Guideline

ASGE guideline for infection control during GI endoscopy

Overview of endoscopic transmission of infection

Over the course of an endoscopic examination, the external surface and internal channels of flexible endoscopes are exposed to body fluids and contaminants. Disinfection of these reusable instruments pose special challenges. Flexible endoscopes are heat labile devices and as such are not suitable for steam sterilization. Therefore, reprocessing is achieved by mechanical and detergent cleaning, followed by high-level disinfection (HLD), rinsing, and drying.

Stringent guidelines for the

Reprocessing of endoscopes

The single best protection against patient-to-patient transmission of microorganisms by endoscopy is careful compliance with reprocessing guidelines and manufacturers’ U.S. Food and Drug Administration (FDA)–approved instructions for use.⁵ This section defines and discusses key concepts in endoscope reprocessing. More in-depth discussion is left to the Multisociety Guideline for Reprocessing of Flexible GI Endoscopes 2016 update.⁵

Reprocessing methods

Endoscope reprocessing is a multistage process that includes manual cleaning, HLD (or sterilization in some cases), rinsing, drying, and storage. The ASGE Multisociety Guideline on the Reprocessing of Flexible GI Endoscopes: 2016 update should be referred to for additional information on the multistage process outlined below.⁵

General infection control

Establishing and maintaining general infection control guidelines within an endoscopy unit are essential for creating a high-quality and safe environment for patients and personnel. However, significant practice variation with regard to infection control has been reported in endoscopy units across the United States. Gaps in both infection control and safety have been noted in over a fifth of U.S. ambulatory endoscopy units, with notable lapses reported for hand hygiene, personal protective

Leadership

Although it is essential for all staff to participate in enforcing and maintaining infection control, it is critical to have a leadership and governance structure in place to develop policies and procedures around infection control as well as to lead and potentially direct quality improvement projects in this area. It is necessary for endoscopy units to have defined and inclusive leadership, with a focus on meeting and satisfying regulatory requirements with regard to safety and infection

Summary

• 1.

  Transmission of infection as a result of GI endoscopes is extremely rare, and most reported cases are attributable to lapses in currently accepted endoscope reprocessing protocols or to defective equipment.

• 2.

  Endoscopes should undergo HLD as recommended by governmental agencies and all pertinent professional organizations for the reprocessing of GI endoscopes (Table 1, Category IB and IC).

• 3.

  Attention should be focused on preventing transmission of highly resistant organisms by duodenoscopes, in

Disclosure

All authors disclosed no financial relationships relevant to this publication.