UV‐C LED Disinfection of Flexible Rhinolaryngoscopes: Microbiological, Economic, Environmental, and Legislative Evaluation

ABSTRACT

Objective

To evaluate the microbiological efficacy of the Ray‐Two ultraviolet‐C (UV‐C) light‐emitting diode (LED) chamber for reprocessing flexible rhinolaryngoscopes in otorhinolaryngology (ORL) practice and compare its economic and ecological impacts with chemical high‐level disinfection using the Tristel Trio Wipes System (TTWS).

Methods

In a prospective study at a tertiary ORL center, bacterial contamination was assessed on 20 flexible rhinolaryngoscopes immediately after routine posterior rhinoscopy and/or laryngoscopy. Paired swab samples were collected from the distal 10–12 cm shaft pre‐ and post‐reprocessing: manual pre‐cleaning with tap water followed by a 4‐min UV‐C LED cycle. Samples were cultured on TSA‐5% sheep blood agar for 36 h at 35°C–37°C, with colony‐forming units (CFUs) enumerated. Per‐cycle costs and carbon footprints were calculated via life cycle assessment (ISO 14040/14044) and compared with TTWS, based on 5000 annual procedures.

Results

Pre‐reprocessing median CFUs (IQR; range) were 15 (3–27; 2 to > 200), reducing to 0 (0–0; 0–1) post‐UV‐C (p < 0.001; > 99% reduction; 19/20 samples sterile). UV‐C per‐cycle cost was €0.56 (vs. €8.32 for TTWS; 93% savings), with a carbon footprint of 6.81 g CO₂e (vs. 115.8 g; 94% reduction). Annual savings: €38,800 and 548 kg CO₂e.

Conclusion

The Ray‐Two UV‐C LED chamber achieves near‐complete bacterial elimination (100% in 19/20 samples; 1 residual CFU in 1/20 samples) on flexible rhinolaryngoscopes, with superior cost‐efficiency and sustainability versus TTWS. This mercury‐free, point‐of‐care method supports greener ORL practice amid evolving EU and US state‐level regulations on mercury‐containing lamps, enhancing infection control without compromising efficacy.

1. Introduction

In otorhinolaryngology (ORL), flexible rhinolaryngoscopes are essential for diagnostic and therapeutic procedures involving the nasal cavity, pharynx, and larynx, with high daily turnover demanding rapid, reliable reprocessing. Effective disinfection is paramount to prevent healthcare‐associated infections (HAIs), as inadequate protocols remain a leading cause of cross‐contamination and patient harm. Balancing infection control with cost containment, environmental sustainability, and instrument longevity presents ongoing challenges in clinical practice [1, 2, 3].

Per the Spaulding classification, flexible rhinolaryngoscopes are semi‐critical devices, those that contact mucous membranes or non‐intact skin but do not penetrate sterile tissue, therefore requiring high‐level disinfection (HLD), defined as near‐complete microbial elimination, sparing only low levels of bacterial spores, to mitigate transmission risks [4, 5, 6, 7].

In ORL settings, manual chemical wipe systems, such as the Tristel Trio Wipes System (TTWS; Tristel plc, Snailwell, UK), predominate for point‐of‐care HLD due to their portability and efficacy against common pathogens [8, 9, 10, 11]. However, these methods are labor‐intensive, requiring precise adherence to multi‐step protocols (pre‐clean, sporicidal wipe with 30‐s contact, rinse) to avoid user error, which can compromise outcomes under time constraints. Medicolegally, documenting compliance is challenging, as retrospective audits often reveal inconsistencies in technique [12, 13].

Beyond efficacy, chemical‐based HLD raises safety and sustainability concerns. Chlorine dioxide (ClO₂), TTWS's active agent, can induce allergic reactions or skin sensitization in staff and degrade instrument surfaces over time, escalating maintenance costs [14, 15]. Disposable wipes generate substantial waste, with production, use, and disposal contributing to greenhouse gas emissions and chemical runoff, conflicting with global health initiatives prioritizing eco‐friendly practices [9, 16, 17].

Emerging alternatives include automated endoscope reprocessors (e.g., peracetic acid or ortho‐phthalaldehyde immersion) and ultraviolet‐C (UV‐C) radiation, the latter providing chemical‐free options with broad‐spectrum germicidal activity. UV‐C (200–280 nm) inactivates pathogens by damaging microbial DNA/RNA, achieving rapid, residue‐free disinfection without heat or mercury hazards [18, 19, 20, 21, 22]. Nonetheless, pre‐cleaning remains essential, as UV‐C is hampered or negatively impacted by organic debris [22].

Light‐emitting diode (LED) UV‐C systems, in particular, enable compact, decentralized chambers for point‐of‐care use, minimizing human variability while complying with impending European Union (EU) restrictions on mercury lamps (effective 2027) and, in the United States, with state‐level phase‐outs of mercury‐containing lamps, from which germicidal lamps are at present generally exempt [23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33].

This study evaluated the microbiological efficacy of the Ray‐Two UV‐C LED chamber (Zaparay, Merelbeke, Belgium) for HLD of flexible rhinolaryngoscopes post‐clinical use. We further compared its economic and ecological footprints to TTWS, incorporating legislative perspectives to support the development of sustainable reprocessing policies in otorhinolaryngology.

2. Methods

2.1. Study Design and Setting

This prospective, observational study was conducted at the Department of Otorhinolaryngology–Head and Neck Surgery, Ghent University Hospital (Belgium), a tertiary referral center performing 4659 flexible rhinolaryngoscopy procedures in 2024. No distinction was made between infectious and non‐infectious cases to reflect routine practice. The study protocol was approved by the institutional ethics committee as exempt (observational, no patient identifiers). Data collection occurred under standard workflow conditions without disrupting clinical operations.

Twenty flexible rhinolaryngoscopes (Karl Storz, Tuttlingen, Germany) were evaluated immediately post‐procedure (posterior rhinoscopy and/or laryngoscopy). For each scope, paired microbiological samples were obtained pre‐ and post‐reprocessing. Reprocessing involved manual pre‐cleaning followed by UV‐C LED disinfection; samples from TTWS‐reprocessed scopes were not collected, as efficacy data for that system are well‐established [34].

2.2. Reprocessing Protocol

All clinical handling steps, including collection of the pre‐ and post‐reprocessing microbiological swabs, manual pre‐cleaning, and UV‐C disinfection, were performed by one investigator (C.M.). Post‐procedure, the first swab sample was collected. Scopes were then pre‐cleaned manually: a single paper towel moistened with tap water was rotated proximally to distally along the shaft to remove gross debris. The scope was inserted into the Ray‐Two UV‐C LED chamber (Zaparay, Merelbeke, Belgium), positioned centrally on a quartz placeholder (maintaining ≥ 2 cm from walls for uniform exposure). The chamber, a fully enclosed unit with a UV‐C‐transparent quartz drawer (20 × 30 cm), features cold UV‐C LEDs (wavelength 260–280 nm range) mounted above and below, delivering a validated 4‐min cycle at 118 mJ/cm² without heat generation or chemical residues. Cycle completion was signaled automatically, followed by immediate post‐swab sampling from the distal 10–12 cm shaft. Disinfection efficacy was previously validated per British Standard BS 8628:2022 (Melbec Microbiology Ltd), confirming inactivation of viruses, fungi, mycobacteria, bacteria, and spores on surfaces.

2.3. Microbiological Assessment

Samples were obtained using eSwab kits with 1 mL Liquid Amies medium (Copan Diagnostics, Brescia, Italy), rolled circumferentially along the specified shaft segment. Swabs were transported in sterile tubes and processed within 2 h. Each tube was vortexed for 20 s to dislodge microorganisms, and a 100 μL aliquot of suspension was plated onto Tryptic Soy Agar with 5% sheep blood (TSA‐5% SB; Becton Dickinson, USA) using the spread‐plate technique. Plates were incubated aerobically at 35°C–37°C for 36 h. Colony‐forming units (CFUs) were manually enumerated and reported as CFU/100 μL. Plates with > 200 colonies or confluent growth were recorded as “too numerous to count” (TNTC). One investigator (blinded to pre/post status) performed all counts. In case of discussion, a second investigator performed the CFU count.

2.4. Labor Time Estimation

Labor times were timed across 20 consecutive cycles for each method by a single observer. For UV‐C, duration spanned procedure end to chamber activation (including pre‐cleaning and placement). For TTWS, it included procedure end to final scope placement post‐rinse. Times were averaged (mean ± SD) using a stopwatch.

2.5. Statistical Analysis

Analyses used SPSS Statistics version 29 (IBM Corp., Armonk, NY, USA). CFU data were tabulated by sample type (pre‐ vs. post‐UV‐C) and descriptively summarized (median, interquartile range (IQR), range). Paired pre/post comparisons employed Wilcoxon signed‐rank test (non‐normal data). Statistical significance was set at p < 0.05; effect sizes were reported as median differences.

2.6. Economical Assessment

Per‐cycle costs for UV‐C were calculated by summing depreciation (€10,000 manufacturer's recommended retail price amortized over 50,000 cycles, the manufacturer‐guaranteed minimum lifetime and therefore a conservative underestimate of expected service life), labor (€40/h, a reasonable local approximation of the employer cost at our institution × measured time in seconds/3600), consumables (1 paper towel + 500 mL tap water at hospital tender and hospital utility prices, respectively), and electricity (0.005 kWh at the hospital electricity rate of €0.152/kWh). TTWS costs included labor (measured time), wipes (€7.00/cycle hospital tender price), and nitrile gloves (€0.04/pair hospital tender price).

2.7. Ecological Assessment

A gate‐to‐gate life cycle assessment (LCA) followed ISO 14040/14044 standards, quantifying cradle‐to‐grave CO₂ equivalents (CO₂e) per cycle. For UV‐C, this included device manufacturing emissions (total 73 kg CO₂e per device, derived from an LCA using the actual Belgian material sources and production processes, then allocated over 50,000 cycles), paper towel (per UK Government GHG factors), electricity (0.005 kWh × Belgian grid mix of 138 g CO₂/kWh, a conservative recent value for the Belgian electricity mix), and water use. TTWS emissions were calculated from packaging, production, and incineration of wipes and gloves, using UK GHG Conversion Factors [35]. Annual impacts were scaled to 5000 cycles.

3. Results

3.1. Microbiological Assessment

Twenty flexible rhinolaryngoscopes yielded paired pre‐ and post‐UV‐C samples. Pre‐reprocessing median CFUs (IQR; range) were 15 (3–27; 2 to > 200), with 2 samples exceeding 200 CFUs (designated TNTC). Post‐reprocessing (after pre‐cleaning and 4‐min UV‐C cycle), median CFUs were 0 (0–0; 0–1), achieving a > 99% reduction (median difference: 15 CFUs; Wilcoxon signed‐rank test, p < 0.001; r = 0.89). Microorganisms were undetectable in 19/20 samples (one showed 1 CFU). Variability in pre‐samples reflected procedure type and patient factors.

3.2. Labor Time

Mean (SD) labor time per cycle was 31 (6) seconds for UV‐C (from procedure end to chamber activation) versus 115 (14) seconds for TTWS (to final placement post‐rinse).

3.3. Economic Assessment

Per‐cycle UV‐C cost totaled €0.56: depreciation €0.20, labor €0.34, consumables €0.02 (paper towel) + €0.002 (water), electricity €0.00076. TTWS per‐cycle cost was €8.32: labor €1.28, wipes €7.00, gloves €0.04. For 5000 annual cycles, UV‐C cost €2800 versus €41,600 for TTWS (93.3% savings; Table 1).

TABLE 1.

Cost and CO₂ emissions per disinfection cycle and per year.

	UV‐C (per cycle)	TTWS (per cycle)	UV‐C annual	TTWS annual
Cost (€)	0.56	8.32	2800	41,600
CO2e (g)	6.81	115.80	34,050	579,000

Note: Cost and CO₂ emissions of the flexible laryngoscope using ultraviolet C (UV‐C) or Tristel Trio Wipes (TTWS). Figures are expressed per cycle (A) and per year (B) assuming 5000 procedures in the hospital.

3.4. Ecological Assessment

Per‐cycle UV‐C carbon footprint was 6.81 g CO₂e: manufacturing 1.46 g, paper towel 4.2 g, electricity 1.0 g, water 0.15 g. TTWS per‐cycle footprint was 115.8 g CO₂e (from wipes packaging/production/incineration + gloves). For 5000 cycles, UV‐C emitted 34 kg CO₂e versus 579 kg for TTWS (94.1% reduction; Table 1).

Per‐cycle and annual costs and emissions were calculated based on an estimated 5000 disinfection procedures performed per year in our hospital.

4. Discussion

This study demonstrates the Ray‐Two UV‐C LED chamber's near‐complete microbiological efficacy in achieving high‐level disinfection (HLD) of flexible rhinolaryngoscopes after routine ORL procedures, reducing bacterial contamination by > 99% (median CFUs from 15 to 0; p < 0.001). Coupled with 93.3% per‐cycle cost savings (€0.56 vs. €8.32 for TTWS) and 94.1% lower CO₂e emissions (6.81 g vs. 115.8 g), this mercury‐free technology offers a compelling, sustainable alternative to chemical wipe‐based methods in high‐volume clinical settings.

The microbiological outcomes align with UV‐C's established mechanism: absorption at 260 nm disrupts thymine dimers in microbial DNA/RNA, halting replication without residues or resistance induction. Our reduction to undetectable levels in 19/20 scopes, comparable to TTWS's reported efficacy against Staphylococcus aureus and other pathogens, underscores consistent performance. While pre‐samples showed wide CFU variability (2 to > 200), likely attributable to patient infection status or procedural site (rhinoscopy vs. laryngoscopy), the results post‐UV‐C showing absence of microbial growth in 19 out of 20 scopes, highlights the reliability of the method. This addresses a key TTWS limitation: user‐dependent application, where deviations from 30‐s contact times can yield incomplete disinfection. The chamber's automated, full‐surface irradiation, including handles, further mitigates cross‐contamination risks overlooked in manual wiping. Although only one device type was tested, previous work has confirmed the efficacy of the Ray‐Two UV‐C LED chamber on various medical instruments [36].

Economically, the UV‐C LED method's low per‐cycle cost (€0.56) stems from minimal consumables, brief labor requirements (31 vs. 115 s for TTWS), and a durable design (50,000‐cycle lifespan), enabling substantial savings when extrapolated to 5000 annual cycles (€2800 total). This yields €37,950 in savings versus accelerated hydrogen peroxide soaks (€40,750 total), €38,800 versus TTWS (€55,950), €57,650 versus ortho‐phthalaldehyde automated reprocessors (€60,450), and €84,850 versus peracetic acid systems (€87,650), highlighting reprocessing costs as a key determinant of feasibility in routine clinical practice, as evidenced by Sowerby and Rudmik's per‐case comparisons of established rhinolaryngoscope disinfection methods (e.g., $20.58 [€17.53] for peracetic acid automated reprocessing [Steris System 1], $14.20 [€12.09] for ortho‐phthalaldehyde automated endoscope reprocessors [Cidex OPA], $9.57 [€8.15] for accelerated hydrogen peroxide soak [Revital‐Ox], and $13.14 [€11.19] for chlorine dioxide wipes [Tristel Trio Wipes System]) [13]. Moreover, UV‐C's point‐of‐care deployment eliminates transport logistics and dedicated personnel needs, thereby enhancing workflow efficiency in busy ORL clinics.

Ecologically, UV‐C's footprint is negligible compared with the waste‐intensive TTWS. Life‐cycle assessments have shown that wet wipes, whether petroleum‐ or bio‐based, generate significant greenhouse gas emissions across both production and incineration stages, with overall impacts only 38% lower for bio‐based alternatives [37]. Life cycle assessments of wet wipes reveal high greenhouse gas emissions from production (petroleum‐ or bio‐based) and disposal (incineration preferred over landfilling to curb leachate). Furthermore, the use of chemical disinfectants and detergents raises additional ecological concerns. Although chlorine‐based compounds are effective for microbial inactivation, they pose risks to aquatic ecosystems and can generate harmful by‐products during both production and wastewater treatment, thereby calling into question the long‐term sustainability of their use in clinical practice [38, 39]. By contrast, UV‐C produces no chemical waste, aligning with WHO sustainability goals and reducing a department's annual emissions by 545 kg CO₂e—equivalent to ~2500 km driven in a mid‐size car.

Occupational safety benefits are equally pronounced. TTWS's ClO₂ can sensitize skin or airways, necessitating gloves, ventilation, and surveillance per NIOSH protocols. UV‐C chambers, with enclosed designs and no aerosols, minimize exposure risks while avoiding heat damage to scopes. This user‐centric approach empowers ORL clinicians to reprocess independently, bypassing nurse bottlenecks. Conventional HLD methods require strict safety measures to mitigate risks of chemical exposure, including the use of personal protective equipment, local exhaust ventilation, and compliance with hazardous substance regulations. Staff working with agents such as chlorine dioxide, peracetic acid, or ortho‐phthalaldehyde may also fall under occupational health surveillance requirements, as outlined in NIOSH guidance, given their irritant, sensitizing, or potentially carcinogenic properties. Beyond occupational safety, these agents also carry environmental hazard classifications: ortho‐phthalaldehyde is toxic to aquatic life [40], peracetic acid is corrosive and hazardous to aquatic environments [41], and chlorine dioxide is a strong oxidizer with ecotoxic potential [42]. Consequently, their production, handling, and disposal contribute to a broader ecological footprint. By eliminating the need for such chemicals, UV‐C technology simplifies workflow, reduces regulatory burden, enhances workplace safety, and minimizes environmental risk. In particular, UV‐C LED systems avoid mercury vapor discharge lamps, which pose additional hazards because breakage can release toxic mercury vapor, necessitating strict precautionary measures and spill protocols.

Legislatively, UV‐C LEDs preempt regulatory shifts: under the EU RoHS Directive, mercury in UV lamps is permitted only under time‐limited exemptions, those relevant to germicidal use being currently set to expire in February 2027. Under the European Union's Restriction of Hazardous Substances, the use of mercury‐containing lamps is being progressively restricted, with exemptions phased out where technically feasible alternatives exist. For germicidal UV‐C sources the applicable entry permits up to 15 mg of mercury per lamp in low‐pressure, non‐phosphor‐coated discharge lamps whose spectral output is required to lie mainly in the ultraviolet range, and which is set to expire on 24 February 2027 [43]; the parallel entry for phosphor‐coated lamps emitting mainly ultraviolet light carries the same date [44]. That date is not necessarily final: renewal requests for the mercury lamp exemptions due to expire in February 2027 are currently under assessment and an exemption for which a renewal application has been submitted in time remains valid until the Commission has taken a decision [45]. Where the lamp forms part of a medical device, the exemptions specific to medical devices in Annex IV also require consideration. A mercury‐free LED source is independent of this renewal cycle. Beyond compliance, UV‐C's digital logging provides verifiable cycle records, bolstering medicolegal defense against Healthcare‐Associated Infections (HAIs) claims—unlike TTWS, where manual logs invite disputes over adherence. From a legal and regulatory perspective, correct and verifiable disinfection is essential to demonstrate compliance with infection prevention standards and to limit the physician's liability in case of adverse events. Reliable documentation confirming that each device has been disinfected according to protocol is therefore crucial. Manual disinfection methods make such traceability difficult, as there is no objective record of the procedure. In contrast, electronically controlled UV‐C systems allow automated logging of each disinfection cycle, which can be linked to patient or device records. This enables traceable, auditable, and legally defensible documentation of every disinfection event.

In the United States, the applicable framework differs in structure rather than in intent. Agents and equipment used to reprocess semi‐critical devices are regulated by the Food and Drug Administration (FDA) as medical devices rather than as biocides, whereas hard‐surface disinfectants fall to the Environmental Protection Agency under the Federal Insecticide, Fungicide and Rodenticide Act. Until recently, the only classification available for a UV chamber was 21 CFR 880.6600, which is confined to low‐level surface disinfection of non‐porous equipment and cannot therefore support an HLD claim [46]. This changed with the De Novo classification of the Chronos device in 2024 (DEN230067), which created 21 CFR 880.6511, ultraviolet radiation disinfection chamber device (Class II, product code SCS) ‐ the first US classification permitting a HLD claim for a UV‐C chamber [47]. The first device cleared through that pathway by premarket notification followed in January 2026 (UV Smart D60, K251354, indicated for transoesophageal echocardiography probes) [48]. Both authorizations are restricted to external surfaces of instruments that contain no lumens and no indentations or channels deeper than their widths, a geometric envelope into which non‐channeled flexible rhinolaryngoscopes fall.

Clearance under this classification requires an evidence package that extends beyond the surface efficacy testing accepted elsewhere. The published authorizations relied on a UV‐C resistance hierarchy across bacterial spores, vegetative bacteria, mycobacteria, yeasts, spore‐forming molds and viruses; potency testing establishing sporicidal, bactericidal, mycobactericidal, fungicidal and virucidal activity; simulated‐use testing demonstrating at least a 6 log₁₀ reduction of the most resistant clinically relevant organism at the geometrically worst‐case (“cold spot”) locations of the specific instrument to be processed; optical verification that those locations receive the minimum effective dose; in‐use testing on clinically used instruments; and independent per‐cycle dose monitoring with door interlocks [47, 48]. Validation to BS 8628:2022, as performed for the Ray‐Two, addresses surface efficacy but does not by itself satisfy these special controls. The Ray‐Two is not currently cleared by the FDA for high‐level disinfection. A high‐level disinfection claim in the United States would require a 510(k) under 21 CFR 880.6511 in which flexible rhinolaryngoscopes are qualified explicitly as the intended load, supported by the testing described above. The present findings should therefore be read as supporting feasibility and as a rationale for such a submission, and not as evidence that a HLD claim has been authorized in the United States. A related caveat applies to the comparator: the Tristel Trio Wipes System is not cleared for high‐level disinfection in the United States, where the manufacturer's cleared product is a foam formulation indicated for ultrasound probes (DEN220041, 2023) and ORL practice relies predominantly on ortho‐phthalaldehyde, accelerated hydrogen peroxide or peracetic acid systems [49]. The economic and ecological comparison presented here should accordingly be read as a comparison of methods rather than as a description of prevailing US practice.

At state level there is no separate premarket approval for reprocessing equipment. State authority is exercised through facility licensure and, in practice, through the Medicare Conditions of Participation and accreditation bodies such as The Joint Commission, which require semi‐critical devices to be reprocessed by a legally marketed method, used according to the manufacturer's instructions for use and to nationally recognized infection prevention guidance. Automated per‐cycle dose verification with an auditable electronic record speaks directly to the reproducibility and documentation expectations that these frameworks share, but does not substitute for the clearance discussed above. The mercury argument, by contrast, carries less direct weight in the United States than in Europe: the clean lighting statutes enacted in California, Colorado, Hawaii, Illinois, Maine, Minnesota, Oregon, Rhode Island, Vermont and Washington target general‐purpose fluorescent lighting and expressly exempt lamps for germicidal use, for disinfection and for use in medical devices [24, 25, 26, 27, 28, 29, 30, 31, 32, 33]. US pressure on mercury lamps is consequently indirect, arising from obligations under the Minamata Convention on Mercury, the handling of spent lamps as hazardous waste under the universal waste rule (40 CFR part 273), and progressive contraction of the mercury lamp supply chain, rather than from a germicidal‐specific prohibition [50]. Because a low‐pressure mercury lamp inside a reprocessing chamber falls within both the germicidal and the medical‐device exemptions, and because these are drafted as open‐ended category exclusions rather than as time‐limited derogations [24, 31], US state law exerts no direct pressure on mercury UV‐C lamps in this application, in contrast to the EU derogation described above [43, 44]. The direction of travel is nonetheless the same, and a mercury‐free LED chamber is consistent with it on both continents.

Study limitations temper these strengths. Bacterial culturing on TSA–5% SB also allows fungal growth but precludes viral assessment; nevertheless, UV‐C's broad germicidal efficacy is well established, with viruses generally more susceptible than bacteria [51, 52]. Paired swabbing on identical scopes risks post‐sample carryover, though minimal (1 CFU outlier—likely due to sampling contamination). Pre‐cleaning with tap water sufficed here but may vary with heavier soiling; shadowing on curved surfaces was mitigated by the reflective chamber design and quartz placeholder, which facilitates optimal positioning to prevent scope self‐contact or wall adjacency, though precise user placement remains essential [21]. The sample size of 20 scopes, while sufficient to demonstrate a highly significant reduction, remains relatively small and warrants confirmation in larger series. As a single‐center study with one scope brand, generalizability warrants multi‐site validation, including resistant pathogens like C. difficile . In addition, the efficacy of TTWS was not re‐evaluated in parallel in the present study, precluding a formal non‐inferiority analysis. Previous work demonstrated non‐inferiority of UV‐C LED disinfection to a chlorine dioxide‐based method on ultrasound probes [53]. Together with the near‐complete bacterial elimination observed here (0 CFU in 19/20 samples), these findings suggest that UV‐C LED disinfection may also be a promising alternative to TTWS for flexible rhinolaryngoscopes.

In addition, the economic and ecological analyses are based on institution‐specific inputs (device capital cost, Belgian labor rates of €40/h, local electricity grid mix of 138 g CO₂/kWh, water tariffs, and an assumed annual volume of 5000 procedures). Absolute per‐cycle and annual cost and CO₂e figures (€0.56 vs. €8.32; 6.81 g vs. 115.8 g CO₂e; projected annual savings of €38,800 and ≈545–548 kg CO₂e) are therefore not directly transferable to other centers or healthcare systems where labor costs, energy prices, consumable pricing, or procedure volumes differ. Moreover, in regions where the Tristel Trio Wipes System is not available and only the Tristel Duo foam (with a longer required contact time of up to 2 min) can be used, the labor time and associated labor cost of the chemical method increase. Although the consumable cost of Duo is typically lower than that of Trio, the longer contact time may also increase the risk of incomplete disinfection due to reduced protocol compliance, further widening the relative practical and economic advantage of the automated UV‐C approach. Overall, given the markedly lower consumable use and labor time of the UV‐C method, the relative cost and environmental advantage is expected to remain favorable under most real‐world conditions, although local parameters should always be considered. Multi‐center costing studies and full cradle‐to‐grave life‐cycle assessments that incorporate site‐specific parameters would be required before the absolute numbers can be generalized.

In addition, the economic and ecological analyses are based on the specific financial and operational realities of our university hospital (device capital cost, Belgian labor rates of €40/h, local electricity grid mix of 138 g CO₂/kWh, water tariffs, and an assumed annual volume of 5000 procedures). Absolute per‐cycle and annual cost and CO₂e figures are therefore not directly transferable to other centers or healthcare systems. Nevertheless, given the markedly lower consumable use and labor time of the UV‐C method, the relative cost and environmental advantage is expected to remain favorable under most real‐world conditions, although local parameters should always be considered. Multi‐center costing studies that incorporate site‐specific inputs would further strengthen generalizability.

Future research should expand to viral loads (e.g., SARS‐CoV‐2 surrogates) and long‐term scope integrity, while modeling full LCA (scope‐to‐grave) across grids. Cost–benefit analyses in US/EU hospitals could quantify ROI under varying regulations.

5. Conclusion

UV‐C LED disinfection may transform ORL reprocessing: efficacious, economical, and eco‐conscious. As sustainability and compliance imperatives intensify, it equips clinicians to safeguard patients and planet alike, redefining HLD in an era of green healthcare. The Ray‐Two UV‐C LED chamber, a mercury‐free, point‐of‐care method, achieves near‐complete bacterial elimination on flexible rhinolaryngoscopes, with superior cost‐efficiency and sustainability versus the Tristel Trio Wipes system.

Funding

The authors have nothing to report.

Conflicts of Interest

H.S. is employee of eLEDricity. A.F.K. is shareholder of eLEDricity. The other authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.