OBJECTIVE  To investigate the knowledge level of cleaning and disinfection of flexible endoscopes and explore its influencing factors, and to provide references for developing targeted intervention strategies for medical and nursing staff.

METHODS  A questionnaire survey on knowledge of flexible endoscope cleaning and disinfection was conducted among 231 endoscopy nurses from hospitals at different levels across 15 cities in Shandong Province from May 2025 to Jun. 2025. Factors associated with inadequate knowledge were analyzed. During the same period, purposive sampling was adopted to select 15 digestive endoscopy nursing staff for semi-structured interviews, and the interview data were analyzed via inductive and deductive methods.

RESULTS  A total of 227 valid questionnaires were collected, with an effective recovery rate of 98.70%. The average score of flexible endoscope cleaning and disinfection knowledge among the study subjects was （72.64±15.19）. Binary logistic regression analysis showed that working in secondary hospitals （OR=17.523）,＜5 years of work experience （OR=9.930）, not being an infection control nurse （OR=13.889） and having no training experience in higher-level hospitals （OR=15.807） were influencing factors for inadequate knowledge of flexible endoscope cleaning and disinfection （P＜0.05）. The mastery of flexible endoscope cleaning and disinfection knowledge among endoscopy nursing staff was at a moderate level, with a phenomenon of "emphasizing practice over theory." A hierarchical, stepwise in-depth analysis revealed the reasons for inadequate cleaning and disinfection competence among endoscopy nurses: （1） External environment factors included delays in updating industry standards and a prevailing attitude of "prioritizing diagnosis and treatment over disinfection". （2） Internal factors comprised insufficient human resources, inadequate departmental training and routinized assessments. （3） Personal factors included gaps in knowledge and cognition,as well as diminished professional competence and psychological state.The quantitative and qualitative findings mutually validated and complemented one another.

CONCLUSIONS  The knowledge level of digestive endoscope cleaning and disinfection among nursing staff is moderate. Administrators should develop targeted intervention strategies for specific personnel based on hospital level and years of experience to improve their competency and ensure patient safety.