Fiberoptic bronchoscope airway: Uses, Safety, Operation, and top Manufacturers & Suppliers

Posted on February 27, 2026 | by drjosehph

Table of Contents

Introduction

Fiberoptic bronchoscope airway is a flexible endoscopic medical device used to visualize the upper and lower airways and to support airway interventions under direct vision. In many facilities it sits at the crossroads of anesthesia, critical care, pulmonology, emergency medicine, and sterile processing—so its impact is clinical and operational.

For clinicians, this medical equipment can improve visualization during airway assessment, difficult airway management, secretion clearance, and confirmation of airway device position. For hospital administrators, biomedical engineers, and procurement teams, it introduces practical questions about reprocessing capacity, infection prevention, staff competency, service contracts, lifecycle cost, and standardization across sites.

This article provides general, informational guidance on Fiberoptic bronchoscope airway uses, safety practices, basic operation, troubleshooting, infection control, and the global market context. It is not medical advice. Always follow local protocols, applicable regulations, and the manufacturer’s instructions for use (IFU).

In practice, you may also hear terms like flexible bronchoscope, FOB, fiberoptic scope, video bronchoscope, or intubation scope. Hospitals sometimes label the same device differently depending on whether it is managed by anesthesia, respiratory therapy, pulmonology, or central sterile. That naming inconsistency can sound harmless, but it matters: it affects where the scope is stored, who can access it, how accessories are stocked, and which reprocessing workflow is used.

A helpful way to think about Fiberoptic bronchoscope airway programs is as a full lifecycle service—not merely a device purchase. A typical lifecycle includes (1) selection and contracting, (2) deployment and training, (3) point-of-care use, (4) post-use handling and validated reprocessing, (5) preventive maintenance and repairs, and (6) end-of-life replacement and decommissioning. Weakness in any one stage can undermine patient safety and staff efficiency in the others.

What is Fiberoptic bronchoscope airway and why do we use it?

Clear definition and purpose

Fiberoptic bronchoscope airway is a flexible bronchoscope configured or selected for airway work, commonly including airway inspection and guidance of airway devices (for example, endotracheal tubes) under direct visualization. Traditionally, “fiberoptic” refers to image transmission through fiber bundles; many modern systems are video-based while still being used in “fiberoptic intubation” workflows. The exact imaging technology, connector type, and compatibility features vary by manufacturer.

In practical hospital terms, the Fiberoptic bronchoscope airway is often treated as a shared clinical device used for:

Visualization of airway anatomy in real time
Guided placement or verification of airway devices
Bronchial inspection and secretion management
Documentation (still images or video) for clinical records and quality review

Beyond the image itself, the “airway” configuration often implies practical characteristics that support bedside and perioperative use, such as portability, fast setup, and durability for repeated urgent deployments. Typical design elements clinicians and engineers pay attention to include:

Outer diameter and working length (important for compatibility with endotracheal tubes, tracheostomy tubes, and patient size ranges)
Tip articulation range and control responsiveness (important for navigation and minimizing repeated attempts)
Working/suction channel diameter (affects suction efficiency and ability to pass accessories where permitted)
Image sensor location and protection (distal tip design influences fogging, secretion adherence, and cleaning difficulty)
Processor/monitor form factor (cart-based vs portable) and startup time
Water resistance and leak integrity (critical for reusable scopes during reprocessing)

These details influence more than “performance.” They also impact repair rates, reprocessing workload, and whether a device can realistically be supported across multiple units (OR, ICU, ED) without constant transport and downtime.

Common clinical settings

Typical environments where Fiberoptic bronchoscope airway may be deployed include:

Operating rooms (anesthesia-led airway management and verification)
Intensive care units (airway assessment, ventilated patient bronchoscopy support)
Emergency departments (difficult airway scenarios, trauma evaluations per protocol)
Bronchoscopy/endoscopy suites (diagnostic and therapeutic bronchoscopy workflows)
Step-down units and procedure rooms (varies by facility scope of practice)

For healthcare operations leaders, it is important to note that the “right” location is not only clinical—it is also determined by reprocessing logistics, storage conditions, and the availability of trained staff.

Many institutions also designate a Fiberoptic bronchoscope airway location based on response-time expectations. Examples of practical placement strategies include:

Dedicated difficult-airway cart integration (scope stored with a compatible monitor/processor, spare batteries, suction accessories, and protective transport case)
Central pooling (a single location such as OR core or respiratory therapy equipment room, with sign-out and tracked transport)
Unit-based staging (ICU-specific scope(s) to reduce delays, with a defined pathway for rapid reprocessing turnaround)

Each strategy has trade-offs. Pooling can improve utilization but can increase transport and “where is it?” delays. Unit-based staging can reduce response time but may increase inventory cost and the risk of inconsistent reprocessing practice if governance is not standardized.

Key benefits in patient care and workflow

When appropriately selected and used by trained teams, the Fiberoptic bronchoscope airway can offer:

Direct visualization rather than blind advancement in complex airways
Better team coordination through shared viewing on a monitor (when available)
Reduced uncertainty when confirming device placement (within the limits of the method)
Integrated suction/working channel capabilities (on many models) to manage secretions
Documentation and teaching value, supporting competency development and case review

From an equipment management perspective, it can also support standardization: one platform (processor/monitor) may support multiple scope sizes, accessories, and service routines—though compatibility varies by manufacturer and by generation of the platform.

Additional workflow advantages that matter in real-world operations include:

Mobility across care areas: portable systems can be moved rapidly between OR, ICU, and ED without relying on fixed infrastructure.
Reduced reliance on external imaging for certain immediate questions (for example, assessing whether a tube is endobronchial), which can help avoid transport of unstable patients.
Training leverage: recorded clips (where permitted) can support structured debriefs, complication review, and competency sign-off.
Potential standardization of accessories: consistent suction valves, adapters, and transport bins reduce “missing part” events that delay urgent airway work.

At the same time, leaders should recognize that benefits are realized only when the device is reliably available, functional, and properly reprocessed—otherwise the scope can become a bottleneck in urgent airway workflows.

Fiberoptic bronchoscope airway vs other airway visualization tools (high level)

Facilities often compare Fiberoptic bronchoscope airway with tools such as video laryngoscopes, rigid bronchoscopes, or ultrasound. At a high level:

Video laryngoscopes can provide rapid upper-airway views but do not typically allow deep tracheobronchial inspection or suction through a channel.
Rigid bronchoscopes are specialized instruments used in selected settings and require different expertise and setup.
Ultrasound can assist with certain airway assessments but does not replace direct intraluminal visualization.

Rather than being interchangeable, these tools are commonly complementary. Many institutions base purchasing decisions on having a “stack” of airway visualization options appropriate to their case mix, staffing model, and infection-control capacity.

When should I use Fiberoptic bronchoscope airway (and when should I not)?

Appropriate use cases (general)

Use cases depend on local scope of practice and clinician judgment, but Fiberoptic bronchoscope airway is commonly considered for:

Anticipated or encountered difficult airway visualization needs
Guided placement of an airway tube or exchange catheter (per protocol)
Confirmation of tracheal versus bronchial positioning of airway devices
Assessment of airway patency, obstruction, or anatomy prior to interventions
Secretion clearance when standard suctioning is insufficient (if a working channel is available)
Support for procedures where airway visualization is required (for example, around tracheostomy workflows), depending on facility policy
Bronchoscopy tasks such as inspection, lavage, or sampling in approved settings and by credentialed users

Operationally, many hospitals also use Fiberoptic bronchoscope airway for “verification and troubleshooting” workflows in ICU and OR settings—because the alternative can be time-consuming imaging or repeated blind manipulation.

In addition to the above, some facilities build specific “trigger” scenarios into protocols where a scope is considered early (not as a last resort), such as:

Recurrent ventilator alarms where tube position or obstruction is suspected and immediate visualization is preferred to repeated blind suctioning
Post-procedure confirmation workflows after certain airway device changes, where direct visualization may be part of a standardized checklist
Teaching cases in which supervised use supports skill maintenance for low-frequency, high-risk airway techniques

These triggers are highly institution-specific; the point is that defining them in advance can reduce delays and ambiguity during urgent events.

Situations where it may not be suitable

Fiberoptic bronchoscope airway may be a poor fit when:

A situation is so time-critical that equipment setup and visualization attempts may delay essential actions (clinical decision)
Heavy secretions, blood, or vomitus are likely to obscure the lens and make visualization unreliable
The environment cannot support safe use (no suction, inadequate monitoring, poor lighting, limited trained staff)
The device has not passed required pre-use checks (for example, failed leak test on a reusable scope)
Reprocessing status is uncertain, documentation is missing, or contamination is suspected
The chosen scope diameter, articulation, or working channel is incompatible with the intended airway device (varies by manufacturer and patient population)

Additional non-suitability themes often arise from operational constraints rather than patient anatomy:

Unreliable power/battery support for portable processors in transport or austere environments (for example, during intra-hospital transfers).
Lack of appropriate adapters (for ventilator circuits or oxygen delivery interfaces) leading to improvised setups that increase risk.
Inability to ensure reprocessing turnaround when demand spikes (for example, multiple ICU patients requiring repeated secretion management), which can result in “no scope available” events.

Safety cautions and contraindications (general, non-clinical)

Contraindications are clinical and vary by patient and facility policy, so this section stays non-prescriptive. Common caution themes include:

Oxygenation and ventilation risks during airway instrumentation
Trauma risks (mucosal injury, bleeding) from forceful advancement or poor visualization
Cross-contamination risk if reprocessing is incomplete or accessories are reused incorrectly
Electrical and thermal risk from damaged cables/connectors or incompatible components
Workflow risk when teams are unfamiliar with the platform, increasing delays and handling errors

A practical rule for operations leaders: if the facility cannot reliably provide trained staff, validated cleaning, and maintenance support, then the Fiberoptic bronchoscope airway program will carry preventable risk—even if the clinical device itself is high quality.

Facilities may also consider aerosol and exposure management as part of safety planning. Airway instrumentation can increase exposure risk to staff in patients with transmissible respiratory pathogens, which may influence:

PPE requirements and room selection (per local infection control policy)
Preference for single-use scopes in certain isolation workflows
Cleaning responsibilities for monitors, carts, and touch points in the room after the procedure

What do I need before starting?

Required setup, environment, and accessories

A typical Fiberoptic bronchoscope airway setup may require:

The scope itself (reusable or single-use, adult or pediatric size as appropriate)
A light source and/or video processor (for reusable systems; architecture varies by manufacturer)
A display monitor (integrated or standalone)
Suction source and suction tubing; collection canister in place
Oxygen source and monitoring equipment as required by facility protocol
Bite block (commonly used for oral insertion workflows)
Swivel/bronchoscopy adapter for use with airway circuits, if applicable
Water-based lubricant and anti-fog solution (compatibility varies by manufacturer)
Spare accessories: suction valves, biopsy port caps, seals, disposable sheaths (if used), cleaning caps, and protective transport trays

From a biomedical engineering perspective, the “system” is often more than the scope: it may include processors, carts, batteries, chargers, data export devices, and network interfaces. Asset labeling and configuration control matter.

Additional “readiness” items that frequently determine whether the scope can be used smoothly include:

A dedicated clean workspace near the patient to stage the processor/monitor without placing it on potentially contaminated surfaces.
A cable management plan (hooks, clips, or routing) to reduce tugging on connectors when staff move around the bed.
Backup visualization options (for example, alternative airway devices) staged nearby so the team does not “over-commit” to the scope if visibility is poor.
Consumables and disposables that are easy to overlook: lens wipes approved by the IFU, compatible detergents for point-of-use pre-cleaning, and labeling materials for transport containers.

Training and competency expectations

Because Fiberoptic bronchoscope airway use is technique-sensitive, facilities commonly formalize competency requirements such as:

Structured onboarding and supervised cases for clinicians
Simulation training for difficult airway workflows and troubleshooting
Familiarity with scope controls (angulation, suction valve, working channel)
Understanding of basic image optimization (white balance, light/gain adjustments)
Reprocessing training for sterile processing staff and unit-based pre-cleaning steps
Annual refreshers, especially where case volume is low

Competency expectations should also include what not to do: forcing the scope, bypassing leak tests, mixing incompatible components, and using damaged accessories.

Many organizations also expand competency beyond “how to steer the scope” to include:

Interdisciplinary coordination: clinicians, respiratory therapists, and nurses sharing the tasks of ventilation management, suction, and documentation.
Equipment failure drills: what to do if the image drops mid-procedure, if suction is lost, or if the processor battery dies.
Scope protection behaviors: avoiding over-bending, preventing drops, and safe storage to reduce expensive repairs.
Infection prevention behaviors: clear understanding of point-of-use wiping, transport in closed containers, and separation of clean vs dirty workflows.

Pre-use checks and documentation

Pre-use checks differ between reusable and single-use models, but many facilities include:

Verify device identity: model, serial/asset ID, and correct size
Confirm reprocessing status for reusable scopes (traceability label/log)
Visual inspection: insertion tube integrity, distal tip condition, connector pins, seals
Functional check: articulation up/down, responsiveness of controls
Image check: adequate illumination, focus, color, and absence of major artifacts
Working channel patency: suction function and unobstructed flow (if present)
Leak testing for reusable flexible scopes (process and criteria vary by manufacturer)
Confirm accessories are present and within expiry (if applicable)

Documentation commonly includes: patient/procedure record, device ID, operator, reprocessing traceability, and any faults noted. This documentation is not just administrative—it supports infection control investigations and service decisions.

To strengthen traceability and reduce “paper gaps,” some facilities use:

Barcoding or RFID to link scope IDs with reprocessor cycle IDs and patient encounter documentation (where permitted).
Standardized fault tags that prompt bedside staff to describe problems in a consistent way (for example, “intermittent image,” “failed leak test,” “channel blockage”).
Quarantine workflows that prevent a scope from accidentally re-entering circulation while awaiting inspection by biomedical engineering or sterile processing leadership.

For single-use scopes, pre-use documentation often includes confirming package integrity and that the correct model is selected for the patient population and planned airway device compatibility.

How do I use it correctly (basic operation)?

Basic step-by-step workflow (general)

Local protocols and IFUs take precedence, but a typical Fiberoptic bronchoscope airway workflow often follows this structure:

Confirm readiness
Verify the scope has been released for use (reprocessing complete or single-use package intact), and confirm all required accessories and backup airway equipment are available.
Assemble and power the system
Connect the scope to the light source/video processor if applicable, power the unit, and confirm the monitor displays an image. Secure cables to reduce trip hazards and accidental disconnection.
Optimize the image
Perform white balance/calibration if required by the platform. Adjust light intensity and gain to avoid glare, underexposure, or washed-out mucosa. These steps vary by manufacturer.
Prepare suction and the working channel
Connect suction tubing and confirm suction control response. If a working channel is used, confirm compatibility with any planned instruments (size and IFU constraints vary by manufacturer).
Use appropriate insertion technique
Insert under direct visualization using gentle movements, maintaining orientation and avoiding force. Keep the lens clear using anti-fog methods and suction/withdrawal to manage secretions.
Perform the intended task
Examples include airway inspection, guiding an airway tube, confirming device position, or clearing secretions. Maintain team communication so the person handling ventilation and the person controlling the scope are coordinated.
Withdraw and conclude
Withdraw under visualization when possible, capture required images/videos per local documentation practice, and transition to post-use handling without contaminating external surfaces.
Immediate post-use handling
Follow point-of-use pre-cleaning steps for reusable scopes (for example, wiping and suctioning detergent per IFU) and transport in a closed container to reprocessing.

A practical operational note: delays often occur not during insertion, but during “everything around it”—missing adapters, dead batteries, incorrect input selection on the monitor, or unclear division of labor. Teams that rehearse the above workflow (even in brief simulations) typically reduce these avoidable delays.

Setup, calibration, and operation notes

Calibration/white balance: Many platforms require a white balance step against a reference card or surface. Skipping this can lead to inaccurate color rendition and poor contrast.
Light management: Excessive light can create glare and reduce detail; insufficient light can obscure anatomy. The “right” level depends on the platform and scene.
Articulation control: Operators should practice small, deliberate deflections rather than rapid maximal bending, which can increase trauma risk and mechanical wear.
Battery-dependent systems: Portable processors/monitors may require battery checks and spare batteries/chargers, especially for emergency carts.

Additional handling notes that frequently improve reliability and longevity include:

Keep connectors clean and dry: fluid or detergent residue at electrical contacts can cause intermittent image issues and corrosion over time.
Avoid twisting the insertion tube as a substitute for tip steering; excessive torque can stress internal components.
Use approved anti-fog methods: some products can leave residue that worsens clarity or complicates cleaning if not compatible with the IFU.
Be deliberate about orientation: some teams mark “top” on the control body or use consistent hand positioning to reduce left-right confusion on the screen.

Typical settings and what they generally mean

Fiberoptic bronchoscope airway platforms may include settings such as:

Light intensity: Controls illumination level; too high can wash out detail.
Gain/brightness: Electronic amplification (common in video systems); high gain can increase noise.
Image enhancement modes: Some systems offer contrast/color enhancements; clinical interpretation depends on training and intended use. Feature availability varies by manufacturer.
Recording/still capture: Enables documentation; ensure patient privacy and correct patient selection on any integrated system.
Suction level: Usually controlled at the wall regulator; excessive suction can cause mucosal “grabbing” and poor visibility.

Some processors also include operational settings that are easy to overlook but can affect workflow:

Auto-dimming or sleep modes on portable monitors (can be confusing mid-procedure if the screen times out).
Audio recording toggles (if present) that may have privacy implications depending on local policy.
User profiles or presets (for example, ICU vs OR) that standardize brightness and color and reduce setup time.

Where platforms interface with hospital IT (for example, exporting images), it is often useful to define which settings are locked, who can change them, and how changes are documented.

How do I keep the patient safe?

Safety practices and monitoring (general)

Patient safety with Fiberoptic bronchoscope airway is a combination of clinical monitoring and device handling discipline. Typical safety elements include:

Pre-procedure briefing and role clarity (who scopes, who manages ventilation, who documents)
Continuous monitoring as required by local protocol (often oxygenation and hemodynamics)
Ready access to suction, oxygen delivery, and backup airway tools
Minimizing procedure time when visualization is poor and repeatedly reassessing whether the approach remains appropriate
Gentle manipulation to reduce trauma risk, especially when visibility is compromised

Because this is a shared piece of hospital equipment, patient safety also depends on upstream processes: validated reprocessing, preventive maintenance, and correct storage.

In addition, teams often reduce patient risk by addressing predictable “failure modes” before they occur, such as:

Lens obscuration planning: having suction ready, ensuring secretions can be cleared, and agreeing on when to pause vs proceed.
Communication discipline: calling out landmarks and key transitions (for example, when entering the trachea or reaching the carina) so all team members share situational awareness.
Ergonomics: positioning the monitor where the operator can maintain neutral posture, reducing tremor and fatigue during longer airway visualization tasks.

Alarm handling and human factors

Some systems generate alarms or alerts related to:

Processor faults (image loss, overheating, software error)
Low battery on portable units
Connection errors between scope and processor
Leak test failures (during reprocessing, not during patient use)

Human factors that commonly affect safety include:

Cable strain causing sudden disconnection at critical moments
Confusion between similar-looking connectors or scope models
Miscommunication when multiple team members view the monitor from different angles
Overreliance on the image despite poor quality (blood/secretions)

Facilities reduce these risks with standardized carts, color-coded components, consistent accessories, and brief “equipment time-outs.”

A particularly common human-factors issue is “device drift” over time—when different units purchase slightly different scope generations or adapters, causing surprise incompatibilities during emergencies. Standardization, labeling, and periodic cart audits help reduce this drift.

Emphasize protocols and manufacturer guidance

The most reliable safety baseline is simple:

Follow facility policies for credentialing, sedation/anesthesia management, and monitoring
Follow the manufacturer’s IFU for insertion technique constraints, accessory compatibility, and reprocessing steps
Do not use damaged scopes, questionable accessories, or unverified reprocessing status
Escalate early when visibility is poor or the device behaves unexpectedly

How do I interpret the output?

Types of outputs/readings

Fiberoptic bronchoscope airway primarily produces visual output:

Live image/video of airway structures on an eyepiece or monitor
Still images or recorded clips for documentation and teaching
System status indicators (for example, battery level, recording status, connection status), which vary by manufacturer

Unlike many monitoring devices, the bronchoscope’s “output” is not a numeric reading; interpretation depends on anatomy recognition and the clinical context.

In some platforms, metadata may accompany the output (for example, timestamp, scope ID, or patient identifier entered into the system). This can be helpful for documentation but also increases the need for privacy-aware workflows and controlled access.

How clinicians typically interpret them (high level)

Common interpretation tasks include:

Identifying anatomic landmarks (upper airway, vocal cords, tracheal rings, carina, main bronchi)
Detecting obstructions, secretions, edema, foreign material, or bleeding
Confirming the position of airway devices relative to key landmarks
Assessing whether visualization is adequate to proceed with the planned airway maneuver

This interpretation should always be performed by appropriately trained clinicians, and documented per local standards.

From a workflow standpoint, teams often agree in advance on what constitutes an “adequate confirmation” for the scenario. For example, confirming the presence of tracheal rings and visualizing the carina may be used as a shared mental model for certain tube position checks, while acknowledging that clinical decision-making remains patient- and situation-dependent.

Common pitfalls and limitations

Fogging and secretions can mimic pathology or hide landmarks.
Rotation/disorientation: A rotated scope can make left/right orientation confusing on screen.
Two-dimensional imaging reduces depth perception; distance judgment can be difficult.
Optical artifacts: Damaged fiber bundles (in true fiberoptic scopes) can produce dark “honeycomb” spots; video sensors can show dead pixels.
Field limitations: The scope cannot “see through” blood, thick secretions, or complete obstructions.

Another practical limitation is that image quality can vary substantially with subtle handling differences—distance to the mucosa, light intensity, and the presence of mucus on the lens. Teams sometimes misinterpret a low-quality view as “device failure” when the issue is actually lens contamination, while the opposite can also happen (true device degradation dismissed as technique). Having a consistent, short checklist for image quality helps reduce both errors.

What if something goes wrong?

Troubleshooting checklist (practical)

If Fiberoptic bronchoscope airway performance degrades, a structured check helps:

No image: confirm power, cable connections, correct input selection, and scope-to-processor seating
Dark image: increase light intensity, verify light source function, check for damaged light cable/connector
Blurry image: clean the distal lens, re-apply anti-fog, confirm focus (if adjustable), reassess white balance
Intermittent image: inspect cable strain relief, check for loose connectors, avoid tension on the umbilical
Poor suction: confirm wall suction, check tubing kinks, ensure valves are seated, flush channel per IFU
Stiff or non-responsive articulation: stop forcing; inspect controls and consider removing from service
Unexpected heat, smell, or fluid at connectors: stop use and isolate the system (potential damage or ingress)

Additional “quick wins” that often resolve problems without escalating include:

Check disposable parts first: a poorly seated suction valve, cracked cap, or missing seal can reduce suction and create leaks around the port.
Confirm correct scope profile on some processors: certain systems display suboptimal image parameters if the wrong scope type is selected.
Inspect the distal tip for debris: dried secretions can create persistent blur even after brief wiping, especially if not pre-cleaned promptly post-use.

When to stop use

Stop and reassess when:

The patient safety situation deteriorates and the current approach is no longer appropriate (clinical decision)
Visualization is consistently inadequate despite basic corrective steps
The scope appears damaged, contaminated, or functionally unreliable
There is any concern for electrical safety, fluid ingress, or connector overheating
Required reprocessing traceability cannot be confirmed for a reusable scope

From an operational risk standpoint, “stop use” also includes decisions like removing the device from the room to prevent further contamination of a cart or monitor, and ensuring that staff do not attempt ad-hoc repairs (for example, taping damaged insertion tubes) that create hidden hazards.

When to escalate to biomedical engineering or the manufacturer

Escalate beyond the bedside team when:

Failures recur across cases or across multiple scopes
Leak tests fail or repeated channel blockages occur
Image quality degrades progressively (possible fiber breakage, sensor issues, or processor faults)
Connectors or cables show wear, bent pins, or intermittent contact
Software errors appear on processors/monitors
Accessories repeatedly fail (valves, caps, seals), suggesting compatibility or supply issues

Biomedical engineering teams typically manage quarantine, evaluation, vendor coordination, and service documentation. Manufacturer technical support may be necessary for platform-specific diagnostics, software updates, or warranty determinations.

Many facilities also benefit from a defined escalation “triangle”:

Clinical escalation (when the airway plan must change)
Equipment escalation (biomed/sterile processing when a scope must be pulled from service)
Supply escalation (materials management when accessories, detergent, or transport containers are missing)

Clarifying these pathways reduces delays and prevents “workarounds” that compromise safety.

Infection control and cleaning of Fiberoptic bronchoscope airway

Cleaning principles (why this device is high-risk if mishandled)

Flexible endoscopes are among the most challenging hospital equipment items to reprocess because they have:

Long, narrow channels that can retain soil
Multiple valves, seals, and removable parts
Sensitive materials that can be damaged by incompatible chemicals or heat

Fiberoptic bronchoscope airway can contact mucous membranes and secretions, so rigorous infection prevention practices are essential. Reprocessing requirements and validated methods vary by manufacturer and are governed by local regulation and facility policy.

A core operational reality is that flexible scopes are vulnerable to biofilm formation if cleaning is delayed or incomplete. Once biofilm establishes in a channel, it can be difficult to remove with routine processes, leading to persistent contamination risk and repeated reprocessing failures. This is why point-of-use pre-cleaning and thorough drying are often emphasized as “non-negotiables” in scope programs.

Disinfection vs. sterilization (general)

Cleaning is the physical removal of soil and bioburden; it is not optional and it must occur before any disinfection.
High-level disinfection (HLD) is commonly used for flexible endoscopes that contact mucous membranes.
Sterilization may be required in certain workflows or for certain accessories; some scopes may not be compatible with some sterilization methods. This varies by manufacturer.

Facilities should align their process with device IFU, national guidance, and their infection control risk assessment.

In planning, administrators and infection prevention teams often map:

Device classification and intended contact (mucous membranes vs sterile sites)
Accessory classification (single-use vs reusable valves, brushes, and adapters)
Validated reprocessing method availability (manual HLD, AER HLD cycles, or sterilization options)

High-touch points and commonly missed areas

High-risk contamination points often include:

Distal tip and lens area (biofilm risk if not cleaned promptly)
Insertion tube along its full length
Working/suction channel and ports
Suction valve assemblies and biopsy caps (if present)
Control body surfaces (frequent gloved handling)
Connector ends to processor/light source (exposed during setup/teardown)
Transport trays, carts, and touchscreens used during the procedure

Operationally, “the scope” is only part of the infection control footprint. The cart, monitor controls, and shared accessories also require defined cleaning responsibilities.

A commonly missed category is the “in-between surfaces”: cable sheaths, strain reliefs, cart handles, and keyboard/mouse surfaces used for recording. These areas may not be obviously contaminated but are frequently touched with gloved hands during airway work, making them important to include in environmental cleaning protocols.

Example cleaning workflow (non-brand-specific)

A typical, non-brand-specific approach (always defer to IFU and local policy) is:

Point-of-use pre-cleaning
Wipe exterior surfaces and suction a compatible detergent solution to reduce drying of soil. Cap ports and transport promptly.
Safe transport
Move the used scope in a closed, labeled container to reprocessing to prevent environmental contamination.
Leak testing (reusable scopes)
Perform leak testing as specified. A failed leak test generally requires removing the scope from service to prevent fluid ingress damage.
Manual cleaning
Brush and flush all channels with approved brushes and detergents, paying attention to valves and ports. Inspect visually where possible.
High-level disinfection or sterilization step
Use an automated endoscope reprocessor (AER) or manual HLD method per validated process and chemical compatibility. Cycle parameters vary by manufacturer.
Rinsing and drying
Rinse with appropriate water quality per policy, then dry channels and exterior surfaces thoroughly. Drying is critical for reducing microbial growth during storage.
Storage
Store in a manner that supports continued drying and avoids kinking or tip damage. Storage cabinet requirements vary by facility and regulation.
Traceability documentation
Record scope ID, patient/procedure linkage as permitted, operator, reprocessor cycle details, and release status.

Where programs struggle, it is often at the transitions—scope leaves the bedside without pre-cleaning, transport container is unavailable, or drying is rushed because the ICU urgently needs a scope back. Some facilities address this by defining “turnaround lanes” (routine vs urgent) and by maintaining a minimum number of scopes to avoid compressing reprocessing steps under clinical pressure.

Reprocessing governance for administrators and engineers

To reduce preventable risk, many facilities implement:

Clear ownership between clinical units and sterile processing (who does point-of-use steps, who releases the scope)
Routine audits of reprocessing logs and competency records
Preventive maintenance schedules aligned to IFU
Channel patency testing and accessory integrity checks
Defined criteria for removal from service (repeated leaks, image defects, persistent channel blockages)
Consideration of single-use scopes in settings where validated reprocessing cannot be reliably maintained (cost, waste, and supply resilience must be evaluated)

Additional governance practices that often improve reliability include:

Standardized brush management (correct brush sizes for each channel, controlled inventory, and replacement cadence).
Water quality oversight for rinsing and AER supply lines, because inconsistent water quality can affect both patient safety and equipment longevity.
Periodic visual inspection tools (where available) to examine channels for damage or retained debris.
Clear incident triggers: defining when a contamination concern becomes an infection-prevention investigation and what data must be available (scope ID, reprocessor cycle ID, staffing, patient list, and any deviations).

For single-use bronchoscopes, infection control responsibility shifts toward:

Ensuring package integrity and correct storage conditions
Preventing re-use of a device labeled as single-use
Defining waste handling and segregation consistent with local policy (including any electronics disposal requirements)

Medical Device Companies & OEMs

Manufacturer vs. OEM (Original Equipment Manufacturer)

A manufacturer is the company that designs, produces (or controls production), validates, and takes regulatory responsibility for a medical device. An OEM may manufacture components or complete products that are then branded and sold by another company, or may supply subassemblies (for example, insertion tubes, connectors, processors, or imaging modules).

For Fiberoptic bronchoscope airway programs, OEM relationships can influence:

Availability of spare parts and repair turnarounds
Consistency of IFUs, updates, and accessory compatibility
Training and service coverage across regions
Long-term platform support (end-of-life policies are not always publicly stated)

Procurement teams often ask whether a device is factory-built by the brand owner or sourced through an OEM model; there is no universal “better” answer, but clarity helps with service planning and risk assessment.

In practical sourcing discussions, it is also helpful to ask how the OEM arrangement affects:

Change control (how design changes are communicated and whether accessories remain compatible over time)
Repair authorization (whether local service centers can repair at component level or only swap assemblies)
Software update cadence for processor-based systems, including validation and downtime planning

Top 5 World Best Medical Device Companies / Manufacturers

The following are example industry leaders commonly recognized for endoscopy and airway visualization platforms; specific product availability and market presence vary by country and regulatory approvals.

Olympus
Olympus is widely associated with flexible endoscopy platforms across multiple specialties. In many markets, its portfolio includes bronchoscopes and endoscopy processors/monitors used in hospitals and endoscopy suites. The company has a broad international footprint, but exact product configurations and service models vary by region.
Fujifilm
Fujifilm is known globally for imaging technologies and has a significant presence in medical endoscopy. Its endoscopy systems are used across GI and pulmonary applications in various countries. Platform features and supported scope families vary by manufacturer generation and local approvals.
PENTAX Medical (HOYA)
PENTAX Medical is recognized for flexible endoscopy systems, including solutions used in bronchoscopy environments. It is present in multiple international markets with a range of processors and scopes. As with others, specific bronchoscopic models, service coverage, and accessory compatibility depend on the local offering.
KARL STORZ
KARL STORZ is well known for endoscopic visualization and surgical instruments, including platforms that may support airway visualization workflows. The company operates globally, often serving operating room environments with integrated visualization ecosystems. Exact bronchoscopy scope options and configurations vary by manufacturer.
Ambu
Ambu is commonly associated with single-use endoscopy solutions in several markets, including bronchoscopy and airway visualization categories. Single-use models can shift the operational balance toward simplified infection control and predictable availability, while introducing ongoing per-case supply needs. Product ranges and regional availability vary by country and regulatory status.

Practical selection criteria (what buyers often compare)

When hospitals compare manufacturers, they often evaluate a mix of clinical, operational, and financial factors, such as:

Image quality and low-light performance (especially important in secretion-heavy environments)
Scope handling characteristics (tip control feel, flexibility, and robustness)
Channel performance (suction effectiveness and resistance to clogging)
Reprocessing compatibility (validated detergents, AER cycles, drying requirements, and accessory complexity)
Service model (local repair capability, loaners, warranty terms, and typical turnaround time)
Standardization potential across departments and facilities (connector compatibility and accessory commonality)
Total cost of ownership including repairs, reprocessing labor, consumables, and expected useful life

These comparisons are most actionable when procurement involves end users, sterile processing leadership, infection prevention, biomedical engineering, and supply chain—so the selected platform fits the whole workflow.

Vendors, Suppliers, and Distributors

Role differences: vendor vs. supplier vs. distributor

These terms are often used interchangeably, but in procurement and operations they can mean different roles:

Vendor: the commercial entity you buy from (may be the manufacturer or a reseller).
Supplier: a broader term for any organization providing goods/services, including accessories, consumables, and reprocessing chemicals.
Distributor: a channel partner that stocks products, manages logistics, provides local invoicing, and may coordinate service, training, and returns.

For Fiberoptic bronchoscope airway procurement, distributor capability matters because bronchoscopes often require reliable access to accessories, loaner scopes, repairs, and reprocessing consumables—beyond the initial capital purchase.

In many regions, distributors also play an outsized role in operational continuity by providing:

On-site in-servicing for new hires and refreshers when clinical teams rotate
Emergency deliveries of accessories (valves, adapters, bite blocks, cleaning caps)
Coordination of returns/repairs and tracking of service tickets across multiple facilities

Top 5 World Best Vendors / Suppliers / Distributors

The following are example global distributors with broad healthcare portfolios; whether they supply Fiberoptic bronchoscope airway products depends on country, contracts, and authorization status.

McKesson
McKesson is a large healthcare distribution organization with deep experience serving hospitals and health systems. Its strengths often include logistics, inventory programs, and contract-based purchasing support. Specific endoscopy category coverage depends on the market segment and manufacturer relationships.
Cardinal Health
Cardinal Health is widely known for distributing medical and surgical supplies and supporting hospital supply chain programs. Many buyers look to such distributors for standardized ordering, consolidated billing, and supply continuity planning. Availability of specialized endoscopy devices varies by region and local agreements.
Medline Industries
Medline operates across a broad range of hospital consumables and supply chain services, often serving acute care, ambulatory, and long-term care buyers. Some organizations use Medline for kits, procedure supplies, and logistics programs that support device utilization. Coverage of bronchoscopy-specific components varies by country.
Henry Schein
Henry Schein is a major distributor in healthcare supply categories, with a footprint that includes medical and dental markets. In many contexts, its value is in procurement support for clinics and outpatient facilities, plus product breadth. Hospital-grade endoscopy distribution depends on local operations and authorization.
Bunzl
Bunzl is a multinational distribution and outsourcing group with a significant presence in healthcare and cleaning/hygiene supply chains in various regions. While not specific to bronchoscopy, organizations may interact with such distributors for infection control consumables, PPE, and facility support items that indirectly affect bronchoscope programs. Device category coverage varies by country and subsidiary.

Contracting and supply-chain considerations (often overlooked)

For high-use airway programs, buyers frequently add practical requirements into contracts and distribution agreements, for example:

Loaner scope availability and maximum repair turnaround targets
Minimum accessory stocking levels (especially for valves, caps, and adapters that can stop a case if missing)
Batch/lot traceability support for single-use scopes and consumables
Training deliverables (initial, refresher, and training for sterile processing)
Clear return and quarantine pathways for suspected contamination or device failure events

Defining these expectations early can prevent “hidden downtime” later, where the scope exists on paper but is not realistically deployable when needed.

Global Market Snapshot by Country

India
Demand for Fiberoptic bronchoscope airway is driven by expanding tertiary hospitals, growth in ICU capacity, and rising procedural volume in urban centers. Many facilities rely on imports for scope platforms and spare parts, while local service coverage can vary sharply between metro and non-metro areas. Single-use options may be considered where reprocessing capacity is constrained.
In procurement, hospitals often compare capital-heavy reusable systems with per-case single-use models while factoring in staffing and reprocessing infrastructure. Training consistency can be a differentiator between large academic centers and smaller private facilities, and multi-site hospital groups may seek standardized platforms to simplify support and reduce repair variability.

China
China’s market reflects strong hospital infrastructure investment and high procedural volumes in major cities, alongside ongoing expansion in county-level hospitals. Import dependence exists for some premium platforms, while domestic medical device manufacturing capability is significant in related equipment categories. Service ecosystems are typically stronger in coastal urban regions than in rural areas.
Purchasing decisions may also be influenced by local tender processes and preferences for scalable training programs. Large health systems frequently prioritize platforms with robust local service networks and reliable accessory supply chains, especially when expanding bronchoscopy capability beyond flagship hospitals.

United States
In the United States, demand is shaped by ICU utilization, anesthesiology airway management practices, and infection prevention scrutiny around endoscope reprocessing. Buyers often evaluate reusable versus single-use scopes through a total cost of ownership lens that includes reprocessing labor, AER capacity, and infection control governance. Service contracts, loaner availability, and documentation integration are common procurement requirements.
Many organizations also assess the impact of scope choice on staffing models—who performs point-of-use cleaning, where reprocessing occurs, and how quickly devices can return to service. Standardization across multi-hospital systems can reduce training burden, while data and privacy requirements can shape how images are stored or exported from bronchoscopy systems.

Indonesia
Indonesia’s archipelagic geography influences distribution, service response times, and training consistency for complex medical equipment. Urban private and public referral hospitals typically anchor bronchoscopy capability, while rural access may be limited. Import dependence and currency effects can influence capital purchasing cycles and spare-part availability.
Facilities may prioritize ruggedness, distributor reach across islands, and availability of onsite training. Where centralized sterile processing is limited or geographically separated, single-use options can appear attractive, but sustained supply reliability and budgeting for ongoing consumables remain key considerations.

Pakistan
Pakistan’s demand is concentrated in large urban hospitals and teaching institutions, where ICU and anesthesia-led airway management drive utilization. Import dependence for scopes and processors is common, and service quality can vary by city. Procurement often balances upfront price with repair turnaround and local technical support availability.
Hospitals may face constraints in spare-parts lead times and may therefore value redundancy (multiple scopes) to avoid service interruptions. Training programs in teaching hospitals can support broader adoption, but consistent reprocessing governance remains essential when utilization expands into additional units.

Nigeria
In Nigeria, Fiberoptic bronchoscope airway access is often strongest in major urban centers and private tertiary hospitals. Import dependence, foreign exchange constraints, and variable biomedical engineering capacity can affect uptime and replacement cycles. Programs that simplify reprocessing and maintenance may be prioritized where centralized sterile services are limited.
Procurement teams often evaluate distributor reliability, availability of loaners, and the feasibility of maintaining validated reprocessing in environments with fluctuating infrastructure. In some settings, the ability to secure consistent consumables—brushes, detergents, and accessories—can be as important as the scope platform itself.

Brazil
Brazil has a sizable healthcare market with sophisticated tertiary centers and a mix of public and private procurement models. Demand is supported by ICU growth and specialized pulmonology services, with purchasing influenced by local regulatory pathways and public tender processes. Regional disparities can affect service availability outside major metropolitan areas.
Large hospital networks may focus on platform standardization and negotiated service agreements to manage repair costs. Public-sector buyers may require strong documentation and tender compliance, while private facilities may prioritize turnaround time, training support, and the ability to scale across multiple sites.

Bangladesh
Bangladesh’s demand is growing in urban hospitals as critical care and surgical volumes increase. Many facilities rely on imported endoscopy platforms, and reprocessing infrastructure maturity varies widely. Training, standardized accessories, and dependable repair support can be decisive factors for sustained program quality.
Some hospitals may adopt a phased approach—starting with limited scope availability and expanding as staff competency and reprocessing capability mature. In this context, clear governance on point-of-use cleaning and transport can reduce avoidable damage and contamination risk, especially when sterile processing resources are stretched.

Russia
Russia’s market demand is concentrated in large regional hospitals and specialized centers, with procurement influenced by public budgeting and evolving supply chain constraints. Import dependence for some advanced endoscopy components can affect availability and service continuity. Facilities may place emphasis on local service capability and spare-part planning.
Hospitals may seek platforms with predictable lifecycle support and the ability to maintain devices with locally available consumables and validated chemicals. Where procurement cycles are long, durability and repairability become central decision points, and some facilities maintain additional inventory to cover extended repair lead times.

Mexico
Mexico shows strong demand in urban private hospital networks and major public institutions, where ICU and anesthesia services drive airway visualization needs. Import dependence is common for high-end platforms, and buyers often evaluate distributor service coverage across multiple states. Rural access and maintenance support can be uneven.
Multi-site organizations may prioritize training consistency and shared reprocessing standards across facilities. Procurement teams frequently assess whether accessories and replacement parts are readily available outside major metro areas, as delays can affect both elective procedures and emergency readiness.

Ethiopia
Ethiopia’s market is characterized by expanding tertiary care capacity alongside significant resource constraints. Import dependence is high, and equipment uptime can be limited by spare-part lead times and constrained biomedical engineering bandwidth. Concentration of services in major cities means rural access remains challenging.
As programs expand, hospitals may prioritize devices that are simpler to maintain and less dependent on complex reprocessing infrastructure. Training models that build local super-users and strengthen sterile processing workflows can be essential to sustaining safe, consistent bronchoscope utilization.

Japan
Japan has mature endoscopy and respiratory care infrastructure with high expectations for device quality, reliability, and service response. Procurement often emphasizes lifecycle management, rigorous documentation, and validated reprocessing practices. Adoption patterns may differ by institution type, with strong capabilities concentrated in well-resourced hospitals.
Hospitals may evaluate platforms based on interoperability with existing endoscopy ecosystems and stringent quality controls. The operational focus often includes preventive maintenance discipline, consistent training, and robust documentation, reflecting a strong culture of standardization and continuous improvement.

Philippines
In the Philippines, demand is driven by growing private hospital capacity and increasing procedural volume in major cities. Import reliance is common, and service availability can be variable across islands. Facilities may prioritize distributor reach, training support, and predictable access to accessories and consumables.
Because geographic dispersion can complicate repairs, some organizations maintain contingency plans such as additional scopes or service agreements with defined turnaround expectations. Reprocessing governance may also vary by facility type, making standardized training and audits important as utilization grows.

Egypt
Egypt’s market combines large public hospitals and a growing private sector, with demand shaped by ICU expansion and tertiary referral services. Import dependence is notable for advanced endoscopy platforms, and procurement can be sensitive to budget cycles and tender requirements. Service ecosystems are typically stronger in Cairo and other major urban centers.
Facilities may prioritize platforms with strong local representation and training programs, especially where bronchoscopy services are being expanded to meet referral demand. Accessory availability and validated reprocessing compatibility can influence long-term satisfaction, as recurring supply disruptions can impact case scheduling.

Democratic Republic of the Congo
In the DRC, access to Fiberoptic bronchoscope airway is often limited to a small number of urban referral facilities, with significant constraints in procurement, infrastructure, and trained staffing. Import dependence and logistics complexity can make maintenance and replacement difficult. Programs may focus on durability, simplified workflows, and robust training to maintain safe use.
In such contexts, buyers often emphasize dependable distributor support, spare parts planning, and realistic maintenance pathways. The feasibility of validated reprocessing may drive interest in simplified systems, while training and retention of skilled users becomes a major factor in sustaining service availability.

Vietnam
Vietnam’s demand is increasing with healthcare investment, hospital modernization, and rising ICU capacity in major cities. Import dependence remains significant for many advanced endoscopy platforms, while local distribution networks continue to mature. As services expand beyond major urban centers, training and standardized reprocessing become key differentiators.
Hospitals may seek platforms that balance image quality with ease of maintenance, particularly where biomedical engineering resources vary. Regional expansion can also increase the importance of standardized accessories and consistent service coverage, reducing variability between urban tertiary centers and provincial hospitals.

Iran
Iran’s market reflects strong clinical demand in major hospitals, with procurement shaped by regulatory pathways and supply chain constraints. Import dependence for certain components may affect lead times and service access. Facilities often emphasize maintainability and local technical support to sustain device uptime.
In operational planning, organizations may prioritize platforms with serviceable components and locally accessible consumables. Training and reprocessing validation can be particularly important when supply constraints require maximizing the useful life of reusable equipment without compromising infection prevention standards.

Turkey
Turkey has a large, diverse healthcare system with significant tertiary capacity and a substantial private hospital sector. Demand for airway visualization devices is supported by surgical volume and critical care utilization. Distributor service quality and regional coverage can influence procurement decisions, particularly for repairs and accessories.
Hospitals may compare platforms on service responsiveness, training support, and compatibility with existing OR and ICU workflows. In private networks, standardization across multiple facilities is often prioritized to reduce training complexity and streamline procurement, while public institutions may focus on tender compliance and lifecycle cost control.

Germany
Germany’s market is characterized by high standards for device quality, validated reprocessing, and documentation. Buyers typically evaluate Fiberoptic bronchoscope airway options with strong attention to infection control workflows, service contracts, and integration into hospital processes. Access is generally strong across urban areas, with mature service ecosystems.
Facilities often emphasize traceability, consistent reprocessing validation, and preventive maintenance discipline. Procurement can also prioritize ergonomic design and robust training support, ensuring that equipment performance is matched by reliable operational readiness across shifts and departments.

Thailand
Thailand’s demand is supported by established tertiary hospitals, expanding private healthcare, and regional medical hubs. Import dependence is common for premium endoscopy systems, with procurement influenced by distributor support and training offerings. Urban centers typically have stronger reprocessing infrastructure and service availability than rural facilities.
Hospitals serving as referral centers may require higher throughput capability and may therefore value platforms with efficient reprocessing workflows or reliable single-use supply options. Training support and accessories availability are often central considerations, particularly as services expand to meet both domestic demand and regional care needs.

Key Takeaways and Practical Checklist for Fiberoptic bronchoscope airway

Treat Fiberoptic bronchoscope airway as a system, not just a scope.
Standardize models and connectors to reduce setup errors.
Confirm reprocessing release status before every use of reusable scopes.
Use clear traceability: patient, scope ID, cycle ID, and operator.
Require documented competency for both users and reprocessing staff.
Build a dedicated cart with labeled accessories and backup components.
Verify suction availability and tubing connections before insertion.
Perform image optimization steps (for example, white balance) if required.
Avoid forcing advancement when visualization is poor.
Plan for lens fogging and secretion management in the workflow.
Keep a backup airway strategy available per local protocol.
Secure cables to prevent accidental disconnects and trip hazards.
Separate “clean” and “dirty” workflow zones around the cart.
Clean and disinfect high-touch cart surfaces after each case.
Inspect distal tip, insertion tube, and connectors before use.
Remove from service any scope that fails leak testing (reusable).
Track recurring faults to identify training or maintenance gaps.
Confirm accessory compatibility with the specific scope model.
Do not mix valves, caps, or seals across platforms unless approved.
Include spare suction valves and caps in procedure kits.
Use closed transport containers for used scopes to protect staff.
Ensure manual cleaning includes brushing of all relevant channels.
Validate chemical compatibility with scope materials (varies by manufacturer).
Prioritize thorough drying to reduce microbial growth during storage.
Store scopes to prevent kinking and distal tip damage.
Define who owns point-of-use pre-cleaning in each clinical area.
Audit reprocessing logs and competency records at a set cadence.
Align preventive maintenance schedules to manufacturer guidance.
Budget for loaners or redundancy to cover repair turnaround.
Evaluate single-use options where reprocessing capacity is limited.
Include total cost items: repairs, brushes, detergents, and AER cycles.
Require service-level expectations in contracts (response and turnaround).
Confirm availability of spare parts and end-of-life timelines if stated.
Train teams on alarm meanings and basic troubleshooting steps.
Stop use if connectors overheat, smell, or show fluid ingress.
Escalate intermittent image loss to biomedical engineering promptly.
Use incident reporting to capture contamination or device failures.
Protect patient privacy when recording or exporting images.
Define cleaning responsibilities for monitors, touchscreens, and keyboards.
Avoid storing used accessories on the cart “for later” without cleaning.
Maintain a controlled inventory of brushes and replace per policy.
Include rural sites in training and service planning, not just flagship hospitals.
Validate packaging integrity and expiry for single-use scopes before opening.
Harmonize procurement across departments to reduce incompatible purchases.
Create quick-reference checklists at the point of use for setup steps.
Review utilization data to right-size the number of scopes and processors.
Include infection control in purchasing decisions, not only unit price.
Ensure biomedical engineering is involved in platform selection early.
Keep IFUs accessible in the clinical area for the exact model in use.
Assign ownership for battery charging and readiness checks on portable systems.
Label carts and processors with the exact compatible scope families to avoid mismatches.
Include a defined “quarantine and tag” process so damaged scopes cannot re-enter circulation accidentally.
Standardize environmental cleaning of cables and strain reliefs, not only the monitor screen.
Define how and where recorded media is stored, who can access it, and how it is linked to the clinical record.
Monitor repair reasons (drops, channel blockage, articulation failure) to target prevention and reduce recurring cost.
Ensure transport containers are available in every area that uses the scope, including ED and remote procedure rooms.
For single-use programs, plan inventory buffers and substitute models for supply disruptions.
Include sterile processing leadership in any decision to change detergents, disinfectants, or AER cycles.

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