriateness of reprocessing practices used at that time. In a historical perspective of the last 20 years different phases were characterized, which retrospectively correspond to the plan-do-check-act- phases of a national quality management program to improve endoscope reprocessing in the physician's offices. The HYGEA-Study reveals questionable results in about 50 % of microbiological surveillance cultures of reprocessed endoscopes. Before introducing a national screening program for colon cancer by colonoscopy in 2002 agreement for a quality assurance assessment was achieved with subsequent establishment of a nationwide quality assurance system. Thereby, the reprocessing quality improved considerably and questionable results of microbiological surveillance cultures drops down nationwide to 5 %. In analogy to the quality assurance assessment for colonoscope reprocessing similar quality assurance assessments for all other endoscopic examinations should be established. The private health assurances should support this quality assurance system
