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Infection Control and Endoscopy: Frequently Asked Questions

How often do infections occur from undergoing an endoscopy?
Endoscopy is a safe and effective procedure; infections are very rare. According to the recently updated guideline from the American Society for Gastrointestinal Endoscopy (ASGE) “Infection control during GI endoscopy,” despite the large number and variety of gastrointestinal (GI) endoscopic procedures performed, documented instances of infectious complications remain rare, with an estimated frequency of 1 in 1.8 million.

Why do infections occur during an endoscopic procedure?
Infections that have been reported in association with endoscopic procedures have occurred because of breaches in following established reprocessing (disinfection) guidelines or general infection control guidelines. When such procedures are followed appropriately, transmission of infection has never been reported in association with gastrointestinal endoscopy.

What types of infections can be contracted during an endoscopy?
Breaches in following established reprocessing guidelines or general infection control principles have led to transmission of blood borne pathogens, most notably hepatitis B and C. HIV has never been reported to have been transmitted related to gastrointestinal endoscopy.

How does a patient know if they have developed an infection after an endoscopic procedure?
Most infections would not manifest any symptoms, but could be detected thorough simple blood testing.

What types of infection control practices do endoscopy units undertake to ensure patient safety and prevent infections from occurring?
The single best protection against infections during endoscopy is reprocessing or disinfecting of the endoscopes.

An endoscope consists of a flexible tube, which is passed into the digestive tract to provide a video image, and control knobs, which allow the endoscopist to maneuver the tip of the flexible tube in a precise manner. Within the tube are the electronics necessary to obtain the video image, cables that allow control of the flexible tip, and channels that permit the passage of devices to sample tissue, stop bleeding, or remove polyps. The endoscope is a complex but durable instrument and is safe for use in thousands of procedures.

In all areas of medicine and surgery, complex medical devices are generally not discarded after use in one patient but rather are reused in subsequent patients. This practice is very safe, provided that the devices are properly prepared, or reprocessed, prior to each procedure, so as to eliminate any risk that an infection could be transmitted from one patient to another.

Prior to the performance of a procedure, an endoscope must be carefully cleaned and disinfected according to guidelines published by the American Society for Gastrointestinal Endoscopy, which have been endorsed by every major medical and nursing association dealing with endoscopy and infection control.

  • Mechanical cleaning: The operating channels and external portions of the endoscope are washed thoroughly, wiped with special detergents that contain enzymes, and brushed with special cleaning instruments. Studies have shown that these steps alone can eliminate potentially harmful viruses and other microbes from an endoscope. However, much more is done before the endoscope is considered ready for use.
  • Disinfection: Next, the endoscope is soaked continuously for an appropriate time period with one of several FDA-approved liquid chemicals that destroy microorganisms which can cause infections in humans, including the AIDS virus, hepatitis viruses, and potentially harmful bacteria.
  • Post-processing: The instrument is rinsed with water to remove residual chemicals, subjected to a final alcohol rinse, and the internal channels dried with forced air.

In addition, the endoscopy unit must train staff involved in endoscopic reprocessing, which is mandatory for quality assurance and for effective infection control. General infection control principles should be adhered to at the endoscopy unit.

Endoscopy, when practiced by expertly trained physicians who follow the practice guidelines set forth by the ASGE and the multi-society guidelines on endoscope reprocessing, is a safe, well-tolerated and potentially life-saving procedure.

How would a doctor inform patients if the endoscopy unit discovered a patient may have contracted an infection while being cared for at the facility?
The ASGE has prepared a protocol for informing patients cared for in an endoscopy facility in the case of suspected infection. Most patients would be notified by phone or mail.

What can patients do in advance of an endoscopic procedure to ensure that their exam will be performed safely?
As a patient, you should ask questions and make sure that your physician is a licensed medical doctor who follows ASGE guidelines for infection control. Here are some questions to ask your GI endoscopist before undergoing an endoscopy.

The answers to all of these should be yes and should re-assure you that you are seeing a trained endoscopist who will safely and effectively perform your colonoscopy or other endoscopic procedure.

  • Are you a licensed medical doctor?
  • Have you had formal training in GI endoscopy? (As opposed to having learned during a short 2-3 day course or self instruction without supervised experience)
  • Does your endoscopic facility have dedicated reprocessing (disinfection) personnel and equipment?
  • Does your facility follow the multi-society guidelines on reprocessing endoscopes as well as follow the ASGE guidelines on infection control?
  • Do you perform more than 100 colonoscopies annually?
  • Do you have endoscopic privileges at a licensed health care facility or hospital?
  • Is polypectomy (polyp removal) routinely performed during elective colonoscopy?
  • Do you offer intravenous sedation for colonoscopy?
  • Do you monitor blood pressure, pulse and blood oxygen levels during sedation?
  • Do you employ a trained endoscopic assistant or nurse?

What is ASGE doing to ensure quality and safety?
The ASGE is committed to setting the highest-quality standards for gastrointestinal endoscopy through its safety guidelines and the training of its members so that patients receive the best and safest care possible. In 2008, ASGE introduced a new program specifically dedicated to promoting quality in endoscopy, in all settings where it is practiced in the United States. The ASGE Endoscopy Unit Recognition Program honors endoscopy units that follow the ASGE guidelines on privileging, quality assurance, endoscope reprocessing and CDC infection control guidelines.

A required component of the program is attendance at the educational course: “Improving Quality and Safety in Your Endoscopy Unit.”

Reviewed November 2010